Alcohol and Alcoholism Advance Access originally published online on May 10, 2006
Alcohol and Alcoholism 2006 41(4):446-450; doi:10.1093/alcalc/agl038
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
THE COMPOSITION OF SURROGATE AND ILLEGAL ALCOHOL PRODUCTS IN ESTONIA
CS31 Department of Public Health, 2 Institute of Pathological Anatomy and Forensic Medicine, University of Tartu, Ravila 19, 50411 Tartu, Estonia, 3 Department of Preventive Medicine, School of Public Health, Medical and Health Science Centre, University of Debrecen, H-4012 Debrecen, Hungary and 4 European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, London, UK
* Author to whom correspondence should be addressed at: E-mail: Martin.McKee{at}lshtm.ac.uk
(Received 19 December 2005; first review notified 26 January 2006; in revised form 12 April 2006; accepted 12 April 2006)
 |
ABSTRACT |
|---|
 TOP ABSTRACT INTRODUCTIONMATERIALS AND METHODSMATERIALSRESULTSDISCUSSIONCONCLUSIONREFERENCES |
|---|
Abstract — Aim: To identify the composition of illegal and surrogate alcohol products consumed in Estonia. Methods: The initial source of information was a series of visits made in August 2005 to a soup kitchen in central Tartu, Estonia. Individuals were asked for brief details of their personal circumstances, what they normally drank, and in addition they were asked to bring samples of the substances they usually consumed. In other cases, the substances identified were purchased by the investigators or from informal contacts in north-eastern part of Estonia, an area that is well known for illegal alcohol consumption. Samples were tested for chemical contents. Results: We identified a range of alcohol-containing substances that are consumed, although, not intended for consumption. These comprised medicinal products, aftershaves, illegally produced spirits, and fire-lighting fuel. The medicinal compounds contained, on average, 67% ethanol by volume; the aftershaves contained slightly less. Both were typically pure, with a few containing detectable quantities of isoamyl alcohol. The illegally produced alcohol contained, on average, 43% ethanol by volume, ranging from 32 to 53%. However, many also contained detectable quantities of long chain alcohols. These substances are half the price or less of commercial vodka, with fire lighting fuels especially inexpensive. Conclusions: There is in Estonia a range of alcohol-containing substances easily available at low cost. Some contain substantially higher concentrations of ethanol than commercial spirits and others also contain toxic long chain alcohols.
|
INTRODUCTION |
|---|
|
TOPABSTRACTINTRODUCTIONMATERIALS AND METHODSMATERIALSRESULTSDISCUSSIONCONCLUSIONREFERENCES |
|---|
A recent study in Russia identified an unexpectedly high frequency of consumption of surrogate alcohols (McKee et al., 2005
). Defined as substances containing ethanol but not intended for consumption, they include medicinal compounds, aftershaves, and technical spirits. In addition, many people consumed a range of home-made spirits. The aftershaves and technical spirits contained very high concentrations of ethanol (typically 
95 v/v %) and while the home-made spirits contained approximately the same concentration of ethanol as did commercially produced vodka, they also contained significant quantities of toxic long chain alcohols. As hazardous alcohol consumption is a major factor in the high burden of premature mortality throughout the countries that have emerged from the Soviet Union, we sought to discover whether products similar to those found in Russia were available in Estonia, another ex Soviet country.
Estonia gained its independence on the break up of the Soviet Union in 1991 and in 2004 became a member of the European Union. Between 1980 and 1998, Estonia, like its neighbours Latvia and Lithuania, experienced similar fluctuations in mortality to those seen in Russia, which reflect trends in alcohol consumption (McKee et al., 2001). Previous research in Estonia indicated that, in the late 1990s, one in 10 Estonian men were drinking at a level that equates to 80 g of ethanol per day (McKee et al., 2000). That survey asked only about wine, beer and spirits and it is likely that there will have been appreciable illegal and surrogate substances in the spirits category. This view is supported by a population survey in Estonia in 2004, with a sample of 720 subjects aged 18–74 years, which reported that 8% of those who consume alcohol (84% of the population in the survey) drank illegal alcohols (equivalent to 6.7% of the total adult population) (Estonian Institute of Economic Research, 2005). This is, however, likely to be an underestimate as population surveys tend to exclude those on the margins of society who may be most likely to consume these substances. Illegal and surrogate products appear to be an important factor in overall consumption of alcohol in Estonia. There is, however, to our knowledge, no previous published research from Estonia on what these substances consist of. This paper seeks to fill this gap.
