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... Over the past decade, many efforts have been made to improve the reliability of the WBE approach (Castiglioni et al., 2013;Castiglioni et al., 2006;Gracia-Lor et al., 2016;Ort et al., 2010;Thai et al., 2016); however, its application is geographically restricted. Although WBE has been applied on a large scale in Europe since 2010 to estimate illicit drug consumption , it has hardly been applied in South/Southeast Asian countries (Du et al., 2020;Fallati et al., 2020;Nguyen et al., 2018). These countries are considered to have severe drug problems due to their proximity to the Golden Triangle region and inadequate governmental regulations. ...
... However, in the present study, COC and FEN were rarely detected, thus suggesting a low prevalence of these drugs in the study area. Previous studies in South Asia also rarely detected COC and FEN (Du et al., 2020;Fallati et al., 2020). On the contrary, METH and HER were the illicit drugs with the highest consumption rates in the present study, which were followed by KET and COD (Fig. 4). ...
... Comparison of the consumption rates in Hanoi with other regions revealed that the METH consumption in Hanoi is higher than that reported for Europe , South Korea (Kim et al., 2015), China (Shao et al., 2020) and the republic of Maldives (Fallati et al., 2020), but similar to that reported for Australia and the city of Kuala Lumpur (Du et al., 2020). The consumption rate of HER in Hanoi was found to be higher than that in Kuala Lumpur (Du et al., 2020), but much lower than that reported for the United states (Gushgari et al., 2019). ...
Siloxanes are organo-silicon compounds containing Si-O-Si linkages and methyl branches. Depending on the structure, siloxanes can be divided into cyclic and linear compounds. Methyl siloxanes with small and medium molecular weights (molecular weights less than 500 g mol-1), are volatile under normal conditions, and hence are referred to as volatile methyl siloxanes (VMSs). VMSs are additive ingredients in many products such as plastics, rubber, personal care products, and household items. This review provides information on the distribution of VMSs in consumer products, indoor air and dust, and their implications for human exposure. VMSs have been used in personal care products and household items at concentrations on the order of hundreds to thousands of micrograms per gram which are the main sources of contamination in the indoor environments. VMSs have been found widely in indoor air and dust. A significant correlation existed between VMS concentrations in indoor air and dust. Among typical VMSs, dodecamethylcylcopentasiloxane (D5) is the major compound found in indoor environments. The human exposure doses to VMSs through dermal absorption, dust ingestion, and inhalation were compiled; Inhalation is a dominant pathway of exposure to VMSs, especially in indoor environments of occupational settings like hair salons. The human exposure doses were higher in children than in adults.
... In wastewater samples, there are several studies available in the recent literature detecting nicotine metabolites cotinine or trans-3′-hydroxycotinine to assess nicotine use (e.g. [17,45,46,50,). Ethanol is one of the most commonly consumed substances in the world  and ethanol intake can also be measured in wastewater. ...
... In wastewater samples, EtS has been proposed for estimating ethanol consumption (e.g. [17,45,61,64]). ...
... THC-COOH has been detected in wastewater, in several studies (e.g. [15,17,47,49,50,61,64,65,). In the literature, the detection of THC itself was also reported (e.g. ...
Wastewater-based epidemiology has emerged as a new analytical strategy for monitoring licit and illicit drug use in a population by measuring the levels of biomarkers in wastewater. The main concept of this approach is that chemical substances ingested by the population will be excreted in urine and feces, which will be discarded into the sewage network and may accumulate at the wastewater treatment plant. Several licit and illicit substances such as ethanol, nicotine, cocaine, amphetamine, methamphetamine and morphine have been investigated and reported in wastewater in worldwide. In recent years, this approach has also been explored for environmental monitoring of novel psychoactive substances (NPS) as well, since analyses of wastewater represent a fast and cost-effective way to evaluate collectively drug intake in a given population served by a sewage network. In this paper, a comprehensive and interdisciplinary review of the forensic, toxicological, chemical and microbiological aspects of the analysis of “traditional” drugs of abuse and NPS in wastewater and examples of applications reported in recently published papers is provided. Wastewater analysis is a very promising strategy in monitoring drug use in the context of Forensic Chemistry and Toxicology, and has been implemented by many researchers in the analysis of drugs of abuse, as supported by many recent literature reports.
... Over time advances in analytical instrumentation allowed improvements to be made in methods targeting specific analytes (Bones et al., 2007;Ort et al., 2010a;Ort et al., 2010b;Zuccato et al., 2011;Khan et al., 2014;O'Brien et al., 2014). In the last 5 years at least, WWA studies have increasingly focused on the detection of New Psychoactive Substances (NPS) and illicit substances across different cities and at-risk areas in response to the rising market (Baz-Lomba et al., 2016;Celma et al., 2019;Fallati et al., 2020). NPS are a "new narcotic or psychotropic drug, in pure form or in preparation, that is not controlled by the United Nations drug conventions, but which may pose a public health threat comparable to that posed by substances listed in these conventions" (EMCDDA, 2020c). ...
... Baker et al. (2014) was able to infer a low usage of TFMPP and BZP in their WWA study without this metabolic based data to corroborate another study. Other studies calculated consumption values without the excretion rates, so use could only be tentatively estimated (Kankaanpää et al., 2014;González-Mariño et al., 2016b;Thai et al., 2016;Bannwarth et al., 2019;Fallati et al., 2020). Following the introduction of the technique, WWA grew in popularity and was applied to the detection of traditional illicit substances (amphetamines, cannabinoids and opiates), and certain pharmaceuticals (codeine, morphine and methadone) in wastewater (Castiglioni et al., 2006;Berset et al., 2010;Baker and Kasprzyk-Hordern, 2011b;Jacox et al., 2017). ...
... Methylone, butylone, ethylone and mephedrone Fallati et al. (2020) extremely low concentrations; limited solubility in wastewater and particulate adsorption issues (both these factors most relevant for the popular class of synthetic cannabinoids); and sporadic use compared to their more traditional drug counterparts. As analytical instrumentation and techniques have improved over the years so has the scale and scope of WWA, with research accommodating an ever widening range of NPS in studies scaling from regional to international. ...
New psychoactive substances (NPS) have made a substantial impact on the global drug market through their dynamic spread into recreational drug consumption and the challenges of developing legislative controls. Drug trends are monitored by organisations such as the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) and the United Nations Office on Drugs and Crime (UNODC), which have been utilized for monitoring the presence of NPS. In particular, improved wastewater analysis (WWA) has been used to monitor NPS use successfully. NPS detection in wastewater has allowed the observation of significant drug trends at regional, national and international levels. Approaches to the technique have evolved over time with non-targeted analysis becoming more utilized in recent years as it offers a wider-scope when searching for certain compounds due to the lack of available reference standards for many of the currently known NPS. In addition to the evolution of available analytical technology so too has the scale and complexity of wastewater investigations evolved. Multi-city and multinational studies have provided detailed insight into the complex patterns of NPS abuse over time and space. The field of wastewater analysis has provided significant advancements to our understanding of these important drug trends, but challenges still remain however, both analytical and logistical. Here we review the state of the art in analytical approaches to the analysis of NPS in wastewater, and present global NPS trends ascertained by WWA.
... Over the last decade, wastewater-based epidemiology, a cost-effective approach to monitor total drug consumption in the population, has been widely applied across Europe , North America [11,12], Australia  and Asia . After years of development, results of wastewater-based epidemiology studies have been adopted as complementary approaches for monitoring drug consumption by authorities in some countries . ...
... In general, the profile of illicit drug consumption of Kuala Lumpur was different to that of other cities around the world. For example, although the levels of methamphetamine consumptions were similar between this study and two cities in South Africa , the prevalence of MDMA was significantly higher in Kuala Lumpur, while cocaine consumption was popular in the South African cities (Figure 1). The drug with second highest consumption in Kuala Lumpur was methamphetamine with mean consumption ranging from 468 ± 64 mg/1000 inh/d (July) to 687 ± 112 mg/1000 inh/d (August) ( Table 3). ...
Southeast Asian countries including Malaysia play a major role in global drug trade and abuse. Use of amphetamine-type stimulants has increased in the past decade in Malaysia. This study aimed to apply wastewater-based epidemiology for the first time in Kuala Lumpur, Malaysia, to estimate the consumption of common illicit drugs in urban population. Influent wastewater samples were collected from two wastewater treatment plants in Kuala Lumpur in the summer of 2017. Concentrations of twenty-four drug biomarkers were analyzed for estimating drug consumption. Fourteen drug residues were detected with concentrations of up to 1640 ng/L. Among the monitored illicit drugs, 3,4-methylenedioxy-methamphetamine (MDMA) or ecstasy had the highest estimated per capita consumptions. Consumption and dose of amphetamine-type stimulants (methamphetamine and MDMA) were both an order of magnitude higher than those of opioids (heroin and codeine, methadone and tramadol). Amphetamine-type stimulants were the most prevalent drugs, replacing opioids in the drug market. The prevalence trend measured by wastewater-based epidemiology data reflected the shift to amphetamine-type stimulants as reported by the Association of Southeast Asian Nations Narcotics Cooperation Center. Most of the undetected drug residues were new psychoactive substances (NPSs), suggesting a low prevalence of NPSs in the drug market.
