Sweat testing for drugs of abuse requires a specially designed collection device that typically consists of an absorbent patch that can be worn on the skin for an extended period of time, but cannot be reattached once it is removed. The device is nonocclusive in that it allows water vapor and other volatile compounds to evaporate while trapping larger drug molecules. The device is also impermeable to external contamination. Sweat collection is noninvasive but at the end of the collection period (e.g., 1 week), the device is sent to a specialized laboratory for testing. The principle analytes in sweat are the parent drugs. Sweat testing provides a cumulative and prospective, rather than retrospective, measure of drug exposure once the device is applied. Thus, sweat testing is a sensitive method for detecting drug use and its use is most applicable in monitoring drug abstinence among individuals enrolled in drug treatment programs or in criminal justice probation/parole programs (11,12). The results, however, at least in detection of cocaine use, may be affected by the collection period and by the site of sweat collection, and loss of cocaine may occur from skin collection patches (13). Other disadvantages of sweat testing is that the entire patch is consumed for testing, thus precluding any re-testing. Moreover, there is no proficiency program to support sweat testing and there is still very little knowledge on the pharmacokinetics and drug disposition into sweat as well as the possible susceptibility of the sweat patches to environmental contamination (14).

The cutoff values for sweat testing in the proposed revisions of the SAMHSA guidelines are listed in Table 2.

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