|
MATERIALS AND METHODS |
|---|
|
TOPABSTRACTINTRODUCTIONMATERIALS AND METHODSMATERIALSRESULTSDISCUSSIONCONCLUSIONREFERENCES |
|---|
Sample collection
The collection of surrogate alcohol samples is not amenable to many of the standard sampling methods used in surveys. The products come from a variety of sources, some of which are illegal. Those who drink surrogate alcohols are likely to be a particularly hard to reach population and can be expected to be concentrated among non-responders in surveys. We adopted a pragmatic approach, initially seeking potential drinkers through a series of visits made in August 2005 to a soup kitchen in central Tartu, the second largest city in Estonia, Individuals were asked to bring samples of the substances they usually consumed and, where necessary, small payments were made to cover the cost of purchase. In other cases, the substances identified were purchased by the investigators. A second source was from informal contacts in the north-eastern part of Estonia, where a population survey had found that one in two respondents knew of outlets selling illegal alcohol, compared with one in four in the rest of Estonia (Estonian Institute of Economic Research, 2005
). Further samples were obtained from a variety of informal sources. The inclusion criteria were that the products should be easily available and that they should be identified by a number of people as substances that are commonly drunk. By this process we identified a range of alcohol-containing substances that are consumed although not intended for consumption. They comprised medicinal products, aftershaves, illegally produced spirits, and fire-lighting fuel. We were informed that, when drunk alone, fire lighting liquid was normally consumed after dilution to 50% with water (although, as noted above, it was also used to strengthen other spirits).
Samples of each product were decanted into sterile glass bottles, allocated codes by one of the investigators (K.L.) to enable blind testing, and sent to Hungary for analysis. The 24 products obtained consisted of five medicines, eight sold as ‘odekolon’ (literally eau de cologne) that are ostensibly sold as skin disinfectants/aftershaves, two types of samogon (moonshine) from a rural area, two types of spirits used for fire lighting, and seven types of illegal spirits, obtained from Tartu and from North-Eastern Estonia. We were unable to ascertain whether the last of these were home produced or based on industrial spirits of some sort, although we did learn that spirits are sometimes mixed with fire lighting fluids.
|
MATERIALS |
|---|
|
TOPABSTRACTINTRODUCTIONMATERIALS AND METHODSMATERIALSRESULTSDISCUSSIONCONCLUSIONREFERENCES |
|---|
Methanol, ethanol, 1-propanol, 1-butanol, 2-butanol, 2-methyl-1-propanol (isobutanol), and 3-methyl-1-butanol (isoamyl alcohol) were purchased from Merck (Darmstadt, Germany) and used as standards for qualitative and quantitative analysis of spirits. Acetone-D6 was used as internal standard (ISTD) and provided by Sigma-Aldrich Chemical Company (Stenheim, Germany). All chemicals were of high performance liquid chromatography grade.
GC/MS analysis of spirits
The samples were analysed on a Hewlett-Packard (Palo Alto, CA) GC/MS system consisting of an HP 5890 gas chromatograph, an HP 5973 mass selective detector (MSD), and an Agilent 7683 automatic liquid sampler (Agilent Technologies, Palo Alto, CA). Separations of methanol, ethanol, 2-butanol, 1-propanol, isobutanol, 1-butanol, isoamyl alcohol (target compounds) and internal standard (ISTD) were accomplished using an HP-FFAP (30 m x 0.2 mm i.d., 0.33 µm film thickness) cross-linked capillary column (Hewlett-Packard Co., Palo Alto, CA) as described previously with minor modifications (Hewlett-Packard Company, 1994). Briefly, the GC/MS parameters were as follows: carrier gas: helium, 3.0 bar, constant pressure; injection: split; inlet temperature: 200°C; oven ramps: 60°C for 4.0 min and 110°C, 5°C/min; GC/MS interface temperature: 280°C; MSD ion source temperature: 230°C; MSD quadrupole temperature: 150°C; ionization energy: 70 eV. The quantitative analysis of the target compounds was carried out following calibration of the GC/MS system. The calibration curves were obtained by injections of 1 µl of the standard mixtures containing individual target compounds at concentrations of 1.0, 0.8, 0.6, 0.4, 0.2, 0.1 volumetric percentage (v/v %) and 0.4 v/v % ISTD. The ethanol concentration of spirits was determined by a separate calibration curve obtained after injections of 1 µl of the standard mixtures consisting of 60.0, 54.0, 48.0, 42.0, 36.0, 30.0 v/v % ethanol and 30.0 v/v % ISTD. Aliquots of 1.0 ml of the spirit samples were mixed with 4.0 µl ISTD and 1 µl of this mixture was injected. System control, data acquisition and analysis were performed with the HP G1701BA MSD Productivity ChemStation Software (Hewlett-Packard Co., Palo Alto, CA). The concentrations of target compounds in v/v % were calculated by the data analysis software according to the calibration curves. In order to compare our data with the measures used in toxicological studies the v/v % was converted to mmol/l using the specific gravity and molecular weight of aliphatic alcohols tested.