... WBE is a commonly applied approach to estimate the prevalence of consumption of illicit drugs by the population in a defined catchment area, based on the quantitative analysis of illicit drugs or their corresponding human metabolites in wastewater utilizing high performance liquid chromatography -mass spectrometry (HPLC-MS). Several WBE studies covering AMPH, METH, MDMA and cocaine (COC) are available, revealing illicit drug consumption in several cities and countries [4,5,. During WBE studies, aberrantly high loads of drugs might be observed that could not be explained by consumption only. ...
... The stability of illicit drugs (e.g. AMPH, METH and MDMA)  and, more recently, of selected NPS  in sewer systems is well investigated and an important part of the WBE approach. However, the stability of ATS synthesis-specific substances like pre-precursors, precursors, intermediates and synthesis by-products under such in-sewer system conditions has not yet been examined but is required if these substances should be included in wastewater-based studies. ...
Environmental impact of toxic and corrosive synthesis waste generated by the clandestine production of amphetamine-type stimulants (ATS) is a known problem, which can even result in a malfunction of wastewater treatment plants (WWTPs), e. g. in case of illegal discharge into the sewage system of large amounts of highly acidic chemical waste which is generated in clandestine labs converting pre-precursors to the most prevalent ATS precursor benzyl methyl ketone (BMK). ATS synthesis-specific substances, precursor chemicals, intermediates and route-specific by-products may also support wastewater-based epidemiology (WBE) studies to explain abnormally high loads of drugs in wastewater by distinguishing whether these high loads were caused by consumption or disposal of synthesis waste into the sewage system. Although some of these synthesis-specific substances can be detected in traces in the final form of consumption of the product, these substances are removed from the drug product to a large extent during cleaning steps, e.g. the frequently applied steam distillation step to purify the amphetamine raw base after clandestine Leuckart synthesis. In contrast, these synthesis-specific by-products are very prominent in chemical synthesis wastes, whereby their detection in wastewater would prove a disposal of synthesis wastes instead of excretion after drug product consumption. As a prerequisite, such substances need to exhibit a certain chemical and biological stability in wastewater and, therefore, lab-scale experiments were performed in a mixture of WWTP effluent and activated sludge. 14 selected synthesis-specific substances, all related to the production of ATS, comprised pre-precursors (e.g. α-phenylacetoacetonitrile (APAAN) or α-phenylacetoacetamide (APAA)), precursors (e.g. BMK), intermediates (e.g. N-formylamphetamine (NFA)), synthesis by-products (e.g. N,N-di-(β-phenylisopropyl)amine (DPIA)) and final products (e.g. amphetamine (AMPH)). Stability of test substances was evaluated by targeted HPLC-MS/MS analysis, while HPLC-HRMS techniques were used for the identification of transformation products (TPs) of substances that have undergone primary degradation. All substances were detectable for five days minimum and seven out of 14 substances underwent at least primary degradation. A total of three TPs were identified: TP164 was formed by oxidation of ephedrine (EPHE) and was further transformed after maximum formation, while TP180-1 and TP180-2 were formed by reduction of APAA and both remained stable. This is the first study investigating the stability of ATS synthesis-specific substances in wastewater demonstrating sufficient stability for wastewater monitoring studies.
... Other sources such as industrial and commercial discharges may cause significant variability (Feng et al., 2018). Some studies based consumption as measured at a WWTP on the total population of the country, which is only applicable for countries with a small population like The Maldives (Fallati et al., 2020). In total, fifteen papers reported a rational estimation of the population, based on the amount of people serving a specific WWTP (Baker et al., 2012;Been et al., 2015;Bijlsma et al., 2016;Causanilles et al., 2017;Croft et al., 2020;Devault et al., 2014a;Klupczynska et al., 2016;Krizman et al., 2016;Kumar et ...
... We evaluated thirteen selected studies, reporting on five different countries (Table 4). Studies from China (Khan et al., 2014;Jing Li et al., 2014;Shao et al., 2020), South-Korea (Kim and Oh, 2020;Yong et al., 2015), Vietnam (Nguyen et al., 2018), the Maldives (Fallati et al., 2020) and Malaysia (Du et al., 2020) have been published in the last decade. Four megacities in China (Beijing, Guangzhou, Shenzhen and Shanghai) show significantly lower drug consumption data compared to other continents (Khan et al., 2014). ...
Illicit drug use is complex, hidden and often highly stigmatized behaviour, which brings a vast challenge for drug surveillance systems. Drug consumption can be estimated by measuring human excretion products in untreated wastewater, known as wastewater-based epidemiology (WBE). Over the last decade, the application of wastewater-based epidemiology to monitor illicit drug loads increased and WBE is currently applied on a global scale. Studies from over the globe are evaluated with regard to their sampling method, analytical accuracy and consumption calculation, aiming to further reduce relevant uncertainties in order to make reliable comparisons on a global level. Only a limited number is identified as high-quality studies, so further standardization of the WBE approach for illicit drugs is desired especially with regard to the sampling methodology. Only a fraction of the reviewed papers explicitly reports uncertainty ranges for their consumption data. Studies which had the highest reliability are recently published, indicating an improvement in reporting WBE data. Until now, WBE has not been used in large parts of Africa, nor in the Middle East and Russia. An overview of consumption data across the continents on commonly studied drugs (cocaine, MDMA, amphetamine and methamphetamine) is provided. Overall, high consumption rates are confirmed in the US, especially for cocaine and methamphetamine, while relatively low illicit drug consumption is reported in Asia.
... In addition, the use of some licit drug compounds, such as tobacco, has relevant impacts on the population's health (Gao et al., 2018). In this context, the knowledge of the illicit and licit drug consumption behavior of a given population is of paramount importance for the planning and monitoring of demand and damage reduction activities, as well as for law enforcement intelligence (Bannwarth et al., 2019;Fallati et al., 2020). Classic monitoring of the consumption of drugs at the population level is based on epidemiological, sociological, and criminological indicators (EMCDDA, 2016). ...
The abuse of legal and illegal drugs is a global public health problem, also affecting the social and economic well-being of the population. Thus, there is a significant interest in monitoring drug consumption. Relevant epidemiological information on lifestyle habits can be obtained from the chemical analysis of urban wastewater. In this work, passive sampling using polar organic chemical integrative samplers (POCIS) was used to quantify licit and illicit drugs biomarkers in wastewater for the application of wastewater-based epidemiology (WBE). In this WBE study, a small urban community of approximately 1179 inhabitants was monitored from 18 March 2020 to 3 March 2021, covering the mobility restriction and flexibilization periods of the COVID-19 pandemic in Brazil. Consumption was estimated for amphetamine, caffeine, cocaine, MDMA, methamphetamine, nicotine, and THC. The highest estimated consumption among illicit drugs was for THC (2369 ± 1037 mg day⁻¹ 1000 inh⁻¹) followed by cocaine (353 ± 192 mg day⁻¹ 1000 inh⁻¹). There was a negative correlation between consumption of caffeine, cocaine, MDMA, nicotine, and THC with human mobility, expressed by cellular phone mobility reports (P-value = 0.0094, 0.0019, 0.0080, 0.0009, and 0.0133, respectively). Our study is the first long-term drug consumption evaluation during the COVID-19 pandemic, with continuous sampling for almost a whole year. The observed reduction in consumption of both licit and illicit drugs is probably associated with stay-at-home orders and reduced access, which can be due to the closure of commercial facilities during some time of the evaluated period, smaller drug supply, and reduced income of the population due to the shutdown of companies and unemployment. The assay described in this study can be used as a complementary and cost-effective tool to the long-term monitoring of drug use biomarkers in wastewater, a relevant epidemiological strategy currently limited to short collection times.
... In China, 2.4 million people are addicted to drugs, among whom 1.35 million are methamphetamine (METH) abusers and account for 56.1% of the drug addicts in the country (China National Narcotic Control Committee, 2018). Amphetamine (AMP)-type stimulants (ATSs, including AMP, METH, 3,4-methylenedioxymethaphetamine (MDMA), 3,4methylenedioxyamphetamine (MDA), and anesthetic ketamine (KET), are among the most frequently detected illicit drugs worldwide (Archer et al., 2017;Baz-Lomba et al., 2016;Croft et al., 2020;Du et al., 2015;Fallati et al., 2020;Khan et al., 2014;Li et al., 2016;Lin et al., 2010;McKay et al., 2020;Shao et al., 2020;Zhang et al., 2017). An important fact is that many of these drugs and/or their metabolites are chiral, and most ATSs are produced in racemic form. ...
