Estimating Community Drug Abuse by Wastewater Analysis

Abstract

BackgroundThe social and medical problems of drug abuse are a matter of increasing global concern. To tackle drug abuse in changing scenarios, international drug agencies need fresh methods to monitor trends and patterns of illicit drug consumption.ObjectiveWe tested a sewage epidemiology approach, using levels of excreted drug residues in wastewater, to monitor collective use of the major drugs of abuse in near real time.MethodsSelected drug target residues derived from use of cocaine, opiates, cannabis, and amphetamines were measured by mass spectrometry in wastewater collected at major sewage treatment plants in Milan (Italy), Lugano (Switzerland), and London (United Kingdom). The amounts of drug residues conveyed to the treatment plants, reflecting the amounts collectively excreted with urine, were used to estimate consumption of the active parent drugs.ResultsReproducible and characteristic profiles of illicit drug use were obtained in the three cities, thus for the first time quickly revealing changes in local consumption (e.g., cocaine consumption rose significantly on weekends in Milan). Profiles of local drug consumption based on waste-water measurements are in line with national annual prevalence estimates.ConclusionsPatterns and trends of drug abuse in local communities can be promptly monitored by this tool, a convenient new complement to more complex, lengthy survey methods. In principle, searching the sewage for excreted compounds relevant to public health issues appears to have the potential to become a convenient source of real-time epidemiologic information.

Illicit drugs in Canadian municipal wastewater and estimates of community drug use

“…1). These ratios are markedly different from the ratios observed in untreated wastewater from cities in continental Europe (Zuccato et al, 2008a(Zuccato et al, , 2005Castiglioni et al, 2006;Mari et al, 2009;Postigo et al, 2010) and in the USA (Chiaia et al, 2008), Table 2 Target compounds and stable isotope surrogates surveyed in this study, with chemical formulas, the chromatographic retention times, the mass spectrometric SRM ion transitions, de-clustering potential (DP) and collision energies for analysis, and the limits of detection (LODs) and limits of quantitation (LOQs) for the target analytes dissolved in wastewater (ng/L) and adsorbed to particulates (ng/g dry weight).…”

“…The method described by Zuccato et al (2008a) was used to estimate community use of the target drugs. Using the mean (n ¼ 3) concentration of the target drug in the samples of untreated wastewater and the daily flow rate in the WWTP, the amount of drug (grams) discharged per day was calculated.…”

“…This value was then normalized to a value of grams per day per 1000 people. Estimates of the fraction of the target drugs excreted in urine provided by Zuccato et al (2008a), were used to obtain a consumption value for each drug within the community. Cocaine consumption was estimated from the data for its major metabolite, benzylecgonine (BE), so a molar ratio value of 1.05 was applied to compensate for the higher molecular weight of BE relative to cocaine.…”

“…doses/day/1000 people), the consumption value was divided by an amount considered typical for a single dose of the target drug. The typical doses were 100 mg for intranasal cocaine, 30 mg for oral amphetamine and methamphetamines, and 100 mg for oral ecstasy (Zuccato et al, 2008a).…”

“…It is difficult to accurately estimate the use of illicit drugs within communities using current indirect survey methods. However, monitoring the levels of drugs of abuse excreted into municipal wastewater has been proposed as a tool for estimating community drug use (Zuccato et al, 2008a). Drug consumption can be estimated from data on the concentrations of the target compounds in untreated wastewater, the flow rates into municipal wastewater treatment plants (WWTPs), the population served by the WWTP, human excretion rates for the target compounds in urine, and estimates of the drug dose.…”