|
RESULTS |
|---|
|
TOPABSTRACTINTRODUCTIONMATERIALS AND METHODSMATERIALSRESULTSDISCUSSIONCONCLUSIONREFERENCES |
|---|
Analysis of products
The compositions of the products by volume and by molar quantity are shown in Tables 1 and 2. For comparison, our previous analyses of commercially produced Russian vodka indicate that they typically contain
44% v/v %, with no long chain alcohols (McKee et al., 2005).
|
|
The medicinal compounds contained, on average, 67% ethanol by volume; the aftershaves contained slightly less. Both were typically pure, with a few containing detectable quantities of isoamyl alcohol. The illegally produced alcohol contained, on average, 43% ethanol by volume, ranging from 32 to 53%. However, many also contained detectable quantities of long chain alcohols, in particular, those obtained from rural areas and north-east of Estonia.
Table 1 also presents the prices of the various substances. It shows that the lowest price per ml is paid for fire lighting fuels [>0.02 EEK (Estonia, Kroon), and equivalent to 
1.28 per litre], which at the same time contain the highest amount of ethanol. Aftershaves and illegal alcohols are also relatively cheap, with mean price per ml ranging between 0.04 and 0.05 EEK (equivalent to 2.6–3.2 per litre). For comparison, the average price of 40 ml commercial vodkas in a 500 ml container was 51.6 EEK (0.10 EEK per ml, equivalent to 6.4 per litre).
|
DISCUSSION |
|---|
|
TOPABSTRACTINTRODUCTIONMATERIALS AND METHODSMATERIALSRESULTSDISCUSSIONCONCLUSIONREFERENCES |
|---|
As noted in the introduction, a 2004 survey revealed that consumption of substances not sold legally for drinking is widespread in Estonia (Estonian Institute of Economic Research, 2005
), indicating that about one-third of the total volume of strong alcohol consumed in Estonia was from surrogate or illegal sources. Survey respondents who admitted to drinking illegal alcohol cited the low price as the most important reason for doing so. Half of those who reported drinking illegal alcohol stated that it was easy to obtain it. Of those drinking illegal alcohol, 59% consumed samogon, 23% other substances (presumably aftershaves and fire lighting liquid) and 18% illegally produced vodka. The survey also reported that illegal alcohol consumption was more prevalent among people with lower education and less income, as well as in the north-east of Estonia.
The key question addressed by this study is what these substances contain. The medicines, typically sold in 25 ml containers, have a concentration of ethanol that is 50% more than commercial vodka but are otherwise pure. Thus, as a group, they are virtually the same as similar products that we have previously analysed in Russia (McKee et al., 2005). The aftershaves and technical spirits are largely pure ethanol, although the concentration is substantially less than similar products sold in Russia, which typically contain 94 v/v %. They are sold in brightly labelled bottles of between 85 and 250 ml. As in Russia, it is difficult to believe that these substances are sold for any purpose other than drinking. Those attending the soup kitchen described how many of these substances are diluted before consumption, although it seems inevitable that, when the individual concerned is already intoxicated, there is a considerable risk of mistakes, a factor that may be relevant in the high rate of acute alcohol poisoning in Estonia. In 2002, the age standardized mortality rate (European standard population) for accidental poisoning in men (X40–49 in ICD-10), most of which is alcohol related, in Estonia was 39.0/100 000 (WHO mortality database — www.who.int). For comparison, the figure is 14.6 in neighbouring Finland. While routine data do not distinguish cases attributable to consumption of surrogates (which is anyway likely to be difficult to ascertain in many cases), unpublished data from the Estonian Bureau of Forensic Medicine report that 11.8% of all fatal alcohol poisonings are attributed to consumption of surrogates. This equals around 23 deaths in Estonia each year but is likely to be an underestimate.