An enantioselective method for quantifying amphetamine-type chiral illicit drugs (CIDs) in wastewater and surface water was developed, validated, and applied to samples from a wastewater treatment plant (WWTP) and its effluent-receiving river in Beijing, China. Water samples were subjected to solid-phase extraction (SPE) and then quantified via liquid chromatography–tandem mass spectrometry. The enantioseparation of CIDs was performed with a CHIRALPAK CBH column. Chromatographic parameters, including mobile phase composition and flow rates, were tested to identify the satisfactory enantiomeric resolution. The SPE method was optimized by evaluating variables, including SPE cartridge types, extraction solvents, and solvent volumes. The Oasis HLB sorbent showed good performance with recoveries exceeding 60% and matrix effects ranging from -19.6% to 26.6% for most target enantiomers, except for norephedrine (NE), in three different aquatic matrixes. The established method was superior to previously reported methods and had a low limit of detection, low limit of quantification, and short runtime (<45 min). The repeatability and reproducibility of the method reached 19.1% and 17.8%, respectively. The method was successfully utilized to monitor the daily variations in CIDs in the influent, effluent, and effluent-receiving river of a WWTP in Beijing over 1 week. The common occurrence of 1R,2S-(-)-ephedrine (1R,2S-(-)-EPH), 1S,2S-(+)-pseudoephedrine (1S,2S-(+)-PEPH), R-(-)-methamphetamine (METH), and S-(+)-METH in wastewater samples was observed. Ephedrines (1R,2S-(-)-EPH and 1S,2S-(+)-PEPH) were the most abundant CIDs in the influent, effluent, upstream, and downstream samples with concentrations of 725.8 ± 181.2 ng/L, 22.9 ± 4.9 ng/L, 12.96 ± 0.79 ng/L, and 11.6 ± 6.7 ng/L, respectively. METH was detectable in most water samples and was present in excess in S-enantiomer form in the influent and in R-enantiomer form in the effluent and surface water. R-(−)-MDMA was detected at a concentration of up to 2.4 ng/L in the influent. The metabolites norketamine (NK), amphetamine(AMP), MDA, and NE were not detected in water samples given the low concentration of their parent drugs.
... It has been estimated that the average global consumption of caffeine is approximately 70 mg/day, but around 90% of adults are regular caffeine consumers, with a mean daily intake of 227 mg/day (Nehlig, 2018). In the city of Malé, the capital of the Maldives, Fallati et al. (2020) report a daily consumption of about 60 mg/day. The average consumption of caffeine by the Maldivians explain the concentration found in Magoodhoo sponges. ...
... WBE has been used to estimate tobacco consumption in different countries including the United States (Chen et al., 2019), Australia (Lai et al., 2018;Mackie et al., 2019), China (Gao et al., 2020;Zheng et al., 2017), Maldives (Fallati et al., 2020), Italy Castiglioni et al., 2015), Spain (Rodríguez-Álvarez et al., 2014;Baz-Lomba et al., 2016), and other European countries (Baz-Lomba et al., 2016;Lopes et al., 2014;Mackul'ak et al., 2015;van Wel et al., 2016). In most published studies, the metabolites of NIC, cotinine (COT), trans-3′-hydroxycotinine (OH-COT), and their glucuronides have been analyzed, and back-calculations performed to estimate the amount of NIC consumed by the population. ...
Wastewater-based epidemiology (WBE) has become a very useful tool to monitor a population's drug consumption or exposure to environmental and food contaminants. In this work, WBE has been applied to estimate tobacco consumption in seven Spanish regions. To this end, 24 h composite wastewater samples were taken daily for one week in 17 wastewater treatment plants, covering altogether a population of ca. 6 million inhabitants. The samples were treated by enzymatic deconjugation and the wastewater content of two human-specific nicotine metabolites (namely, cotinine and trans-3′-hydroxycotinine) was measured to estimate the daily consumption of nicotine. The population-weighted average nicotine consumption in the seven analyzed regions was 2.2 g/(day∙1000 inh.), without any daily pattern. This average estimated nicotine consumption value agreed with the value derived from official tobacco sales data. Differences in consumption among the seven studied regions were found, being Galicia, the region with the lowest rate, and the Basque Country and Catalonia those with the highest rates. However, no conclusive correlation was found between those values and the prevalence data taken from two different national surveys, nor sociodemographic and health data. This study demonstrates that this tool can complement other indicators in order to accurately assess tobacco consumption rates at regional and national levels and provides the most extensive application of the approach in the Spanish territory.
... However, carbamazepine in Australia was 18−67 times lower than the five WWTPs in Belgium (2900−8700 mg/day/1000 inh) and Oslo (2400 mg/day/ 1000 inh) but more than 3 times higher than that in Malèin the Maldives (38 mg/day/1000 inh). 21,34,35 The different prescription habits and/or disease prevalence among countries would contribute to the observed per capita mass load differences. ...
... Indeed, in-sewer experiments with the presence of biofilm reported mephedrone as highly unstable . Mephedrone is currently used as a WBE biomarker , but its stability under different wastewater compositions could lead to different transformation rates . This study illustrated how complicated a backcalculation model for mephedrone can be, since it was also formed from DHM incubation. ...
There is a paucity of information on biotransformation and stability of new psychoactive substances (NPS) in wastewater. Moreover, the fate of NPS and their transformation products (TPs) in wastewater treatment plants is not well understood. In this study, batch reactors seeded with activated sludge were set up to evaluate biotic, abiotic, and sorption losses of p-methoxymethylamphetamine (PMMA) and dihydromephedrone (DHM) and identify TPs formed during these processes. Detection and identification of all compounds was performed with target and suspect screening approaches using liquid chromatography quadrupole-time-of-flight mass spectrometry. Influent and effluent 24 h composite wastewater samples were collected from Athens from 2014 to 2020. High elimination rates were found for PMMA (80%) and DHM (97%) after a seven-day experiment and degradation appeared to be related to biological activity in the active bioreactor. Ten TPs were identified and the main reactions were O- and N-demethylation, oxidation, and hydroxylation. Some TPs were reported for the first time and some were confirmed by reference standards. Identification of some TPs was enhanced by the use of an in-house retention time prediction model. Mephedrone and some of its previously reported human metabolites were formed from DHM incubation. Retrospective analysis showed that PMMA was the most frequently detected compound.
In this research the technical feasibility of catalytic wet air oxidation reactions (CWAO) with a novel ruthenium supported onto carbon nanospheres (CNS-Ru) catalyst for the degradation of a non-steroidal anti-inflammatory drug (NSAID), naproxen (NPR), has been tested. The operating conditions of the reaction, the different loads of ruthenium in the catalyst, the reuse of the material, the reaction kinetics and the degradation mechanism of the pollutant were studied. The complete degradation of the compound was reached in one cycle at the following conditions: 130 °C, 20 bar, [NPR]0 = 20 mg∙L⁻¹, [CNS-Ru] = 0.75 g∙L⁻¹, 2%wt. of ruthenium and an initial pH of 7.0. At these conditions, the efficiency for the pollutant degradation of a platinum-based catalyst (CNS-Pt) as well as its reusability were also tested. In this sense, better results regarding to the NPR degradation were obtained with the CNS-Ru material. Nevertheless, both catalysts could be considered stable after 4 consecutive runs. Furthermore, two potential kinetic models were investigated in order to simulate the degradation of NPR in both WAO and CWAO processes. Thus, the detection of 13 reaction compounds allowed to propose a degradation mechanism for NPR by CWAO. The efficiency of both catalysts was tested in a real hospital wastewater matrix; it was also proved that the NPR degradation decreased in comparison to that one found for the ultrapure water solutions, and that CNS-Ru catalyst achieved a higher pollutant degradation rather than that obtained for CNS-Pt catalyst.
This study evaluated the occurrence and fate of fourteen contaminants of emerging concern (CECs) at two South African wastewater treatment works (WWTW). Daily loads of the drug targets were calculated in the aqueous phase of influent-and effluent wastewater to evaluate their fate at the treatment works, along with population-normalised daily loads in raw influent wastewater to identify community-wide substance use patterns in the two study areas. Environmental risk characterisation of the CECs at WWTW effluent discharge was done using conventional risk quotient (RQ) estimations. A significant reduction of most CECs was observed at both WWTW locations, except for some that have been previously recorded to persist through various WWTW processes globally, including the illicit drug methaqualone that was reported here for the first time to evaluate its fate during wastewater treatment, substance use trends, and potential toxicological risk. Moderate-to high-RQs were estimated for several target CECs during the sampling period for both treatment facilities. The results presented here suggest the need for a multidisciplinary approach to WWTW monitoring of CECs and highlight the need for further refinement of risk assessment approaches to mitigate recalcitrant-or pseudo-persistent CECs in waste-water discharge. Such refinement should include: (1) identifying the potential ecological risk on a wider range of sentinel indicators, (2) interaction of CECs with various biochemical pathways (including sub-lethal toxicity responses), (3) identifying the persistence and toxicological risks of breakdown products and (4) partitioning of CECs in the aqueous environment and/or bioaccumulation in freshwater biota.
