1. 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

2. 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

3. 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

4. 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

5. 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)

6. 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%)

7. 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

8. 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.

9. 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)

10. 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 (mean 15) mg/100mL/h
Chronic heavy drinkers (mean 25) mg/100mL/h

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

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

13. 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%)

14. 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)

15. 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

16. 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

17. 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

18. 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

19. 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 ,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

20. 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.”

21. Henry’s Law

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

23. Mouth Alcohol Effect

24. Poor Breath Sample

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

26. Electromagnetic Spectrum

27. IR Spectrum for Alcohol

28. Optical System of IR Instrument (Fig 2)

29. Intoxilyzer and 9.4 um IR

30. Remote Breath Sampling Mlynczak et al 2014

31. Functional Diagram of ASD (Fuel Cell)

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

33. Intox EC/IR

34. 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

35. Passive Alcohol Screening

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

37. 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

38. 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)

39. 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

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

41. 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

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

43. Impairment with Increasing BACs

44. Decrease in Human Performance (Table 6, p23)

45. 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

46. 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

47. 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

48. 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

49. 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

50. 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

51. 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