The illegal alcohols were heterogeneous. Those obtained in rural areas and north-east of Estonia were especially likely to contain long chain alcohols. The presence of isoamyl alcohol reflects their production from grain. As in Russia, methanol is absent. It is produced from pectin, found in fruit seeds, so it is more often found in home-produced spirits in countries such as Hungary where fruit are more commonly the source of sugar (Szucs et al., 2005). However, there are a few cases of methanol poisoning in Estonia each year, with the largest number of death in 2001 when one episode claimed 68 lives (Vassiljev and Väli, 2003). This occurred when some individuals obtained a barrel containing industrial methanol. Viewing this as an opportunity to make money, they diluted it with water and sold it in vodka bottles. Thus, while methanol-containing substances are especially dangerous, the findings of our admittedly limited study suggest that their consumption is limited to certain exceptional circumstances.
Although methanol has attracted most attention in studies of illegally produced alcohol, it is important to recognize that long chain alcohols are substantially more hepatotoxic than ethanol in vitro (Strubelt et al., 1999), and while there are no long-term studies of exposure in humans, the mean level of isobutanol in the seven products that contained detectable quantities (34 mg/100 ml) far exceeds the Council of Europe recommendation that foodstuffs should contain no more than 2.5 mg/100 g (Council of Europe, 1981). There is also some suggestive evidence from other parts of the world in which home-brewed ‘country liquor’ is commonly consumed. In rural areas of India it has been reported that alcoholic liver diseases is more common among those who drink illicit liquor compared with consumers of legal alcoholic beverages (Narawane et al., 1998) and a study from Mexico City and surrounding states suggested that the high level of cirrhosis mortality was attributable to the consumption of home-produced ‘pulque’ (Narro-Robles et al., 1992). Consumption of substances containing appreciable quantities of long chain alcohols is common in a band of countries stretching from Slovenia through Hungary and Romania to Moldova, a region in which death rates from cirrhosis are among the highest in Europe. A case–control study examining the factors associated with cirrhosis, recently begun in Hungary, is expected to shed some much-needed light on this issue. However, this study also indicates a need for appropriate epidemiological studies of the health impact of these substances in Estonia.
This study adds to the limited evidence on surrogate and illegally produced alcohol in the countries of the former Soviet Union. It is well known that they are consumed extensively, a phenomenon catalogued in numerous reports from newspaper and from law enforcement agencies, and in White's description of the 1985 Soviet anti-alcohol campaign (White, 1996). Most surveys of drinking patterns in this region have concentrated on conventional beverages (McKee et al., 2000; Pomerleau et al., 2005), although the few that have asked about other alcohols have identified significant levels of consumption. For example, a study undertaken in Moscow in 1991 reported that 27% of men and 8% of women drank ‘moonshine’ at least occasionally, with 2 and 1%, respectively, drinking it at least weekly (Palosuo et al., 1997). In the study undertaken in Izhevsk, in Russia, 7.3% of men aged 25–54 years had drunk it in the past year, with 4.7% drinking it weekly or more often (McKee et al., 2005). However, all such surveys are likely to underestimate the extent of consumption as those who are most likely to consume such substances are likely to be concentrated among non-responders to surveys.
This small study adds to our earlier work that has reported easy access in both Hungary and Russia to various alcoholic substances that contain either appreciable concentrations of toxic long chain alcohols or dangerously high levels of ethanol. We suggest that action is needed to make them less easily available. While recognizing the difficulties in tackling illegal distillation in rural areas, there is much that could be done. One example might be a ban on the sale of fire lighting liquid, as alternatives in the form of paraffin wax blocks are easily available and are anyway much safer for lighting fires. Another would be a requirement for aftershaves to include an emetic substance, which could be done without detracting from the legitimate use of these substances.
|
CONCLUSION |
|---|
|
TOPABSTRACTINTRODUCTIONMATERIALS AND METHODSMATERIALSRESULTSDISCUSSIONCONCLUSIONREFERENCES |
|---|
We have identified a range of alcohol-containing substances that appear to be easily available at low cost in Estonia. Some contain substantially higher concentrations of ethanol than commercial spirits and others also contain toxic long chain alcohols. Policies on the health effects of alcohol in Estonia should address the availability of these substances.
