SWEAT

HOW IS THE SWEAT SPECIMEN FOR DRUG ABUSE TESTING COLLECTED?

A. General aspects of sweat sampling
Different kinds of materials are utilized in the collection of sweat. Such are the collection of
sweat using a dry gauze covered with waterproof plastic; the use of pads impregnated with
salts; cotton swabs, polyvinyl shirts, perspiration stains from clothing, drug wipes, and a
transcutaneous chemical collection by band-aid-like devices equipped with a water/gel matrix
with the function to absorb compounds. In performing sweat sampling using these equipment,
there are ways to fasten the collection of the specimen, i.e. thermal and pharmacological, using
the plant chemical, pilocarpine. By using these sampling techniques, various drugs, including
methadone, phenobarbital, morphine, cocaine, THC and methamphetamine have been
analysed.
B. Specific ways of Sweat Collection
1. Collection by sweat patches
The patch adhesive is particularly made such that the patch cannot be reapplied to the
skin once it has been removed, whether unintentionally or on purpose. An absorbent pad
allows evaporation of oxygen, carbon dioxide, and water while retaining non-volatile
components like pharmaceuticals. The most common sweat patch is the Pharmchek™
patch. Its use was approved in 1993 by the United States Food and Drug Administration
for analysis of cocaine, opoids, phencyclidine, amphetamines and cannabinoids.
Features of PharmChek™ Sweat Patch
1. A “3M’s Tegaderm™ 1625 transparent wound dressing” polyurethane/adhesive layer,
that is approximately 6 cm wide, 7 cm long, and 0.025 mm in thickness and is a
hypoallergenic, water-resistant adhesive. It infiltrates the exfoliated stratum corneum
cells when it adheres to the skin. As a result, when it is withdrawn, the cells attach to the
adhesive and prevent it from being reapplied, to avoid altering of the original specimen.
It is identified by a unique identifying number, which eliminates the possibility of
replacement.
2. A collection pad approximately 3 cm wide, 5 cm long and 0.7 mm thick composed of
medical grade cellulose. It retains the non-volatile components of sweat.
3. The release liner, a very thin medical-grade tissue paper (approximately 3 cm wide, 5 cm
long, and 0.003 mm thick) interposed between the polyurethane film and the absorption
pad. It allows the release of the collection pad from the adhesive after patch wear.
HOW MUCH SPECIMEN IS COLLECTED?
The sweat patch is not measured by a particular mL in each collection period. Reportedly, the
PharmChek™ provides an adequate amount of sample after it has been worn for a minimum
period of 24 hours. A brand of sweat patch PharmaChek, can absorb about 2mL in the patch
each week, this is considering the evaporation of the water. The product is worn about 7-10
days to collect the specimen.
It is important to take note that because the patch's adhesion is highly forceful, it should be
avoided on skin areas prone to movement-related strain. Suitable sites include the upper arm,
lower rib cage area, and upper back. Before applying, clean the skin with two isopropanol
wipes, for example. Allow the alcohol to completely evaporate before applying to avoid skin
irritation caused by isopropanol trapped behind the perspiration patch. The patch is often placed
to the upper arm, which should be bent during application to alleviate skin tension. Also,
contamination can be avoided by cleaning the skin twice with isopropanol wipes or with
isopropanol followed by water and soap.

HOW IS THE SPECIMEN FURTHER PREPARED?

Drug extraction

Extraction method Analyte/class of analytes

Liquid-liquid extraction Amphetamines
Methamphetamines
Phencyclidine
Solid-phase extraction Cannabinoids
Cocaine
Opioids
Solid-phase micro extraction Cocaine
Cocaethylene
Table 1. Summary of extraction of controlled drugs in sweat specimen
In table 1, the Liquid-liquid extraction, includes amphetamines, methamphetamines,
phencyclidine. Solid-phase extraction includes drugs such as cannabinoids, cocaine, and
opioids. cocaine and cocaethylene are chemicals recovered by Solid-phase micro extraction.
Target compounds can be eluted from the pad placed in a vial with 2.5, 4 or 6 ml of methanol:
0.25 M (pH 5.0) sodium acetate buffer (25:75, v/v) or with 5 ml methanol or acetonitrile. The vial
is shaken for 30 min. and the extraction fluid is collected after forcing the collection pad to the
bottom of the vial. Prior to analysis, the elution fluid generally undergoes further clean-up and
concentration steps. These extraction procedures, in principle, should not differ from those
applied to other, more complex biological fluids, such as urine or plasma/serum.