Wastewater-based drug monitoring is a complementary tool that has been used worldwide in recent years, and many cities have periodically reported monitoring results. However, this study is the first to analyze drugs in wastewater in a single city with a high population during four periods simultaneously from 14 treatment plants. The aim was to estimate the consumption of conventional illicit drugs [amphetamine (AMP), methamphetamine (METH), 3,4-methylenedioxymethamphetamine (MDMA), cannabis, cocaine, and heroin], tobacco, and alcohol in 2019 for quarterly periods in Istanbul city, which has a population of almost 20 million, to aid in implementing evidence-based measures. Additionally, the seasonal variations among the 14 wastewater treatment plants and their weekday/weekend comparison of drug use patterns and consumption per substance were examined. Solid phase extraction was followed by liquid chromatography-tandem mass spectrometry and a previously validated method was enhanced by adding new parameters (morphine, cotinine, and ethyl sulfate), and satisfactory results were obtained. In this study, alcohol, nicotine, and cannabis had the highest estimated per capita consumption with mean values of 29655.3 mL/1000 inh/day, 5507.6 mg/1000 inh/day and 3607.0 mg/1000 inh/day, respectively. These results were followed by heroin and cocaine consumption with mean values of 557.0 and 200.9 mg/1000 inh/day, respectively, whereas AMP-type stimulants had the lowest values among the targeted substances. METH and cannabis were also highly consumed drugs when compared with the results of other metropolitan cities, whereas heroin consumption was remarkably high owing to Turkey's location on a possible heroin trafficking route. Because Istanbul is the business center of the country and has the potential to attract tourists in all four seasons, meaningful seasonal consumption differences were not observed for all substances.
Illicit drug abuse is a worldwide social and health problem, and monitoring illicit drug use is of paramount importance in the context of public policies. It is already known that relevant epidemiologic information can be obtained from the analysis of urban residual waters. This approach, named wastewater-based epidemiology (WBE), is based on the measurement of specific markers, resulting from human biotransformation of the target drugs, as indicators of the consumption of the compounds by the population served by the wastewater treatment installation under investigation. Drug consumption estimation based on WBE requires sewage sampling strategies that express the concentrations along the whole time period of time. To this end, the most common approach is the use of automatic composite samplers. However, this active sampling procedure is costly, especially for long-term studies and in limited-resources settings. An alternative, cost-effective, sampling strategy is the use of passive samplers, like the polar organic chemical integrative sampler (POCIS). POCIS sampling has already been applied to the estimation of exposure to pharmaceuticals, pesticides, and some drugs of abuse, and some studies evaluated the comparative performances of POCIS and automatic composite samplers. In this context, this manuscript aims to review the most important biomarkers of drugs of abuse consumption in wastewater, the fundamentals of POCIS sampling in WBE, the previous application of POCIS for WBE of drugs of abuse, and to discuss the advantages and disadvantages of POCIS sampling, in comparison with other strategies used in WBE. POCIS sampling is an effective strategy to obtain a representative overview of biomarker concentrations in sewage over time, with a small number of analyzed samples, increased detection limits, with lower costs than active sampling. Just a few studies applied POCIS sampling for WBE of drugs of abuse, but the available data support the use of POCIS as a valuable tool for the long-term monitoring of the consumption of certain drugs within a defined population, particularly in limited-resources settings.
The medical and societal consequences of the misuse of pharmaceuticals clearly justifies the need for comprehensive drug utilization research (DUR). Wastewater-based epidemiology (WBE) employs the analysis of human metabolic excretion products in wastewater to monitor consumption patterns of xenobiotics at the population level. Recently, WBE has demonstrated its potential to evaluate lifestyle factors such as illicit drug, alcohol and tobacco consumption at the population level, in near real-time and with high spatial and temporal resolution. Up until now there have been fewer WBE studies investigating health biomarkers such as pharmaceuticals.
WBE publications monitoring the consumption of pharmaceuticals were systematically reviewed from three databases (PubMed, Web of Science and Google Scholar). 64 publications that reported population-normalised loads or defined daily doses of pharmaceuticals were selected.
We document that WBE could be employed as a complementary information source for DUR. Interest in using WBE approaches for monitoring pharmaceutical use is growing but more foundation research (e.g. compound-specific uncertainties) is required to link WBE data to routine pharmacoepidemiologic information sources and workflows. WBE offers the possiblity of i) estimating consumption of pharmaceuticals through the analysis of human metabolic excretion products in wastewater; ii) monitoring spatial and temporal comsumption patterns of pharmaceuticals continuously and in near real-time; and iii) triangulating data with other DUR information sources to assess the impacts of strategies or interventions to reduce inappropriate use of pharmaceuticals.
The consumption of licit and illicit psychoactive drugs (PAD) is ubiquitous in all communities and a serious public health problem. Measuring drug consumption is difficult but essential for health-care professionals, risk assessment and policymakers. Different sources of information have been used for a comprehensive analysis of drug consumption. Among them, Wastewater based epidemiology (WBE) emerged as an essential and complementary methodology for estimating licit and illicit drugs consumption. This methodology can be used for quantification of unchanged drugs or their human-specific metabolites in wastewater for estimation of consumption or screening of new PAD. Although some limitations are still being pointed out (e.g., estimation of the population size, use of suitable biomarkers or pharmacokinetics studies), the non-invasive and potential for monitoring real-time data on geographical and temporal trends in drug use have been showing its capacity as a routine and complementary tool. Chromatographic methods, both non-enantioselective and enantioselective are the analytical tools used for quantification of PAD in wastewaters and further estimation of consumption. Therefore, this manuscript aims to summarize and critically discuss the works used for wastewater analysis of PAD based on WBE using non-enantioselective and enantioselective methods for estimation of consumption. Non-enantioselective methods are among the most reported including for chiral PAD. Nevertheless, a trend has been seen towards the development of enantioselective methods as most PAD are chiral and determination of the enantiomeric fraction can provide additional information (e.g., distinction between consumption or direct disposal, or manufacture processes) and fulfill some WBE gaps.
The study evaluated the mass balance of various contaminants of emerging concern (CEC) from a South African wastewater treatment works (WWTW) and surface waters located upstream-and downstream from the point of discharge. A total of 45 CECs that are grouped into 16 drug classes were quantified during multiple sampling events that spanned over a period of two years in the study area. Daily loads (DL; in g/day) of the target analytes in the WWTW showed persistence of various CECs, along with population-normalised daily loads (PNDL; in mg/day/1000inh) of pharmaceuticals and DOA that were estimated for the first time in the study area using the wastewater-based epidemiology (WBE) approach. Multiple chemical markers were recorded in river water located upstream of the WWTW discharge, suggesting other urban pollution sources that contribute towards the CEC loading in the surface water environment. Environmental risk characterisation for the WWTW effluent and surface waters was done to calculate multiple risk quotients (RQs) for each CEC spanning over various sentinel trophic levels. High risk profiles (RQ>1.0) with a frequency of exceedance (FoE) larger than 75% were recorded for several CECs in both WWTW effluent and surface water locations that warrants the need for more refined surveillance of pollution hotspots in the urban catchment. These findings highlight the need for developing an urban water profiling (UWP) approach similar to conventional WBE approaches, at least for LMICs where some (peri)urban communities are not connected to municipal sewage infrastructure and thus leads to direct discharge of human waste products into the natural environment.
There is a need for a simple water sampling technique to enable routine monitoring of community drug consumption through wastewater-based epidemiology (WBE). This study investigates the potential use of diffusive gradients in thin films to sample organic compounds (o-DGT) for WBE. Three types of resin gels (HLB, XAD 18, and XDA-1) within o-DGT samplers each were deployed in triplicate at the inlets of two sewage treatment plants of Southern Asian cities. The target compounds included 15 illicit drugs and 18 antibiotics. A comprehensive evaluation was undertaken regarding each resin’s ability to accumulate the target compounds and accuracy by comparing active samples. The organic compounds accumulated on each resin gel were characterised at the molecular level using Fourier transform ion-cyclotron-resonance mass spectrometry (FT-ICR MS). The results showed that the HLB resin performed better than the XAD 18 and XDA-1 resins. Based on calculations using the HLB-DGT data, methamphetamine and heroin were the two most popular illicit drugs consumed among the studied populations, and were followed by ketamine and codeine, which agreed well with the authoritative reports and reference data. The total drug consumption in Hanoi was one order of magnitude higher than that in Guangzhou, thus implying a probably more serious drug situation in the former. Overall, the findings of this study demonstrate that o-DGT passive samplers are a promising tool for WBE studies, particularly at WWTPs or in urban streams where an automatic sampler for taking composite water samples is absent.
The Maldives islands in recent decades have experienced dramatic land-use change. Uninhabited islands were turned into new resort islands; evergreen tropical forests were cut, to be replaced by fields and new built-up areas. All these changes happened without a proper monitoring and urban planning strategy from the Maldivian government due to the lack of national land-use and land-cover (LULC) data. This study aimed to realize the first land-use map of the entire Maldives archipelago and to detect land-use and land-cover change (LULCC) using high-resolution satellite images and socioeconomic data. Due to the peculiar geographic and environmental features of the archipelago, the land-use map was obtained by visual interpretation and manual digitization of land-use patches. The images used, dated 2011, were obtained from Digital Globe’s WorldView 1 and WorldView 2 satellites. Nine land-use classes and 18 subclasses were identified and mapped. During a field survey, ground control points were collected to test the geographic and thematic accuracy of the land-use map. The final product’s overall accuracy was 85%. Once the accuracy of the map had been checked, LULCC maps were created using images from the early 2000s derived from Google Earth historical imagery. Post-classification comparison of the classified maps showed that growth of built-up and agricultural areas resulted in decreases in forest land and shrubland. The LULCC maps also revealed an increase in land reclamation inside lagoons near inhabited islands, resulting in environmental impacts on fragile reef habitat. The LULC map of the Republic of the Maldives produced in this study can be used by government authorities to make sustainable land-use planning decisions and to provide better management of land use and land cover.
