Spatial differences and temporal changes in illicit drug use in Europe quantified by wastewater analysis.

To perform wastewater analyses to assess spatial differences and temporal changes of illicit drug use in a large European population. Analyses of raw wastewater over a 1-week period in 2012 and 2013. Catchment areas of wastewater treatment plants (WWTPs) across Europe, as follows: 2012: 25 WWTPs in 11 countries (23 cities, total population 11.50 million); 2013: 47 WWTPs in 21 countries (42 cities, total population 24.74 million). Excretion products of five illicit drugs (cocaine, amphetamine, ecstasy, methamphetamine, cannabis) were quantified in wastewater samples using methods based on liquid chromatography coupled to mass spectrometry. Spatial differences were assessed and confirmed to vary greatly across European metropolitan areas. In general, results were in agreement with traditional surveillance data, where available. While temporal changes were substantial in individual cities and years (P ranging from insignificant to <10(-3) ), overall means were relatively stable. The overall mean of methamphetamine was an exception (apparent decline in 2012), as it was influenced mainly by four cities. Wastewater analysis performed across Europe provides complementary evidence on illicit drug consumption and generally concurs with traditional surveillance data. Wastewater analysis can measure total illicit drug use more quickly and regularly than is the current norm for national surveys, and creates estimates where such data does not exist.

Ort C ，van Nuijs AL ，Berset JD ，Bijlsma L ，Castiglioni S ，Covaci A ，de Voogt P ，Emke E ，Fatta-Kassinos D ，Griffiths P ，Hernández F ，González-Mariño I ，Grabic R ，Kasprzyk-Hordern B ，Mastroianni N ，Meierjohann A ，Nefau T ，Ostman M ，Pico Y ，Racamonde I ，Reid M ，Slobodnik J ，Terzic S ，Thomaidis N ，Thomas KV ... -  《-》

Comparing illicit drug use in 19 European cities through sewage analysis.

The analysis of sewage for urinary biomarkers of illicit drugs is a promising and complementary approach for estimating the use of these substances in the general population. For the first time, this approach was simultaneously applied in 19 European cities, making it possible to directly compare illicit drug loads in Europe over a 1-week period. An inter-laboratory comparison study was performed to evaluate the analytical performance of the participating laboratories. Raw 24-hour composite sewage samples were collected from 19 European cities during a single week in March 2011 and analyzed for the urinary biomarkers of cocaine, amphetamine, ecstasy, methamphetamine and cannabis using in-house optimized and validated analytical methods. The load of each substance used in each city was back-calculated from the measured concentrations. The data show distinct temporal and spatial patterns in drug use across Europe. Cocaine use was higher in Western and Central Europe and lower in Northern and Eastern Europe. The extrapolated total daily use of cocaine in Europe during the study period was equivalent to 356 kg/day. High per capita ecstasy loads were observed in Dutch cities, as well as in Antwerp and London. In general, cocaine and ecstasy loads were significantly elevated during the weekend compared to weekdays. Per-capita loads of methamphetamine were highest in Helsinki and Turku, Oslo and Budweis, while the per capita loads of cannabis were similar throughout Europe. This study shows that a standardized analysis for illicit drug urinary biomarkers in sewage can be applied to estimate and compare the use of these substances at local and international scales. This approach has the potential to deliver important information on drug markets (supply indicator).

Thomas KV ，Bijlsma L ，Castiglioni S ，Covaci A ，Emke E ，Grabic R ，Hernández F ，Karolak S ，Kasprzyk-Hordern B ，Lindberg RH ，Lopez de Alda M ，Meierjohann A ，Ort C ，Pico Y ，Quintana JB ，Reid M ，Rieckermann J ，Terzic S ，van Nuijs AL ，de Voogt P ... -  《-》

Spatio-temporal assessment of illicit drug use at large scale: evidence from 7 years of international wastewater monitoring.

Wastewater-based epidemiology is an additional indicator of drug use that is gaining reliability to complement the current established panel of indicators. The aims of this study were to: (i) assess spatial and temporal trends of population-normalized mass loads of benzoylecgonine, amphetamine, methamphetamine and 3,4-methylenedioxymethamphetamine (MDMA) in raw wastewater over 7 years (2011-17); (ii) address overall drug use by estimating the average number of combined doses consumed per day in each city; and (iii) compare these with existing prevalence and seizure data. Analysis of daily raw wastewater composite samples collected over 1 week per year from 2011 to 2017. Catchment areas of 143 wastewater treatment plants in 120 cities in 37 countries. Parent substances (amphetamine, methamphetamine and MDMA) and the metabolites of cocaine (benzoylecgonine) and of Δ9 -tetrahydrocannabinol (11-nor-9-carboxy-Δ9 -tetrahydrocannabinol) were measured in wastewater using liquid chromatography-tandem mass spectrometry. Daily mass loads (mg/day) were normalized to catchment population (mg/1000 people/day) and converted to the number of combined doses consumed per day. Spatial differences were assessed world-wide, and temporal trends were discerned at European level by comparing 2011-13 drug loads versus 2014-17 loads. Benzoylecgonine was the stimulant metabolite detected at higher loads in southern and western Europe, and amphetamine, MDMA and methamphetamine in East and North-Central Europe. In other continents, methamphetamine showed the highest levels in the United States and Australia and benzoylecgonine in South America. During the reporting period, benzoylecgonine loads increased in general across Europe, amphetamine and methamphetamine levels fluctuated and MDMA underwent an intermittent upsurge. The analysis of wastewater to quantify drug loads provides near real-time drug use estimates that globally correspond to prevalence and seizure data.

