Substance Abuse and Mental Health Services Administration
Clinical Drug Testing in Primary Care Sweat
Several collection devices have been manufactured for collecting sweat specimens. The two most common are the patch and the swipe; however, the sweat patch is the only device approved by the U.S. Food and Drug Administration (FDA). The quantity of sweat collected is determined by the length of time the patch is worn and the physiology of the person wearing the patch. The patch should be worn for at least 3 days, but no longer than 7 days, although most drugs will have been excreted within the first 48 hours (Barnes et al., 2009; Huestis et al., 2008; Kacinko et al., 2005; Schwilke et al., 2006). This ensures that a sufficient amount of sweat is collected for testing. The sweat collected with the patch detects drug use that occurred shortly before the patch was applied and while the device remains on the skin.
The skin should be thoroughly cleaned with soap and water and then swabbed well with alcohol. The patch should then be applied to the skin by a staff member, not the patient (Watson et al., 2006). After 7 days, the patch is removed by the practitioner and sent to the laboratory for analysis. Mainly the parent drug is found in sweat; however, some drug metabolites also may be detected (Dasgupta, 2008). Drugs and drug metabolites that have been detected in sweat include tetrahydrocannabinol (THC), amphetamine, methamphetamine, methylenedioxymethamphetamine (MDMA, or “Ecstasy”), codeine, morphine, heroin metabolite, phencyclidine (PCP), and cocaine and its metabolites (e.g., benzoylecgonine, ecgonine methyl ester) (Barnes et al., 2009; Dasgupta, 2008).
Because sweat can be collected only in limited quantities, there may not be sufficient specimen for repeat or confirmatory testing. Sweat is less susceptible to tampering or adulteration than is urine. The accuracy of sweat testing is not standardized. Its accuracy remains somewhat controversial (Chawarski, Fiellin, O’Connor, Bernard, & Schottenfeld, 2007; Watson et al., 2006) and more research is needed (Barnes et al., 2009; Huestis et al., 2008; Kacinko et al., 2005; Schwilke et al., 2006). However, the sweat patch is used extensively in the criminal justice system, and its use to identify relapse or violations of conditions of probation has been upheld by the courts.
HHS Publication No. (SMA) 12-4668 Substance Abuse and Mental Health Services Administration Printed 2012
Cited
Barnes, A. J., De Martinis, B. S., Gorelick, D. A., Goodwin, R. S., Kolbrich, E. A., & Huestis, M. A. (2009). Disposition of MDMA and metabolites in human sweat following controlled MDMA administration. Clinical Chemistry, 55(3), 454–462.
Huestis, M. A., Scheidweiler, K. B., Saito, T., Fortner, N., Abraham, T., Gustafson, R. A., et al. (2008). Excretion of delta-9-tetrahydrocannabinol in sweat. Forensic Science International, 174(2–3), 173–177.
Chawarski, M. C., Fiellin, D. A., O’Connor, P. G., Bernard, M., & Schottenfeld, R. S. (2007). Utility of sweat patch testing for drug use monitoring in outpatient treatment for opiate dependence. Journal of Substance Abuse Treatment, 33(4), 411-415.
Kacinko, S. L., Barnes, A. J., Schwilke, E. W., Cone, E. J., Moolchan, E. T., & Huestis, M. A. (2005). Disposition of cocaine and its metabolites in human sweat after controlled cocaine administration. Clinical Chemistry, 51(11), 2085–2094.
Schwilke, E. W., Barnes, A. J., Kacinko, S. L., Cone, E. J., Moolchan, E. T., & Huestis, M. A. (2006). Opioid disposition in human sweat after controlled oral codeine administration. Clinical Chemistry, 52(8), 1539–1545.
Dolan, K., Rouen, D., & Kimber, J. (2004). An overview of the use of urine, hair, sweat and saliva to detect drug use. Drug and Alcohol Review, 23(2), 213–217.
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