| Summary: | In Belgium, the analysis of indirect biomarkers such as carbohydrate deficient transferrin (CDT%), gamma-glutamyltransferase (GGT), aspartate aminotransferase/alanine aminotransferase (AST/ALT) and mean corpuscular volume (MCV), is currently used to monitor the alcohol consumption in cases of fitness to drive assessment. To estimate how the use of direct ethanol markers (e.g. ethylglucuronide (EtG), ethylsulfate (EtS) and phosphatidylethanol species (PEths)) could improve the current process, three quantitative methods (EtG in hair; EtG and EtS in urine; and PEth 16:0/18:1, PEth 18:1/18:1 and PEth 16:0/16:0 in blood, venous (V) and capillary (C) dried blood spots (DBSs)) were developed, validated and tested. Fifty volunteers, for whom fitness to drive had to be assessed and for whom a blood analysis for indirect biomarkers was requested, were included in the study. The sampling and analysis of hair, urine and C-DBS were added to the process currently used. Hair EtG and C-DBS PEths are more sensitive to detect alcohol abuse than the currently used indirect biomarkers and allow to disprove an abstinence period. EtG and EtS in urine form a relevant parameter to detect recent alcohol intake (even one single alcohol consumption) during the days (up to 5 days) prior to the sampling and can thus be used to disprove strict abstinence. The three analyses tested here provide different levels of information and can be used separately or combined. The combined use of the three strategies allows better inference about the evolution of the alcohol consumption prior to the sampling. Moreover, the exclusive use of non- or minimally invasive sampling (hair, urine and C-DBS) allows this to be performed directly during the fitness to drive assessment by regular staff members. In conclusion, the three approaches that were evaluated in this work offer the potential to improve the Belgian driver’s licence regranting process
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