Monitoring the scale of pharmaceuticals, illicit and licit drugs consumption is important to assess the needs of law enforcement and public health, and provides more information about the different trends within different countries. Community drug use patterns are usually described by national surveys, sales and seizure data. Wastewater-based epidemiology (WBE) has been shown to be a reliable approach complementing such surveys. Method
This study aims to compare and correlate the consumption estimates of pharmaceuticals, illicit drugs, alcohol, nicotine and caffeine from wastewater analysis and other sources of information. Wastewater samples were collected in 2015 from 8 different European cities over a one week period, representing a population of approximately 5 million people. Published pharmaceutical sale, illicit drug seizure and alcohol, tobacco and caffeine use data were used for the comparison. ResultsHigh agreement was found between wastewater and other data sources for pharmaceuticals and cocaine, whereas amphetamines, alcohol and caffeine showed a moderate correlation. methamphetamine and 3,4-methylenedioxymethamphetamine (MDMA) and nicotine did not correlate with other sources of data. Most of the poor correlations were explained as part of the uncertainties related with the use estimates and were improved with other complementary sources of data. Conclusions
This work confirms the promising future of WBE as a complementary approach to obtain a more accurate picture of substance use situation within different communities. Our findings suggest further improvements to reduce the uncertainties associated with both sources of information in order to make the data more comparable.
Drugs of abuse are increasingly consumed worldwide. Such consumption could be back-calculated based on wastewater content. The West Indies, with its coca production and its thriving illicit drug market, is both a hub of world cocaine trafficking and a place where its consumption is prevalent particularly in the form of crack. The present study will firstly investigate Caribbean consumption by a daily 5 to 7day sampling campaign of composite wastewater samples from the four wastewater treatment plants of the Martinique capital, including working and non-working periods. The local consumption of cocaine is ten to thirty times higher than OECD standards because of the prevalence of crack. The excretion coefficient for crack consumption and the impact of temperature on drug stability need further investigation. However, the low diversity of illicit drugs consumed and the crack prevalence suggest practices driven by the transiting of drugs for international trafficking.
Issues of power and politics are central to the development of the tourism sector and its prospects for contributing to sustainable development. This is demonstrated through a case study of the evolution of tourism in the Maldives, a luxury tourism destination where the government has followed a consistent policy of ‘quality tourism’ that has often been cited as a prime example of sustainable tourism. However, recently concerns have been raised about environmental degradation, human rights abuses, connections between the political and economic elite, and huge economic disparities associated with tourism here. Research on sustainable tourism needs to recognise the state's pivotal role in directing tourism development and consider how states balance the competing interests of other powerful tourism stakeholders.
The 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.
We 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.
Selected 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.
Reproducible 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.
Patterns 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.
Interpretation of marijuana-positive urine tests requires an understanding of the excretion pattern of marijuana metabolites in humans. However, limited urinary excretion data from controlled clinical studies of marijuana use are available. In this study, six subjects smoked a single marijuana cigarette (placebo, 1.75% delta 9-tetrahydrocannabinol [THC], or 3.55% THC) each week while residing on the clinical ward of the Addiction Research Center. Individual urine specimens were collected for 7 days after drug administration and analyzed for 11-nor-9-carboxy-delta 9-tetrahydrocannabinol (THCCOOH) by gas chromatography-mass spectrometry (GC-MS) with a limit of detection of 0.5 ng/mL. Substantial intersubject variability in patterns of THCCOOH excretion was noted between subjects and between doses. Mean THCCOOH concentrations in the first urine collections were 47 +/- 22.3 ng/mL and 75.3 +/- 48.9 ng/mL after the 1.75 and 3.55% THC cigarettes, respectively. Mean peak urine THCCOOH concentrations averaged 89.8 +/- 31.9 ng/mL and 153.4 +/- 49.2 ng/mL after smoking of approximately 15.8 mg and 33.8 mg THC, respectively. The mean times of peak urine concentration were 7.7 +/- 0.8 h after the 1.75% THC and 13.9 +/- 3.5 h after the 3.55% THC dose. Mean GC-MS THCCOOH detection times for the last positive urine sample after the smoking of a single 1.75 or 3.55% THC cigarette were 33.7 +/- 9.2 h and 88.6 +/- 9.5 h, respectively, when a 15-ng/mL cutoff concentration was used. An average of 93.9 +/- 24.5 micrograms THCCOOH (range, 34.6-171.6 micrograms) was excreted by each subject during the 7-day period after smoking of a single 1.75% THC cigarette. The average amount of THCCOOH excreted in the same time period after the high dose was 197.4 +/- 33.6 micrograms (range, 107.5-305.0 micrograms). This represented an average of only 0.54 +/- 0.14% and 0.53 +/- 0.09% of the original amount of THC in the low-and high-dose cigarettes, respectively. These data provide a detailed complication of THCCOOH concentrations in urine after administration of marijuana that may aid in the interpretation of urine cannabinoid results.
Background and aims:
Tobacco and alcohol consumption remain priority public health issues worldwide. As participation in population-based surveys has fallen, it is increasingly challenging to estimate accurately the prevalence of alcohol and tobacco use. Wastewater-based epidemiology (WBE) is an alternative approach for estimating substance use at the population level that does not rely on survey participation. This study examined spatio-temporal patterns in nicotine (a proxy for tobacco) and alcohol consumption in the Australian population via WBE.
Daily wastewater samples (n=164) were collected at 18 selected wastewater treatment plants across Australia, covering approximately 45% of the total population. Nicotine and alcohol metabolites in the samples were measured using liquid chromatography-tandem mass spectrometry. Daily consumption of nicotine and alcohol and its associated uncertainty were computed using Monte Carlo simulations. Nationwide daily average and weekly consumption of these two substances were extrapolated using ordinary least squares and mixed effect models.
Nicotine and alcohol consumption was observed in all communities. Consumption of these substances in rural towns was three-to-four times higher than in urban communities. The spatial consumption pattern of these substances was consistent across the monitoring periods in 2014-2015. Nicotine metabolites significantly reduced by 14-25% (p=0.001-0.008) (2014-2015) in some catchments. Alcohol consumption remained constant over the studied periods. Strong weekly consumption patterns were observed for alcohol but not nicotine. Nationwide, the daily average consumption per person (aged 15-79 years) was estimated at about 2.5 cigarettes and 1.3-2.0 standard drinks (weekday-weekend) of alcohol. These estimates were close to the sale figure and apparent consumption respectively.
Wastewater-based epidemiology is a feasible method for objectively evaluating the geographic, temporal and weekly profiles of nicotine and alcohol consumption in different communities nationally.
The occurrence of several classes of emerging contaminants (ECs) was assessed in the River Lambro basin, one of the most urbanized and industrialized areas of Italy. The study aims were to identify the main sources of ECs, quantify their amounts circulating in the water cycle, and study their fate in the aquatic environment. More than 80 ECs were selected among pharmaceuticals (PHARM), personal care products (PCPs), disinfectants (DIS), illicit drugs (IDs), perfluorinated compounds (PERF), alkylphenols and bisphenol A (Alk-BPA), and anthropogenic markers (AM). Specific analytical methods were developed for quantitative analysis based on solid phase extraction and liquid chromatography tandem mass spectrometry. ECs were measured in rivers upstream and downstream of the main city (Milan), and in untreated and treated wastewater from Milan to assess the contribution to river contamination, and in superficial and deep groundwater in the city area to study the relationship between river and groundwater contamination. Samples were collected in a two-year monitoring campaign. Almost all ECs were ubiquitous in untreated wastewater, at concentrations up to the μg/L range, and the most abundant classes were PHARM and AM. Removals during different wastewater treatment processes were studied and the most stable substances were PHARM, PCPs and PERF. The mass loads increased for all the classes of ECs along the River Lambro basin. A mass balance was done in the river basin and allowed to identify the main sources of contamination, which were domestic, from treated or untreated wastewater, for PHARM, PCPs and IDs, mainly industrial for PERF, and both industrial and domestic for Alk-BPA. The study of AM helped to identify direct discharges of untreated wastewater. A substantial contribution of surface water to groundwater contamination was observed. This study improves the knowledge on occurrence, sources and fate of multiple classes of ECs in a highly urbanized area providing useful information to help the establishment of EU regulations for ECs.