METHODS FOR THE ANALYSIS OF DRUGS IN SWEAT

A. Screening Test
To boost analytical productivity, the fluids produced by patch devices (also known as patch
eluate) are frequently preliminarily tested using immunochemical methods to identify the
probable presence of pharmaceuticals. This works by introducing the sweat to the antibody
ligands of the drugs contained in the testing wells of the screening kit.
Steps in performing drug screening test using sweat specimen
1. Load the sample and the enzyme-labelled hapten conjugate in the antibody-coated
microtitre wells.
 2. After a predetermined time, when the competitive binding between the drug and the
antibody coated on the surface of the microplate is complete, wash the wells six times
with de-ionized water to remove the enzyme conjugate and the excess of the drug.
3. Add 3,3’,5,5’-tetramethylbenzidine (substrate).
4. Incubate for a further 30 min.
5. Stop the reaction by adding 100 μl of 4 M sulfuric acid.
6. 6. Read the microplates by means of a microplate reader at 450 and 630 nm wavelength
(calculate differential radiation absorption).
The signal strength is inversely proportional to the amount of drug or metabolites in the solution,
as in all competitive immunoassays. Because ELISA is based on the drug-antibody interaction,
it is susceptible to cross-reactivity and should only be used as a qualitative screening test. A
preliminary review of a sufficient number of "negative" samples should be used to determine the
cut-off value. Positive samples, as well as "critical" negative samples in many cases, should
always be subjected to more accurate confirmation analysis, often by GC-MS or LC-MS/MS.
B. Confirmatory Test
GC-MS or LC-MS/MS analyses are performed, analogously to urine, blood or hair analysis, with
the following purposes:

• Since immunoassays allow the identification of mere classes of compounds (drugs

and/or metabolites), confirmation techniques should identify unam- biguously the specific
analyte(s).
• As immunoassays are limited by the availability of antisera, GC-MS or LC-MS/MS can
be used to screen and identify compounds for which no antisera are available.
• Because immunoassays, due to different cross-reactivity towards structurally related
compounds, are unsuitable for quantitative determinations, GC-MS or LC-MS/MS are
instead used to accurately quantify the analytes.
Classification of Methods used in confirmatory test
1. Gas chromatography–mass spectrometry (GC-MS)
GC-MS is an analytical method used to identify, separate, and measure the chemical
components of a sample mixture to ascertain whether or not they are present and/or in what
amounts.
2. Liquid chromatography-mass spectrometry (LC-MS)
LC, operating in liquid phase and at room temperature, has a much wider analytical applicability
than GC, being able to separate polar, thermally labile, high molecular weight or ionized
molecules.
 LC-MS operating conditions

Sample preparation: Vigorous shaking of patches in 20 mM ammonium

formate buffer, pH 7.0: methanol (50:50 vol/vol). Direct

injection of 15 µL of the filtered solution

Column: 2.1 mm (I.D) x 50 mm, 5 μm. HyPURITY Aquastar

column (ThermoFisher)

Mobile phase: Gradient from 95 % A (20 mM ammonium formate,

Injection volume: 10 µl

Acquisition: Triple quadrupole in positive ion electrospray ionization

(ESI) mode

Multiple reaction monitoring (MRM) mode

WHAT DRUGS ARE PRESENT OR DETECTED?

Screening levels Enzyme Confirmation levels GC-

immunoassay MS or LC-MS/MS
Drug class PharmChem SAMSHA Drug/metabolite PharmChem SAMSHA
ng/ml ng/patch ng/ml ng/patch
Marijuana 1.5 4 THC parent drug 0.5 1
Cocaine 10 25 Cocaine 10 25
Benzoylecgonine 10 25
Heroin 10 —
6-Acetyl Morphine 10 25
Opioids 10 25
Morphine 10 25
Codeine 10 25
Phencyclidine 7.5 20 Phencyclidine 7.5 20
Amphetamine 10 25
Methamphetamine 10 25
Amphetamines 10 25
MDA — 25
MDEA — 25
MDMA — 25 MDMA — 25
Table 2. Summary of Drugs detected and Their Cutoff levels by PharmaChem, and SAMSHA
Table 2. shows that the dangerous drugs that can be detected in a sweat specimen are THC
parent drug, cocaine, benzoylecgonine, heroin, 6-acetyl morphine, morphine, codeine,
phencyclidine, amphetamine, methamphetamine, MDA (3,4-methylendioxyamphetamine),
MDEA (3,4-methylendioxymethamphetamine), MDMA (3,4-methylendioxyethylamphetamine).
Sweat patch drug results can be expressed as ng/ml of reconstituted acetate buffer/ methanol
or, as proposed by the Substance Abuse and Mental Health Services Administration (SAMHSA)
guidelines, as ng/patch. The following cut-off levels have been proposed by the manufacturer,
PharmChem, Inc., and by SAMSHA limited to workplace drug testing.
Other Drugs detected by PharmCheck (with cutoff level)