González-Mariño I ，Baz-Lomba JA ，Alygizakis NA ，Andrés-Costa MJ ，Bade R ，Bannwarth A ，Barron LP ，Been F ，Benaglia L ，Berset JD ，Bijlsma L ，Bodík I ，Brenner A ，Brock AL ，Burgard DA ，Castrignanò E ，Celma A ，Christophoridis CE ，Covaci A ，Delémont O ，de Voogt P ，Devault DA ，Dias MJ ，Emke E ，Esseiva P ，Fatta-Kassinos D ，Fedorova G ，Fytianos K ，Gerber C ，Grabic R ，Gracia-Lor E ，Grüner S ，Gunnar T ，Hapeshi E ，Heath E ，Helm B ，Hernández F ，Kankaanpaa A ，Karolak S ，Kasprzyk-Hordern B ，Krizman-Matasic I ，Lai FY ，Lechowicz W ，Lopes A ，López de Alda M ，López-García E ，Löve ASC ，Mastroianni N ，McEneff GL ，Montes R ，Munro K ，Nefau T ，Oberacher H ，O'Brien JW ，Oertel R ，Olafsdottir K ，Picó Y ，Plósz BG ，Polesel F ，Postigo C ，Quintana JB ，Ramin P ，Reid MJ ，Rice J ，Rodil R ，Salgueiro-González N ，Schubert S ，Senta I ，Simões SM ，Sremacki MM ，Styszko K ，Terzic S ，Thomaidis NS ，Thomas KV ，Tscharke BJ ，Udrisard R ，van Nuijs ALN ，Yargeau V ，Zuccato E ，Castiglioni S ，Ort C ... -  《-》

National study of illicit drug use in Slovakia based on wastewater analysis.

The aim of this study was to analyze illicit drugs and their metabolites in wastewater from eight selected wastewater treatment plants (WWTPs) in Slovakia. The effect of two of the biggest music festivals in Slovakia on illicit drugs in wastewater was also investigated. Urinary bio-markers of amphetamine, methamphetamine, cocaine, cannabis and ecstasy use were analyzed by liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS). We then compared our results with data obtained in other parts of Europe and the world. This study demonstrates that Slovakia has one of highest methamphetamine consumption rates in Europe. Within Slovakia, the highest level of methamphetamine consumption was found in Petržalka, where the mean specific load of this drug in sewage was 169 mg/day/1000 inhabitants; the next highest loads were detected in Piešťany (128 mg/day/1000 inhabitants) and Bratislava (124 mg/day/1000 inhabitants). Amphetamine, ecstasy and cannabis consumption in our study were comparable to that found in other European cities, whereas cocaine consumption was lower. We also analyzed the pattern of drug consumption over the course of a week. The load of the cocaine metabolite benzoylecgonine in wastewater increased during the weekend. The use of this drug was most common in the capital of Slovakia. Increased consumption was also found during a folk festival in Piešťany. The ecstasy load in wastewater from larger cities also significantly increased over the weekend. An increase of drug consumption was also detected during a music festival in Trenčín, especially for ecstasy. The specific load of ecstasy during this festival increased from 3mg/day/1000 inhabitants to 29 mg/day/1000 inhabitants. The possible influence of music styles on the consumption of certain drugs was also observed. During a folk festival, methamphetamine and cocaine were more commonly used.

Mackuľak T ，Skubák J ，Grabic R ，Ryba J ，Birošová L ，Fedorova G ，Spalková V ，Bodík I ... -  《-》

Refining the estimation of illicit drug consumptions from wastewater analysis: co-analysis of prescription pharmaceuticals and uncertainty assessment.

Wastewater analysis is a promising monitoring tool to estimate illicit drug consumption at the community level. The advantage of this technique over traditional surveys and other surveillance methods has been emphasized in recent studies. However, there are methodological challenges that can affect reliability. The objectives of this study were to systematically reduce and assess uncertainties associated with sampling (through a stringent optimization of the sampling method) and the back calculation of per capita drug consumption (through a refined estimation of the number of people actively contributing to the wastewater in a given period). We applied continuous flow-proportional sampling to ensure the collection of representative raw wastewater samples. Residues of illicit drugs, opioids, prescription pharmaceuticals and one artificial sweetener were analyzed by liquid chromatography coupled with tandem mass spectrometry. A parameter estimating the number of people actively contributing to wastewater over a given period was calculated from the measured loads of prescription pharmaceuticals, their annual consumption and relative excretion data. For the calculation of substance loads in sewage, uncertainties were propagated considering five individual components: sampling, chemical analysis, flow measurements, excretion rates and the number of people contributing to the wastewater. The daily consumption per 1000 inhabitants was estimated to be almost 1000 mg for cannabis and several hundred mg for cocaine, methamphetamine and ecstasy. With the best sampling practice and current chemical analysis, we calculated the remaining uncertainty to be in the range of 20-30% (relative standard deviation, RSD) for the estimation of consumed drug masses in the catchment; RSDs for the per capita consumption were lower (14-24%), as one of the biggest uncertainty components (i.e. error in flow measurements) cancels out in the proposed method for the estimation of the number of people contributing to the daily wastewater volume. In this study, we provide methodological improvements that substantially enhance the reliability of the estimation method--a prerequisite for the application of this technique to meaningfully assess changes in drug consumption and the success of drug intervention strategies in future studies.

Lai FY ，Ort C ，Gartner C ，Carter S ，Prichard J ，Kirkbride P ，Bruno R ，Hall W ，Eaglesham G ，Mueller JF ... -  《-》