Caffeine metabolites in wastewater were investigated as potential biomarkers for assessing caffeine intake in a population. The main human urinary metabolites of caffeine were measured in the urban wastewater of ten European cities and the metabolic profiles in wastewater were compared with the human urinary excretion profile. A good match was found for 1,7-dimethyluric acid, an exclusive caffeine metabolite, suggesting that might be a suitable biomarker in wastewater for assessing population-level caffeine consumption. A correction factor was developed considering the percentage of excretion of this metabolite in humans, according to published pharmacokinetic studies. Daily caffeine intake estimated from wastewater analysis was compared with the average daily intake calculated from the average amount of coffee consumed by country per capita. Good agreement was found in some cities but further information is needed to standardize this approach. Wastewater analysis proved useful to providing additional local information on caffeine use.
Introduction and aims:
New Zealand is considered to have unusual drug use patterns by international standards. However, this understanding has largely been obtained from social surveys where respondents self-report use. The aim of this paper is to conduct the first wastewater study of drug use in Auckland.
Design and methods:
Wastewater sampling was completed from 2 May to 18 July 2014 at 2 Auckland wastewater treatment plants which service 1.3 million people. Samples were analysed for 17 drug residues by using liquid chromatography-tandem mass spectrometry. Consumption of methamphetamine, 3,4-methylenedioxymethamphetamine (MDMA), cocaine, codeine and methadone (mg/day/1000 people) was estimated by using a back-calculation formula.
Methamphetamine, codeine, morphine and methadone were detected with high frequency (80-100%), followed by amphetamine (~60%), MDMA (~7%, i.e. 8 occasions) and methylone (3 occasions). An overall mean of 360 mg of methamphetamine and 60 mg of MDMA was estimated to have been consumed per day per 1000 people. Methamphetamine consumption was found at similar levels in both catchments (377 and 351 mg/day/1000 people). Cocaine was only detected in 1 catchment and on only 8 occasions. JWH-018 was detected in 1 catchment and only on 1 occasion. Methamphetamine, codeine and other opioids were detected at a consistent level throughout the week. 3,4-Methylenedioxymethamphetamine and methylone were detected only during the weekends.
Wastewater analysis confirms that methamphetamine was one of the most commonly detected illegal drugs in Auckland and was detected consistently throughout the week. In contrast, cocaine and MDMA were rarely detected, with detection limited to weekends. [Lai FY, Wilkins C, Thai P, Mueller JF. An exploratory wastewater analysis study of drug use in Auckland, New Zealand. Drug Alcohol Rev 2017;00:000-000].
Synthetic cathinones are among the most consumed new psychoactive substances (NPS), but their increasing number and interchangeable market make difficult to estimate the real size of their consumption. Wastewater-based epidemiology (WBE) through the analysis of metabolic residues of these substances in urban wastewater can provide this information. This study applied WBE for the first time to investigate the presence of seventeen synthetic cathinones in four European countries. A method based on solid-phase extraction and liquid chromatography coupled to tandem mass spectrometry was developed, validated and used to quantify the target analytes. Seven substances were found, with mephedrone and methcathinone being the most frequently detected and none of the analytes being found in Norway. Population normalized loads were used to evaluate the pattern of use, which indicated a higher consumption in the UK followed by Spain and Italy, in line with the European prevalence data from population surveys. In the UK, where an entire week was investigated, an increase of the loads was found during the weekend, indicating a preferential use in recreational contexts. This study demonstrated that WBE can be a useful additional tool to monitor the use of NPS in a population.
Obtaining representative information on illicit drug use and patterns across a country remains difficult using surveys because of low response rates and response biases. A range of studies have used wastewater-based epidemiology (WBE) as a complementary approach to monitor community-wide illicit drug use. In Australia, no large-scale WBE studies have been conducted to date to reveal illicit drug use profiles in a national context. In this study, we performed the first Australia-wide WBE monitoring to examine spatial patterns in the use of three illicit stimulants (cocaine, as its human metabolite benzoylecgonine; methamphetamine; and 3,4-methylendioxymethamphetamine (MDMA)). A total of 112 daily composite wastewater samples were collected from 14 wastewater treatment plants across four states and two territories. These covered approximately 40% of the Australian population. We identified and quantified illicit drug residues using liquid chromatography coupled with tandem mass spectrometry. There were distinctive spatial patterns of illicit stimulant use in Australia. Multivariate analyses showed that consumption of cocaine and MDMA was higher in the large cities than in rural areas. Also, cocaine consumption differed significantly between different jurisdictions. Methamphetamine consumption was more similar between urban and rural locations. Only a few cities had elevated levels of use. Extrapolation of the WBE estimates suggested that the annual consumption was 3 tonnes for cocaine and 9 tonnes combined for methamphetamine and MDMA, which outweighed the annual seizure amount by 25 times and 45 times, respectively. These ratios imply the difficulty of detecting the trafficking of these stimulants in Australia, possibly more so for methamphetamine than cocaine. The obtained spatial pattern of use was compared with that in the most recent national household survey. Together both WBE and survey methods provide a more comprehensive evaluation of drug use that can assist governments in developing policies to reduce drug use and harm in the communities.
Quantitative measurement of drug consumption biomarkers in wastewater can provide objective information on community drug use patterns and trends. This study presents the measurement of alcohol consumption in 20 cities across 11 countries through the use of wastewater-based epidemiology (WBE), and reports the application of these data for the risk assessment of alcohol on a population scale using the margin of exposure (MOE) approach. Raw 24-h composite wastewater samples were collected over a one-week period from 20 cities following a common protocol. For each sample a specific and stable alcohol consumption biomarker, ethyl sulfate (EtS) was determined by liquid chromatography coupled to tandem mass spectrometry. The EtS concentrations were used for estimation of per capita alcohol consumption in each city, which was further compared with international reports and applied for risk assessment by MOE. The average per capita consumption in 20 cities ranged between 6.4 and 44.3 L/day/1000 inhabitants. An increase in alcohol consumption during the weekend occurred in all cities, however the level of this increase was found to differ. In contrast to conventional data (sales statistics and interviews), WBE revealed geographical differences in the level and pattern of actual alcohol consumption at an inter-city level. All the sampled cities were in the “high risk” category (MOE < 10) and the average MOE for the whole population studied was 2.5. These results allowed direct comparisons of alcohol consumption levels, patterns and risks among the cities. This study shows that WBE can provide timely and complementary information on alcohol use and alcohol associated risks in terms of exposure at the community level.
Monitoring consumption by population surveys (PS) is an important way to challenge the spread of illicit drugs (ID). To improve the information, we explored a complementary method, particularly wastewater analysis (WWA).
We estimated the prevalence of use by PS, and the consumption by WWA, of cocaine, opioids, cannabis, methamphetamine and MDMA (ecstasy) from 2010 to 2014 in Italy and compared the results.
According to PS, cannabis and cocaine were the ID most used in Italy (last month prevalence 3.0% and 0.43% respectively in 2010) followed by opioids (0.17%) and amphetamines (0.14%). WWA gave similar findings, with cannabis consumption (4.35g THC/day/1000 inhabitants) exceeding cocaine (0.78g), heroin (0.092g), methamphetamine and MDMA (0.103g). The time trend investigated by PS showed significant decreases for all ID from 2010 to 2012. WWA also indicated a reduction of consumption for methamphetamine (p<0.0001) and heroin (p<0.01). Both methods showed an increase for cannabis in 2014 (p<0.001) with the other ID unchanged. Spatial investigations by WWA showed that cannabis and cocaine were consumed significantly more in central Italy than in the north and south. PS indicated the same but only for cannabis. WWA was helpful to study weekly patterns of consumption, showing increases in cocaine and MDMA at weekends.
PS and WWA were confirmed as complementary methods and when used together improved the information on ID use in Italy. We suggest that the combined use of the two approaches can give better information on ID use in the population.
In recent years, scientific evidence has emerged that wastewater-based epidemiology can deliver complementary information concerning the use of different substances of abuse. In this study, the potential of wastewater-based epidemiology in monitoring spatial and temporal trends in alcohol consumption in different populations in Belgium has been examined.
Concentrations of ethyl sulphate, a minor Phase-II metabolite of ethanol, in 163 influent wastewater samples from eight wastewater treatment plants in Belgium in the period 2013-2015 were measured with liquid chromatography coupled to tandem mass spectrometry and used to estimate alcohol consumption.
The highest levels of alcohol consumption were detected in the metropoles Antwerp and Brussels compared to smaller villages. Annual variations were detected, with a higher alcohol consumption measured in 2013 compared with 2014. The weekly pattern showed a clear week and weekend difference in alcohol use, with intermediate levels on Monday and Friday. The results were extrapolated and a use of 5.6L pure alcohol per year per inhabitant aged 15+ has been estimated in Belgium. The comparison with available information on drinking habits of the Belgian population further demonstrated the usefulness of the wastewater-based epidemiology approach.
This is the largest wastewater-based epidemiology study monitoring alcohol consumption to date, demonstrating that objective and quick information on spatio-temporal trends in alcohol consumption on a local and (inter)national scale can be obtained.
