The Forensic Toxicology of Alcohol and Best Practices for Alcohol Testing in the Workplace Canadian Nuclear Safety Commission December 3rd 2014 James G. Wigmore Forensic Alcohol Toxicologist www.wigmoreonalcohol.com

Summary of Report Best method to determine impairment due to alcohol is by measuring BAC Best method to determine BAC is by breath alcohol testing Best method for screening large number of persons for alcohol quickly is by passive screening

BAC Units Criminal code of Canada uses milligrams of alcohol in 100 millilitres of blood Legal limit is 80 mg/100mL In US, use grams of alcohol in 100 millilitres of blood Legal limit is .08 g/100mL 80 = .08 50 = .05 150 = .150

Main Sections of Report 1. Absorption, Distribution and Elimination of alcohol 2. Breath alcohol testing and advantages 3. BAC and impairment of human performance 4. Impairment, intoxication and SFSTs 5. Conclusions and Recommendations

Alcohol Ethanol, ethyl alcohol, grain alcohol (CH3CH2OH) Small, simple molecule Mixes with water in all proportions Enters the blood by diffusion (from area of high concentration to a lower concentration)

Absorption, Distribution Elimination (p6-8) Absorption: alcohol is absorbed into the blood by simple diffusion from stomach and small intestine Distribution: Once alcohol is in the blood it is distributed to all parts of the body that contain water Elimination: Once blood passed into the liver there is elimination of alcohol (95-98%)

Absorption Alcohol rapidly absorbed through the stomach and small intestine after oral ingestion as it requires no digestion Concentration of alcohol in the stomach decreases so rapidly that it is seldom effective for gastric lavage (stomach pump) for alcohol-poisoned persons Food slows absorption and promotes a “plateau” but does not increase time to peak BAC Carbonation increases alcohol absorption but not warm beverages or salty foods

Distribution Tissues with a high water content will hold more alcohol than tissues with low water content. High Brain, blood, liver, kidney Low Bone, fat The amount of water in the body depends on the person’s body weight and gender.

Distribution The greater the total body water of the individual the lower the BAC, as the consumed alcohol is diluted. 1 fld oz of vodka distributed in a 220 lb man (70% water) is equal to 13 mg/100mL (Table 2) 1 fld oz of vodka distributed in a 90 lb woman (60% water) is equal to 37 mg/100mL (Table 1)

Elimination Alcohol is eliminated from the body by two processes; oxidation of alcohol by the liver (95-98%)and passive diffusion via breath sweat and urine (2-5%) Oxidation of alcohol occurs in liver by enzymes, alcohol is converted at a fixed rate into acetaldehyde and eventually to carbon dioxide and water Social drinkers- 12-20 (mean 15) mg/100mL/h Chronic heavy drinkers- 13-31 (mean 25) mg/100mL/h

Fate of Alcohol in the Body After Drinking Re-do as pure PowerPoint slide - Past in Pics of Beer, Wine etc...

Drink is a drink is a drink (Fig 1, p 9)

Drink is a Drink is a Drink (Table 1, p 8) 1.5 oz of liquor (40%) has the same amount of alcohol as 5 oz glass of wine (12%) 1 bottle of beer (12 oz, 5%)

BAC Calculations Between 6:00 p.m. and 8:00 p.m. a 130 lb woman and 200 lb man consume 2 glass of wine with dinner. What would BAC be at 8:00 a.m. when they go to work? 1 glass of wine has the same amount of alcohol as 1.5 oz of liquor (2 glass is equivalent to 3 oz)

BAC Calcuations (female) From Table 1 1 oz for 130 lb women = 26 mg/100mL So 3 oz is equivalent to 3 x 26 = 78 mg/100mL No. of hours to zero from start of drinking is 78 divided by 15 = 5 hours

BAC Calculations (male) From Table 2, 1 oz for 200 lbs man is 14 mg/100mL So 3oz = 3 x 14 = 52 mg/100mL Time to zero 52 divided by 15 = 3 hrs

Advantages of Breath Testing (pg 11) Noninvasive, no needles required no possibility of injury or infection No privacy or human dignity issues as in collection of urine samples Breath samples cannot be tampered with unlike urine Results are known immediately not 2-3 weeks

Advantages of Breath Testing No continuity, (chain of custody) storage or transportation issues, no biohazard storage etc. No phlebotomists are required No real or alleged needle phobia Urine is a pooled sample in bladder and will remain positive even when BAC is 0

Principles of Breath Testing (p 12) Alcohol is a volatile compound and evaporates readily into the air, it is water soluble and is a drug that is 100-10,000X greater concentration in the blood than other drugs, eg THC Henry’s Law (1803) There is a fixed ratio of a volatile between a liquid and air at equilibrium at constant temperature

Henry’s Law (1803) “When the water solution of a volatile compound is brought into equilibrium with air, there is a fixed ratio between the concentration of the compound in air and its concentration in water. This ratio is constant at a given temperature.”