|
ACKNOWLEDGEMENTS |
|---|
This study was sponsored by the Estonian Science Foundation grant number 6578. Conflict of interest: The authors have no conflict of interest.
|
REFERENCES |
|---|
|
TOPABSTRACTINTRODUCTIONMATERIALS AND METHODSMATERIALSRESULTSDISCUSSIONCONCLUSIONREFERENCES |
|---|
Council of Europe (1981) Flavouring substances and natural sources of flavourings. 3rd edn, Council of Europe, Strasbourg.
Estonian Institute of Economic Research (2005) Consumption and Trade of Illegal Alcohol in Estonia (Based on Population Survey). Estonian Institute of Economic Research, Tallinn.
Hewlett-Packard Company (1994) Analytical Columns and Supplies 1994/1995. Capillary Columns. Hewlett-Packard Company, Palo Alto, CA.
Mckee, M., Pomerleau, J., Robertson, A. et al. (2000) Alcohol consumption in the Baltic Republics. Journal of Epidemiology and Community Health 54, 361–366.
Mckee, M., Shkolnikov, V. and Leon, D. A. (2001) Alcohol is implicated in the fluctuations in cardiovascular disease in Russia since the 1980s. Annals Epidemiology 11, 1–6.
Mckee, M., Szucs, S., Sárváry, A. et al. (2005) The composition of surrogate alcohols consumed in Russia. Alcohol Clinical Experimental Research 29, 1884–1888.[CrossRef][Web of Science][Medline]
Narawane, N. M., Bhatia, S., Abraham, P. et al. (1998) Consumption of ‘country liquor’ and its relation to alcoholic liver disease in Mumbai. The Journal of the Association of Physicians of India 46, 510–513.[Medline]
Narro-Robles, J., Gutierrez-Avita, J. H., Lopez-Cervantes, M. et al. (1992) Liver cirrhosis mortality in Mexico. II. Excess morality and pulque consumption. Salud Publica de Mexico, 34, 388–405.[Medline]
Palosuo, H., Uutela, A., Zhuravleva, I. and Lokomova, N. (1997) Observations on the use of alcohol in Helsinki and Moscow in 1991. In Simpura, J. and Levin, B. M. eds, Demystifying Russian Drinking: Comparative Studies From the 1990s. STAKES, Helsinki, 149–174.
Pomerleau, J., Mckee, M., Rose, R. et al. (2005) Drinking in the Commonwealth of Independent States—evidence from eight countries. Addiction 110, 1647–1668.
Strubelt, O., Deters, M., Pentz, R. et al. (1999) The toxic and metabolic effects of 23 aliphatic alcohols in the isolated perfused rat liver. Toxicological Sciences 49, 133–142.
Szucs, S., Sárváry, A., Mckee, M. et al. (2005) Could the high level of cirrhosis in central and eastern Europe be due partly to the quality of alcohol consumed? An exploratory investigation. Addiction 100, 536–542.[CrossRef][Web of Science][Medline]
Vassiljev, V. and Väli, M. (2003) Methanol Poisoning in Estonia in 2001. In Proceedings of the 16th Meeting of the International Association of Forensic Sciences. Monduzzi Editore - International Proceeding Division, Montpellier France.
White, S. (1996) Russia Goes Dry. Cambridge University Press, Cambridge.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  D. Jasilionis, V. M Shkolnikov, and E. M Andreev Commentary: The study by Leinsalu et al. on mortality differentials in Eastern Europe highlights the need for better data Int. J. Epidemiol., April 1, 2009; 38(2): 525 - 527. [Full Text] [PDF]
|
|
|
|
 |
|
 D. W. Lachenmeier, B. Sarsh, and J. Rehm The Composition of Alcohol Products from Markets in Lithuania and Hungary, and Potential Health Consequences: A Pilot Study Alcohol Alcohol., January 1, 2009; 44(1): 93 - 102. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Stickley, M. Leinsalu, E. Andreev, Y. Razvodovsky, D. Vagero, and M. McKee Alcohol poisoning in Russia and the countries in the European part of the former Soviet Union, 1970 2002 Eur J Public Health, October 1, 2007; 17(5): 444 - 449. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||