The quantitative determination of urinary biomarkers in raw wastewater has emerged in recent years as a promising tool for estimating the consumption of illicit drugs, tobacco and alcohol in a population and for comparing local and temporal trends. In this study, a three-year monitoring campaign (2012-2014) was conducted to compare alcohol and cocaine use in two European cities (Santiago de Compostela, Spain, and Milan, Italy) by wastewater analysis. Ethyl sulphate and benzoylecgonine were used, respectively, as biomarkers of ethanol and cocaine consumption and cocaethylene as an indicator of co-consumption of both substances. Biomarkers were measured using liquid chromatography-tandem mass spectrometry and concentrations were converted to rates of consumption using specific correction factors. Results were statistically compared in terms of geographic and temporal tendencies. Alcohol intake was significantly higher in Santiago than in Milan (13.6. L versus 5.1. L ethanol/1000 people day, averages). Cocaine use was higher in Milan than in Santiago de Compostela (800 versus 632. mg/1000 people day, averages). A significant higher consumption of both alcohol and cocaine was observed during the weekends (~. 23-75% more than on weekdays) in both cities. In terms of years, slight changes were observed, but no clear trends as representative of the whole year could be identified because of the limited number of days sampled. Co-consumption was evaluated using the cocaethylene/benzoylecgonine ratio, which was higher during the weekend in both cities (58% in Santiago and 47% in Milan over the non-weekend day means), indicating a greater co-consumption when cocaine is used as a recreational drug. Wastewater-based epidemiology gave estimates of alcohol and cocaine use in agreement with previous wastewater studies and with recent European surveillance and prevalence data, and weekly profiles of use and preferential patterns of consumption could be plot.
Wastewater analysis was applied in a four-year monitoring study to assess temporal and spatial patterns of ketamine and mephedrone use in the general population in Italy. Composite raw wastewater samples were collected from sewage treatment plants (STPs) in seventeen cities. Target analytes were measured using a validated method based on solid phase extraction and liquid chromatography coupled to tandem mass spectrometry analysis. Mass loads were use to assess ketamine and mephedrone use and were normalized to the population served by the plants. Ketamine was detected in wastewater in all except one (Palermo) of the cities investigated, while mephedrone was detected only in Bologna and Florence. Ketamine mass loads progressively increased from 2010 to 2013, and in Milan rose from 1-1.5 g/day in 2008-2010 to 3.4-3.6 g/day in 2013-2014. Mass loads were higher in north and central Italy than in the south, and in large than small cities. Wastewater analysis was suitable to provide objective and up-to-date information on the use of ketamine in Italy, to identify ketamine spatial and temporal changes, and to confirm the low use of mephedrone. These results can complement information from population surveys which often provide only scant and incomplete figures for these substances.
Objective We propose a novel approach for measuring tobacco use in a community through the chemical analysis of nicotine metabolites in urban wastewater. It offers frequent monitoring and ‘real-time’, ‘evidence-based’ estimates of tobacco consumption which may complement epidemiological surveillance systems normally repeated only every few years.
Methods Two urinary metabolites of nicotine, namely cotinine and trans-3′-hydroxycotinine, were selected as biomarkers of tobacco consumption in urban wastewater. During smoking, a known amount of nicotine is absorbed and after metabolism excreted as metabolites in urine, ending up in the wastewater; quantitative analysis of the metabolites in the wastewater allows back-calculation of the nicotine collectively absorbed by the population producing the sewage and, indirectly, their tobacco use. Representative samples of wastewater were collected from sewage treatment plants in eight Italian cities and analysed by mass spectrometry. Mass loads of the metabolites were used to estimate nicotine consumption.
Results Wastewater analysis in the cities under study was used to estimate the number of cigarettes smoked, in order to compare the results of this study with those obtained from population surveys. The number of cigarettes calculated with the two methods were closely comparable and wastewater analysis was sufficiently sensitive to confirm the differences in tobacco consumption between northern and southern Italy, previously described in population surveys.
Conclusions The described approach can serve as a supplementary indicator of tobacco consumption in local communities. This approach can provide objective and updated information, which are useful to assess the efficacy of tobacco-control interventions, with the aim of designing and implementing effective tobacco control plans.
AimsTo perform wastewater analyses to assess spatial differences and temporal changes of illicit drug use in a large European population.DesignAnalyses of raw wastewater over a 1-week period in 2012 and 2013.Setting and ParticipantsCatchment 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).MeasurementsExcretion 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.FindingsSpatial 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.Conclusions
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.
Sewage epidemiology is a rapidly expanding field that can provide information on illicit drug usage in communities, based on the measured concentrations in samples from wastewater treatment plants (WWTPs). In this study, select illicit drugs (six drugs and eight metabolites) were determined on a daily basis for a week in wastewater, suspended particulate matter (SPM), and sludge from two WWTPs in the Albany area in New York State. The WWTP that served a larger population (~100,000, with a flow rate of 83300 m3/d) showed 3.2 (methadone) to 51 (3,4-methylenedioxyamphetamine;MDA) times higher mass flows of illicit drugs than did the WWTP that served a smaller population (~15,000, with a flow rate of 6850 m3/d). The consumption rate of target illicit drugs in the communities served by the two WWTPs was estimated to range from 1.67 to 3510 mg/d/1000 people. Between the dissolved and particulate phases, the fraction of methadone, 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP), amphetamine, and MDA sorbed to SPM ranged from 34.3 to 41.1% of the total mass in the waste stream. The removal efficiencies of illicit drugs from the two WWTPs ranged from 4% (norcocaine) to 99% (cocaine); however, methamphetamine, methadone, and EDDP showed a negative removal in WWTPs. The environmental emission of illicit drugs from WWTP discharges was calculated to range from 0.38 (MDEA) to 67.5 (EDDP) mg/d/1000 people. Other markers such as caffeine, paraxanthine, nicotine, and cotinine were found to predict the concentrations of select illicit drugs in raw wastewater (r2 = 0.20-0.79; p ≤ 0.029).
Several drugs of abuse, including amphetamines, cocaine and its metabolite, benzoylecgonine and several opioid prescription drugs were detected in wastewater from two Canadian cities, a small community (75,000 population) and a large urban center (1.6million population). The objective of this study was to evaluate community use of these drugs in two cities with large differences in population size and demographics. In addition, we evaluated the use of the Polar Organic Chemical Integrative Sampler (POCIS) as a monitoring tool for drugs of abuse. Heroin was not detected at either location, probably because this illicit drug is metabolized to morphine prior to excretion. Acetylcodeine and acetylmorphine were also not detected. Estimates of community consumption from wastewater analysis indicated that the most widely used drug was cocaine at a median level of consumption in the larger city of approximately 38 doses per day per 1000 people. Consumption of the substituted amphetamine, ephedrine, as well as methamphetamine was also higher in the larger city, at 21 and 1.8 doses per day per 1000 people, respectively. Use of amphetamine, MDMA and tramadol were similar in both centers, but use of oxycodone was greater in the smaller city. Use of MDMA (ecstasy) peaked on weekends. Ketamine was detected in wastewater from the larger city; the first report of abuse of this veterinary anesthetic in a North American city. POCIS sampling rates were determined for the first time for 7 of the target compounds. Comparing the time weighted average concentrations estimated from POCIS data to the concentrations obtained from 24-h composite samples, the data were generally comparable, except for some compounds which were not detected in POCIS deployed in the untreated wastewater, probably because of biofouling or accumulation of debris on the cages containing the POCIS. This study indicates that the size and demographics of population centers can influence the patterns of abuse of drugs.
To discuss the need to develop ethical guidelines for researchers using sewage epidemiology to monitor drug use in the general population and specific precincts, including prisons, schools and workplaces.
Describe current applications of sewage epidemiology, identify potential ethical risks associated with this science, and identify key means by which these risks may be mitigated through proportionate ethical guidance that allows this science to be fully developed.
A rapidly advancing field of research is sewage epidemiology (SE) - the analysis of wastewater samples to monitor illicit drug use and other substances. Typically this research involves low ethical risks because individual participants cannot be identified and, consequently, review has been waived by human research ethics committees. In the absence of such oversight, ethical research guidelines are recommended for SE teams, peer reviewers and journal editors; guidelines will assist them to mitigate any risks in general population studies and studies of prisons, schools and workplaces. Potential harms include the stigmatisation of participants and, in the prison setting, austere policy responses to SE data that impact negatively upon inmate-participants. The risk of harm can be managed through research planning, awareness of the socio-political context in which results will be interpreted (or, in the case of media, sensationalised) and careful relations with industry partners. Ethical guidelines should be developed in consultation with SE scholars and be periodically amended. They should include publication processes that safeguard scientific rigour and be promulgated through existing research governance structures.
Guidelines will assist to promote an ethical research culture among SE teams and scholars involved in the publication process and this will work to protect the reputation of the field.
