Monitoring Road Safety with Alcohol Biomarkers: Types, Measurement, Interpretation, and Recommendations

Context Technologies for detecting alcohol use among drivers have advanced rapidly in recent years. Private sector businesses that supply alcohol monitoring products, such as portable breath testers, ignition interlocks or transdermal monitoring bracelets, are motivated to educate government authorities about their wares. The authorities may know about some alcohol biomarkers GGT, AST, MCV, ALT or CDT, but less often about PEth, EtG (hair or urine), or FAEE (hair), all of which have been studied as decision aides in forensic situations. There is no sole outside supplier of alcohol biomarkers measurements. Most test availability and biomarker measurement expertise germane to road safety is dispersed throughout academic research communities. Objective The objective is to conduct a preliminary assessment of prospective end users of this information. Recommendations are warranted for those interested in collection of bodily specimens (hair, blood or urine) for the purpose of estimating exposure to alcohol by using biomarkers. There is still no central information clearinghouse for helping with driver-related monitoring decisions. This pilot project distinguishes markers by consumption levels reflecting “excessive” alcohol use using published evidence and cutoffs that can support decisions. These initial recommendations will be revised with more input. Outcomes Information and classifications include: test availability, estimated costs, specimen types, direct or indirect markers, surveillance windows, sensitivity, and specificity for detecting alcohol consumption in the past days to past months. Evidential bases are from DUI populations, clinical populations, self-report assessments, diagnostic assessments, and interlock or driver data. Discussion and Conclusions While several nations have long used alcohol biomarkers to support driver fitness decisions, it is still uncommon in North America. This study provides a set of reference materials for those with responsibilities for making judgments about driver fitness and might want a primer on the types, virtues and liabilities of alcohol biomarkers.