• Opiates: EIA 10ng/mL

• Fentanyl: 1 ng/mL
• Norfentanyl: 1 ng/mL
• Hydrocodone: 10 ng/mL
• Hydromorphone: 10 ng/mL
• Oxycodone: 10 ng/mL
• Oxymorphone: 10 ng/mL

HAIR

HOW IS THE SWEAT SPECIMEN FOR DRUG ABUSE TESTING COLLECTED?

A proper specimen collection protocol forms the basis of a correct interpretation of the
toxicological results. According to the guidelines of the Society of Hair Testing (SoHT) [9],
sample collection should be performed by a responsible authority respecting the legal, ethical
and human rights of the person being tested. A competent individual, but not necessarily a
medical practitioner, should collect hair samples.

Collection location: collection must be performed within a secure contamination free facility with
access restrictions in place.

Collection devices and consumables:

• A chain of custody form;

• A foil and a collection envelope;
• A security seal;
• A transportation envelope.

The subject should be informed of the procedure and identified by an ID. The collector must
wear gloves and use clean tools to avoid any risk of interindividual contamination.

Collection site: the posterior vertex region of the head is the preferred sampling site as this
region is associated with the smallest variation in growth rate. As an alternative, or in addition to
scalp hair sampling, pubic, beard or axillary hair can be collected, taking into account the
interpretation issues posed by these differing specimens.

Collection procedure: a lock of hair should be tied and cut as close to the skin as possible.

Description (depending on the purpose of the test): It Depending on the test's objective, the
case history, pertinent anamnesis information, color, length, collection site, and any cosmetic
procedures should all be noted. When packaging, it is important to align and clearly identify the
root end of scalp hairs. For the sample to remain intact and prevent contamination, it must be
firmly fastened, perhaps with aluminum foil.

Storage: Hair samples must be kept at room temperature in a dry, dark location. Avoid being in
the sun's direct beams. Low-temperature storage is not advised because it might cause drug
loss, mold growth, and hair to swell. Storage in plastic bags must be avoided due to plastic
softeners' contamination. The ability of plastic to absorb lipophilic compounds is also possible.
The hair sample can be stored easily by being wrapped in aluminum foil and placed inside of a
paper envelope.

HOW MUCH SPECIMEN IS COLLECTED?

The quantity of sample taken is crucial in order to perform screening and confirmatory routine
tests and, if necessary, repeat the analyses (including counter-analysis by a second laboratory).
A "lock of hair with the thickness of a pencil" should suffice as a general rule. When a sufficient
volume of hair is sampled from one location, it might leave a noticeable "bald patch" on the
scalp, especially in youngsters or patients who already have balding or thinning hair. This can
be prevented by taking numerous, smaller samples from various locations on the scalp, perhaps
in the vertex area.
The final prepared specimen is recommended to be 20-50 mg of powdered or cut hair but it is
required to be decontaminated.

METHODS FOR THE ANALYSIS OF DRUGS IN SWEAT

Screening techniques (Immunological methods)

When compared to urine testing, methods for hair analysis must cope with lower drug
concentrations and a limited amount of sample collected. A screening procedure to distinguish
between presumptively positive samples and negative ones can be performed by either
immunological or GC-MS methods.

These methods are based on the molecular recognition between an antibody and its
antigen(s) (drugs or metabolites) and are poorly affected by biological matrix interferences.
They are most suitable under controlled conditions, e.g. when the sample solution has a pH and
composition compatible with the reactivity of antibodies and the reactions used for the detection.