Henry’s Law

Respiratory Tract 250 million alveoli large surface area entire blood supply each min

Mouth Alcohol Effect

Poor Breath Sample

Methods of Breath Testing (pg 13) Infrared (IR) Electrochemical (fuel cell) Both methods

Electromagnetic Spectrum

IR Spectrum for Alcohol

Optical System of IR Instrument (Fig 2)

Intoxilyzer 8000 3.4 and 9.4 um IR

Remote Breath Sampling Mlynczak et al 2014

Functional Diagram of ASD (Fuel Cell)

Alcotest 6810 Screener (Fuel Cell) Digital (0-49) Warn (50-99) Fail (100+)

Intox EC/IR

Types of Breath Testing Instruments (p16-17) Passive alcohol sensors (large flashlight, wave in front of face and sample breath) AIID typically warn at 20 mg/100mL and fail at 40 mg/100mL Approved Screening Devices used by police at roadside Approved instruments

Passive Alcohol Screening

Breath Testing Program in Ontario Stopped Driver Approved Instrument (e.g., Intoxilyzer 5000C) ASD Alcotest 7410 GLC DIGITAL 0 to 0.049 g/210L Graduated Licensing WARN 0.050 to 0.099 g/210L 12-Hour Suspension Suspicion RPG FAIL 0.100 g/210L and above

Alcohol Test Committee Committee of the Canadian Society of Forensic Science composed of forensic alcohol experts from across Canada Formed in 1967 Scientific advisor to Ministry of Justice on blood and breath alcohol testing Evaluate breath testing instrument and set up standards and recommendations which are basis of my report

Report Approved Screening devices and approved instruments (pg 17) were evaluated and approved by ATC Training adapted from ATC (pg 18)- Breath Alcohol Technician Breath testing procedure adapted from ATC (pg 18) Maintenance and record keeping (pg 20)

Breath Test Procedure (p 19) Subject should no have anything in mouth for 10 minutes prior to test Blank Test conducted and should be less than 10 mg/100mL Calibration check using alcohol standard is conducted and results within 10 mg/100mL 2 subject tests agree within 20 mg/100mL Lowest of breath tests used

BAC Ranges and Actions (p 21) BAC 0 to 9 (0-0.009) Alcohol not detected BAC 10 to 19 (0.01-0.019) Traces of alcohol detected BAC 20- 39 (0.020-0.039) temporary removal of safety sensitive worker BAC 40 mg/100mL + (.04+) policy violation

Alcohol and Impairment “Alcohol impairs driving ability by its effects on the central nervous system acting like a general anesthetic. It renders slower and less efficient both information acquisition and information processing, making divided attendtion tasks such as steetin and braking more difficult to carry out without error” JAMA 25: 1986

Relative Risk of Being Killed in SMVA (Zador et al)

Impairment with Increasing BACs

Decrease in Human Performance (Table 6, p23)

Impairment at Low BACs (p22-23) At BACs of 20 mg/100mL +, alcohol-induced impairment of Pursuit tracking Detection of peripheral stimuli Glare recovery RT to onset of motion Co-ordination

Impairment vs Intoxication Impairment is a decrease in human performance compared to sober state and occurs at BACs well before obvious physical effects or intoxication Intoxication is obvious physical effects of alcohol also known as “drunkenness” and alcoholic may have tolerance to showing intoxication

Physical Tests- SFST (p24-26) Typically will detection intoxication and not more subtle impairment. Standardized Field Sobriety Tests conducted by police become very inaccurate at BACs < 80 mg/dL. Require a lot of training and experience and require 5-10 minutes to conduct it

False Positives and False Negatives False negatives caused by persons with a high tolerance to alcohol due to heavy chronic alcohol use.- tolerance False positive, caused by other factors not just alcohol intoxication and

SFSTs and Other Physical Tests “Abandon all such tests because even the best of them (HGN) produces substantial numbers of false positive (and negatives) results and move more in the direction of chemical-based enforcement” Perrine et al 1993

Conclusions of Report Best method to determine impairment due to alcohol is by measuring BAC Best method to determine BAC is by breath alcohol testing Best method for screening large number of persons for alcohol quickly is by passive screening

Recommendations (p28) Breath test screening should be conducted upon arrival to workplace If alcohol is detected in initial screening, ASD test is conducted right there If ASD is positive then EBTI No different BAC cutoffs depending on time at work required