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 ... -  《-》

A comparison of trends in wastewater-based data and traditional epidemiological indicators of stimulant consumption in three locations.

To compare long-term trends in wastewater data with other indicators of stimulant use in three locations and to test the reliability of estimates based on 1 week of sampling. Comparison of trends in quantities ('loads') of stimulants or their metabolites in wastewater with trends in other indicators of stimulant use (e.g. treatment, police, population survey data). Populations in Oslo (Norway), South-East Queensland (Australia) and Eindhoven (the Netherlands). Wastewater data were modelled for MDMA (3,4-methyl​enedioxy​methamphetamine), benzoylecgonine (a metabolite of cocaine), amphetamine and methamphetamine in Oslo; benzoylecgonine in Eindhoven; and methamphetamine in South-East Queensland. Choice of stimulants modelled in each region was primarily determined by availability of useable data. In Oslo, wastewater data, driving under the influence of drugs statistics and seizure data all suggested increasing MDMA use between 2009 and 2017. In South-East Queensland, there was an estimated 31.1% [95% confidence interval (CI) = 29.4-32.9%] annual increase in daily loads of methamphetamine in wastewater between 2009 and 2016, compared with a 14.1% (95% CI = 10.9-17.3%) annual increase in seizures. Some of the increase in wastewater can be explained by increased purity. In Eindhoven, there was no evidence of a change in cocaine consumption from wastewater, but a reduction was observed in numbers in treatment for cocaine use from 2012 to 2017. In approximately half the cases examined in Oslo, credible intervals around estimates of annual average loads from a regression model versus estimates based on a single week of sampling did not overlap. Long-term trends in loads of stimulants in wastewater appear to be broadly consistent with trends in other indicators of stimulant use in three locations. Wastewater data should be interpreted alongside epidemiological indicators and purity data. One week of wastewater sampling may not be sufficient for valid inference about drug consumption.

Goulding N ，Hickman M ，Reid M ，Amundsen EJ ，Baz-Lomba JA ，O'Brien JW ，Tscharke BJ ，de Voogt P ，Emke E ，Kuijpers W ，Hall W ，Jones HE ... -  《-》

Illicit drug consumption estimated using wastewater analysis and compared by settlement size in New Zealand.

Estimation of consumption of illicit drugs by wastewater-based epidemiology provides estimates of community drug-use patterns. This study describes monitoring data of three illicit drugs in New Zealand using wastewater-based epidemiology. Wastewater samples were collected at monthly intervals for larger (population ~ 50,000+) cities or in smaller towns where more data was required by authorities. In other smaller towns, samples were collected every 2 months. Samples were extracted and analysed for parent compounds and metabolites of methamphetamine, MDMA, cocaine, heroin and fentanyl consumption using solid-phase extraction followed by liquid chromatography coupled with tandem-mass spectrometry (LC-MS/MS) detection. Back calculations were performed to estimate the consumption of each drug in each catchment area. Methamphetamine was the drug measured with the highest estimated mean consumption rates (724 mg/1000 people per day) in New Zealand. North Island small urban settlements had the highest estimated mean methamphetamine consumption rates (1259 mg/1000 people/day). Cocaine had the lowest estimated consumption rates (9.4 mg/1000 people/day). The highest estimated mean cocaine consumption rate was in North Island major urban settlements (24.4 mg/1000 people/day). Major urban settlements had the highest estimated mean MDMA (420 mg/1000 people/day) and cocaine consumption rates (18.8 mg/1000 people/day). South Island medium urban settlements had unexpectedly high estimated mean consumption rates of MDMA (533 mg/1000 people/day) and cocaine (17.0 mg/1000 people/day). The higher-than-expected estimated cocaine consumption was from one medium urban settlement that is also a popular tourist destination in the South Island. Heroin biomarkers were not detected at any locations, and fentanyl was detected around or below the limit of reporting. This research provides information for appropriate responses for improved social and health investment to support social services associated with illicit drug consumption.

Chappell A ，Armstrong B ，Jay E ，Phung K ，McCormick S ，Grigg S ，Waite B ... -  《-》

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 ... -  《-》

Estimating daily and diurnal variations of illicit drug use in Hong Kong: a pilot study of using wastewater analysis in an Asian metropolitan city.

The measurement of illicit drug metabolites in raw wastewater is increasingly being adopted as an approach to objectively monitor population-level drug use, and is an effective complement to traditional epidemiological methods. As such, it has been widely applied in western countries. In this study, we utilised this approach to assess drug use patterns over nine days during April 2011 in Hong Kong. Raw wastewater samples were collected from the largest wastewater treatment plant serving a community of approximately 3.5 million people and analysed for excreted drug residues including cocaine, ketamine, methamphetamine, 3,4-methylenedioxymethamphetamine (MDMA) and key metabolites using liquid chromatography coupled with tandem mass spectrometry. The overall drug use pattern determined by wastewater analysis was consistent with that have seen amongst people coming into contact with services in relation to substance use; among our target drugs, ketamine (estimated consumption: 1400-1600 mg/day/1000 people) was the predominant drug followed by methamphetamine (180-200 mg/day/1000 people), cocaine (160-180 mg/day/1000 people) and MDMA (not detected). The levels of these drugs were relatively steady throughout the monitoring period. Analysing samples at higher temporal resolution provided data on diurnal variations of drug residue loads. Elevated ratios of cocaine to benzoylecgonine were identified unexpectedly in three samples during the evening and night, providing evidence for potential dumping events of cocaine. This study provides the first application of wastewater analysis to quantitatively evaluate daily drug use in an Asian metropolitan community. Our data reinforces the benefit of wastewater monitoring to health and law enforcement authorities for strategic planning and evaluation of drug intervention strategies.

Lai FY ，Bruno R ，Leung HW ，Thai PK ，Ort C ，Carter S ，Thompson K ，Lam PK ，Mueller JF ... -  《-》