Confirmation techniques (Immunological methods)

In hair analysis (and generally in pharmaco-toxicological analysis of biosamples), GC-

MS and LC-MS/MS are by far the most recognized techniques, due to the high specificity and
selectivity of the MS or MS/MS detection. However, laboratories using GC-MS and/or LC-MS for
confirmation of results should ensure that their confirmation techniques:

• Have sufficient sensitivity to detect low drug levels, well below the suggested cut-
offs;
• Are able to describe the drug/metabolite ratios in hair, where relevant;
 • Have an adequate accuracy for quantification in real conditions;
• Can identify drugs not included in the traditional screening panels by a wider
detection window.

Capillary Gas Chromatography-Mass Spectrometry - has been by far the method most
frequently used in hair analysis. To undergo GC-MS, the targeted analytes must be volatile and
thermally stable. Derivatization helps to analyse compounds which are not inherently suitable
for GC-MS. As in every GC-MS analytical method, analytes must be identified by comparison to
the retention times and the relative abundances of the qualifier ions of the same analytes in a
positive quality control sample run in the same analytical session.

Amphetamines by GC-MS (adapted from Frison et al.)

Solubilization/extraction - Prepare 30-50 mg of decontaminated, powdered or cut hair,
accurately weighed, add 1 ml 1 M NaOH and 1 ng/mg of deuterated amphetamine derivatives.
Allow to stand for 10 min. Incubate at 45°C overnight (or in an ultrasonic bath for a shorter time).
Add 5 ml ethyl acetate and homogenize. Agitate on a horizontal shaker or by inversion for 20
min. Centrifuge for 15 min. at 3,500-4,000 rpm. Collect the organic phase, add 2 drops of
methanol-HCl (99:1 v/v) and evaporate to dryness. Do not overdry.
Derivatization - Add 15 μl of 2,2,2-trichloroethylchloroformate. Add 35 μl of ethyl acetate.
Incubate for 15 min. at 80°C. Re-evaporate to dryness. Dry solvents and reagents must be
used. Solvents can be dried using molecular sieves.
Analysis - Dissolve the derivatized extract in 50 ml ethyl acetate.

Cannabis by GC-MS
a. Determination of THC, CBD, CBN Extraction
• To 30-50 mg decontaminated, powdered or cut hair add 100 ng of tri-deuterated ∆9-
tetrahydrocannabinol (∆9-THC-d3). 2 ml 1M KOH (or NaOH). Incubate for 30 min at 95°C (or
overnight at 45°C). Then cool the sample.
• LLE clean-up - Add 5 ml iso-octane. Agitate by inversion for 15 min. Centrifuge for 15 min. at
3,500-4,000 rpm. Collect the organic phase in a glass vial. Evaporate to dryness under nitrogen
at 40°C. Dissolve the extract in 40 µl iso-octane.

b. Determination of THC-COOH Extraction

• LLE clean-up - Add 1 ml HCL 1M pH 4 and 3 ml hexane: ethylacetate 9:1. Agitate by inversion
for 15 min. Centrifuge for 15 min. at 3,500-4,000 rpm. Collect the organic phase in a glass vial.
Add again 3 ml hexane: ethylacetate 9:1. Agitate by inversion for 15 min. Centrifuge for 15 min.
at 3,500-4,000 rpm. Collect the organic phase in a glass vial. Put together both organic phases.
Evaporate to dryness under nitrogen at 40°C. Derivatize with 50 µl N,O-
Bis(trimethylsilyl)trifluoroacetamide, (BSTFA), 1 % trichloromethylchlorosilane (TCMS) at 70°C
for 30 min.
 Opioids and cocaine by GC-MS

• Extraction - to 30-50 mg of decontaminated powdered or cut hair, accurately weighed, add 1 ml

0.1 M HCl and then 1 ng/mg of deuterated opoid and cocaine derivatives (e.g. benzoylecgonine-
d3, cocaine-d3, morphine-d3). Add a magnetic stir bar and incubate for 16 h at 56°C while
stirring.
• Clean-up - Neutralize the extract, adding 1 ml of 0.1 M NaOH and 2 ml of 1 M phosphate buffer,
pH 8.4. Add 10 ml dichloromethane-isopropanol-n-heptane (50:17:33, v/v) and homogenize.
Agitate on a horizontal shaker or by inversion for 20 min. Centrifuge for 15 min. at 3,500-4,000
rpm and separate the organic layer. Add 5 ml 0.2 M HCl, extract and collect the organic layer.
Add 1 ml 1 M NaOH, 2 ml 1 M phosphate buffer, pH 8.4, 5 ml dichlo- romethane, extract and
collect the organic phase. Evaporate the extract to dryness.
• Derivatization - To the dried extract add 30 µl bis(trimethylsilyl) trifluoroacetamide (BSTFA) or N-
Methyl-N-(trimethylsilyl) trifluoroacetamide (MSTFA) plus 1 % tri- methylchlorosilane (TMCS).
Incubate for 30 min. at 70°C.

Another confirmatory test, Liquid chromatography-mass spectrometry (LC-MS) LC, operating in

liquid phase and at room temperature, has a much wider analytical applicability than GC, being
able to separate polar, thermally labile, high molecular weight or ionized molecules.
Opiates and cocaine by LC-MS

• Decontamination - Wash 20 mg of hair three times with 1 ml dichloromethane then dry the
sample at 40°C.
• Homogenization/pulverization - then cut the sample into small segments. Put it into a stainless
steel smashing vial immersed in liquid nitrogen. Pull a magnetic plunger back and forth in the
vial to pulverize the sample. Alternatively, pulverize in a ball mill.
• Extraction - Add 10 μl of a 1000 ng/ml of deuterated internal standard solution
(benzoylecgonine-d3, cocaine-d3, codeine-d3, morphine-d3, 6-MAM-d6). Add 990 ml methanol.
Incubate for 4 h at 40°C under ultrasonication.
• Analysis - Transfer approximately 800 ml of supernatant into an auto-sampler vial. Inject 10 μl
into the LC/MS-MS.

WHAT DRUGS ARE PRESENT OR DETECTED?

Screening Confirmation

Group Cut-off (ng/mg) Target analyte Cut-off (ng/mg)

amphetamines 0.2 Amphetamines 0.2

Metamphetamines 0.2

MDA 0.2

MDMA 0.2

Cannabinoids 0.05 THC 0.05

 THC COOH 0.0002

Cocaine 0.5 Cocaine 0.5

BE, EME CE, NC BE/COC 0.05

Opioids 0.2 Morphine 0.2

Codeine 0.2

6-Acetylmorphine 0.2

Methadone 0.2 Methadone 0.5

EDDP 0.06

Buprenorhine 0.02 Buprenorphine 0.01

Norbuprenorphine 0.01

Table 3. Detected Dangerous Drugs and their Cutoff levels using Hair Specimen
These values are not limits of quantification or detection, but “decisional” values and must be
used with special attention to the specific issue to which the test is applied. For example, in
cases of drug facilitated crimes, the expected concentrations can be much lower than the above
cut-offs due to single exposure to an impairing drug. THC-COOH, the specific metabolite of THC
that would allow to discriminate between passive, external contamination and active intake of
Cannabis I. preparations, may be present in hair at extremely low concentrations (in the low
pg/mg range). Consequently, very sensitive and specific methods must be used to detect THC-
COOH in hair, exhibiting a lower limit of quantification < 0.2 pg/mg; a specific extraction such as
bead-assisted liquid-liquid extraction on pulverized hair is required, followed by derivatization
and GC-MS/MS detection in negative ion chemical ionization (NICI) conditions with methane as
a reagent gas.

MECONIUM
In the year 1991, the meconium testing was first introduced commercially by the United States
Drug Testing Laboratory, pioneering newborn toxicology techniques and knowledge. The first
stool after birth, meconium contains the amniotic fluid that the fetus secreted during the second
half of pregnancy. Meconium offers a far longer window of exposure, up to about 20 weeks, and
is simpler to collect than neonatal urine. Only accounts associated with hospitals or health
systems may submit meconium specimens.

HOW IS THE MECONIUM SPECIMEN FOR DRUG ABUSE TESTING COLLECTED?

A diaper is modified by adding a liner so the meconium is collected at the diaper. The
meconium is transferred to a collection container with the use of a spatula or a wooden tongue
depressor. The ID number or newborn ID sticker is written on the provided document form for
recording and enter the date and time of birth. Accomplish the other information that are
required to be filled. It should be noted that the container should be a leakproof polypropylene.

Generally, the standard turnaround time for reporting negative screening test results is the next
business day, with an additional 1-2 business days for specimens that require confirmatory
testing. Turnaround time begins from the receipt of the valid specimen – accompanied by a
properly documented valid order – into the laboratory. Some tests require additional processing
time and will fall outside the standard turnaround time window.

Specimens must be delivered frozen if heroin usage is suspected to preserve the heroin
metabolite 6-monoacetylmorphine (6MAM). In less than 24 hours, a sizable portion of 6MAM
will convert to morphine when refrigerated.

Cocaine metabolite in meconium will deteriorate after 72 hours of collection unless it is

refrigerated.

HOW MUCH SPECIMEN IS COLLECTED?

The amount of sample that is gathered requires a minimum of 3 grams. The USDTL
recommends weighing the specimen on a jeweler’s scale. If there is not enough specimen to
run the test, the results are reported out as QNS. Quantity Not Sufficient (QNS) is a result of not
having a sufficient quantity (volume) of specimen to test for the panels ordered. Drugs and
metabolites can last in the meconium for up to 2 weeks at room temperature. Storage in a
refrigerator or freezer is preferred. Transport Conditions should be Ambient and room
temperature is acceptable.

METHODS FOR THE ANALYSIS OF DRUGS IN SWEAT

Meconium drug testing begins with an immunoassay. Positive results are confirmed and
quantitated by liquid chromatography-tandem mass spectrometry (LC-MS/MS). Drug
confirmation is necessary because some prescribed or over the counter medications cross-react
and produce a positive screening result.

Screening test (Immunoassays)

Numerous immunological techniques have been created; the majority of them focus on a
specific drug or its metabolites in urine. A few of them have been modified and are often used
for the first, quick screening of a small number of illicit substances in several matrices, including
serum and meconium. Since immunological methods are based on antibody/antigen
interactions, they tend to be relatively nonspecific for some drugs and are therefore susceptible
to interferences that can produce false positive (for example, an immunoassay response to
unrelated compounds) or negative results (for example, an incorrect target drug causing an
insufficient response). Because immunoassays were first developed for drug testing in urine
samples, it is also challenging to swiftly adapt them for the detection of novel substances in
meconium. However, the creation of a meconium-specific test has helped to increase
immunoassay sensitivities. Nevertheless, immunological testing is quick and requires less work
than other types of testing, which accounts for its usefulness in drug screening as the initial step
in finding drugs in patient samples.

Confirmatory Tests (Chromatographic Methods)

Chromatographic techniques are typically employed to verify immunological screen findings that
are presumed to be positive (see immunoassays above). These approaches are more precise
and delicate, but they also need more work and unique knowledge. They are not appropriate for
screening since they take a long time to process. Drug screening by chromatography has been
possible with the development of liquid chromatography connected to tandem mass
spectrometric detectors (LC-MS/MS). The mass spectrometer's excellent resolution allows it to
identify a variety of drugs and their metabolites in a single run. In most cases, interferences may
be minimized if the procedure is properly evaluated. Therefore, a patient sample may be
screened using LC-MS/MS for a variety of medications and their metabolites..

WHAT DRUGS ARE PRESENT OR DETECTED?

Drugs that are found and measured in the meconium sample are opiates (morphine,
hydromorphone, oxycodone), cocaine and its metabolites (benzoyle ecgonine and m-
hydroxybenzoyl ecgonine), methadone, phencyclidine, amphetamine, metamphetamine, THC

Before being sent to the lab for testing, it is advised that meconium samples gathered at various
periods for a newborn be pooled together (for example, a preterm infant, when many collections
are necessary to obtain enough meconium).

Meconium samples are tested for illicit drugs at Warde Medical Laboratory using screening by
LC-MS/MS, a technique that has been used regularly in our lab for more than four years. The
sensitivity and selectivity needed to correctly detect pharmaceuticals in meconium are combined
in this. Except for amphetamine and methamphetamine, which have a threshold of 40 ng/mL, all
substances have a positive cutoff of 20 ng/mL. Currently, immunoassay is used to check for
THC.

The limit of quantitation varies for each of these drug groups (ClinLab Navigator, n.d.).

1. Amphetamines: >100 ng/g

2. Methamphetamines: >100 ng/g
3. Cocaine and metabolite: >100 ng/g
4. Opiates: >100 ng/g
5. Tetrahydrocannabinol carboxylic acid: >20 ng/g
6. Phencyclidine (PCP): >20 ng/g

Reference value is no drug detected in meconium.

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