A decline in 3,4-methylenedioxy-N-methylamphetamine (MDMA) use in Adelaide, Australia from 2009 to 2010 was confirmed by us previously. Reports suggested that the shortage in MDMA supply was associated with an increased prevalence of other synthetic stimulants, but quantitative measurements were unavailable. To obtain objective data on the community use of synthetic stimulants, we collected wastewater samples from multiple treatment plants in Adelaide, Australia from 2009 to 2011 and analysed them using solid-phase extraction/liquid chromatography/tandem mass spectrometry (SPE-LC-MS/MS), targeting MDMA and some of the most reported synthetic cathinones and piperazines. Data were temporally compared. MDMA and six other synthetic stimulants were detected and quantified in wastewater samples. While MDMA level decreased markedly from 2009 to 2010 and remained low in 2011, localized increased use of mephedrone, methylone, methylenedioxypyrovalerone (MDPV), benzylpiperazine (BZP), 3-trifluoromethylphenylpiperazine (TFMPP), but not methcathinone, was observed in 2010 and 2011. This suggested that the decline in MDMA use was associated with an increase in the use of a number of other synthetic stimulants. However, the lag time from the decrease in MDMA to the increase in use of a number of these stimulants, together with the highly regionalized use of all synthetic stimulants except methcathinone indicates that there was no direct population wide substitution in response to the reduction in MDMA.
The aim of this study was to integrally address the uncertainty associated with all the steps used to estimate community drug consumption through the chemical analysis of sewage biomarkers of illicit drugs. Uncertainty has been evaluated for sampling, chemical analysis, stability of drug biomarkers in sewage, back-calculation of drug use (specific case of cocaine), and estimation of population size in a catchment using data collected from a recent Europe-wide investigation and from the available literature. The quality of sampling protocols and analytical measurements have been evaluated by analyzing standardized questionnaires collected from 19 sewage treatments plants (STPs) and the results of an interlaboratory study (ILS), respectively. Extensive reviews of the available literature have been used to evaluate stability of drug biomarkers in sewage and the uncertainty related to back-calculation of cocaine use. Different methods for estimating population size in a catchment have been compared and the variability among the collected data was very high (7-55%). A reasonable strategy to reduce uncertainty was therefore to choose the most reliable estimation case by case. In the other cases, the highest biases are related to the analysis of sewage drug biomarkers (uncertainty as relative standard deviation; RSD: 6-26% from ILS) and to the back-calculation of cocaine use (uncertainty; RSD: 26%). Uncertainty can be kept below 10% in the remaining steps, if specific requirements outlined in this work are considered. For each step, a best practice protocol has been suggested and discussed to reduce and keep to a minimum the uncertainty of the entire procedure and to improve the reliability of the estimates of drug use.
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).
The quantitative measurement of urinary metabolites in sewage streams and the subsequent estimation of consumption rates of the parent compounds have previously been demonstrated for pharmaceuticals and narcotics. Ethyl sulfate and ethyl glucuronide are excreted in urine following the ingestion of alcohol, and are useful biomarkers for the identification of acute alcohol consumption. This study reports a novel ion-exchange-mediated chromatographic method for the quantitative measurement of ethyl sulfate and ethyl glucuronide in sewage effluent, and presents a novel calculation method for the purposes of relating the resulting sewage concentrations with rates of alcohol consumption in the region.
A total of 100 sewage samples covering a 25-day period were collected from a treatment plant servicing approximately 500,000 people, and analyzed for levels of ethyl sulfate and ethyl glucuronide. The resulting data were then used to estimate combined alcohol consumption rates for the region, and the results were compared with alcohol related sales statistics for the same region.
Ethyl glucuronide was found to be unstable in sewage effluent. Ethyl sulfate was stable and measurable in all samples at concentrations ranging from 16 to 246 nM. The highest concentrations of the alcohol biomarker were observed during weekend periods. Sixty one percent of the total mass of ethyl sulfate in sewage effluent corresponds to alcohol consumption on Friday and Saturday. Sales statistics for alcohol show that consumption in the region is approximately 6,750 kg/d. The quantity of ethyl sulfate passing through the sewage system is consistent with consumption of 4,900 to 7,800 kg/d.
Sewage epidemiology assessments of ethyl sulfate can provide accurate estimates of community alcohol consumption, and detailed examination of the kinetics of this biomarker in sewage streams can also identify time-dependent trends in alcohol consumption patterns.
Wastewater analysis can provide estimates of illicit drug (ID) consumption in local communities.
We used repeated raw wastewater analysis in urban wastewater treatment plants to estimate loads of cocaine, heroin, methamphetamine, and cannabis consumed daily by the inhabitants of two cities in Northern Italy, Milan and Como, from 2005 to 2009.
Daily cocaine loads did not change in Milan from 2005 to 2008 but fell 45% in 2009 (ANOVA, p<0.001, followed by Tukey-Kramer HSD test [2009 vs. others], p<0.05), and there was a similar drop in Como (41%, p<0.0001, t-test). Heroin also fell from 2008 to 2009 in Milan (66%, ANOVA, p<0.001, followed by Tukey-Kramer [2009 vs. others], p<0.05) and Como (26%, p=0.017, t-test). However, methamphetamine, which had risen in Milan from 2005 to 2008, rose further in 2009 (Kruskal-Wallis test, p<0.001, followed by Steel-Dwass [2009 or 2008 vs. previous], p<0.05), and cannabis, which was falling from 2005 to March 2009, rose again in September 2009 (40%, p=0.027, t-test).
Results suggest a trend toward a decrease in consumption of costly ID, such as cocaine and heroin. This might be due to a reduction in the number of consumers and/or to a change in their behaviour since there was also an increase in the consumption of less expensive ID. This itself might reflect a drop in consumers' money supply, caused by the economic crisis. Wastewater analysis was useful to estimate ID consumption levels in local communities in real time and promptly identify changes in trends.
The consumption of illicit drugs causes indisputable societal and economic damage. Therefore it is necessary to know their usage levels and trends for undertaking targeted actions to reduce their use. Recently, a new approach (namely sewage epidemiology) was developed for the estimation of illicit drug use based on measurements of urinary excreted illicit drugs and their metabolites in untreated wastewater. This review aims at critically evaluating the published literature and identifying research gaps of sewage epidemiology. Firstly, the existing analytical procedures for the determination of the four most used classes of illicit drugs worldwide (cannabis, cocaine, opiates and amphetamine-like stimulants) and their metabolites in wastewater are summarized and discussed. The focus lies on the sample preparation and on the analysis with chromatographic techniques coupled to mass spectrometry. Secondly, back-calculations used to transform measured concentrations in wastewater (in ng/L) into an amount of used illicit drug (in g/day per 1000 inhabitants or doses/day per 1000 inhabitants) are discussed in detail for the four groups of illicit drugs. Sewage epidemiology data from Spain, Belgium, UK, Italy, Switzerland and USA are summarized and compared with data from international organisations, such as the European Monitoring Centre for Drug and Drug Addiction (EMCDDA) and the United Nations Office on Drugs and Crime (UNODC). The results derived from wastewater analysis show in general good agreement with existing prevalence data (percentage of a population that uses illicit drugs at a given time) and demonstrate the potential of sewage epidemiology. However, this review confirms that future work should focus on further optimisation and standardisation of various important parameters (e.g. sample collection and back-calculations). In the future, sewage epidemiology could be used in routine drug monitoring campaigns as a valuable tool in addition to the classical socio-epidemiological studies for the determination of local, national and international illicit drug use.
Abstract Substance misuse is a global phenomenon. However, little is known about substance misuse issues in Islamic nations or about the provision of preventative and rehabilitative services in such nations. This thesis explores the legal context of such services in the Maldives and pays particular attention to tensions between the formal policies of the National Narcotics Control Bureau and clinical practice. Findings are drawn from a review of government and service policy documents, five semi-structured individual interviews with clinical practitioners and senior administrative staff from rehabilitative services, and a three day focus group workshop with clinical staff. Findings show the lack of awareness of the legal and policy contexts for service provision and the ways in which existing policy frameworks often detract from the forging of therapeutic alliances. The primary concern raised by the analysis is the lack of involvement of clinical staff in policy formation and revision. This contributes to series of tensions and contradictions between official aims for services and the actual provision of these services. Further a range of ethical issues arose as a result of inadequate professional monitoring, training, and peer review. Recommendations are made regarding how these issues should be addressed in order to enhance the Maldivian response to increasing substance misuse.
To determine the utility of community-wide drug testing with wastewater samples as a population measure of community drug use and to test the hypothesis that the association with urbanicity would vary for three different stimulant drugs of abuse.
Single-day samples were obtained from a convenience sample of 96 municipalities representing 65% of the population of the State of Oregon.
Chemical analysis of 24-hour composite influent samples for benzoylecgonine (BZE, a cocaine metabolite), methamphetamine and 3,4-methylenedioxymethamphetamine (MDMA). The distribution of community index drug loads accounting for total wastewater flow (i.e. dilution) and population are reported.
The distribution of wastewater-derived drug index loads was found to correspond with expected epidemiological drug patterns. Index loads of BZE were significantly higher in urban areas and below detection in many rural areas. Conversely, methamphetamine was present in all municipalities, with no significant differences in index loads by urbanicity. MDMA was at quantifiable levels in fewer than half the communities, with a significant trend towards higher index loads in more urban areas. CONCLUSION; This demonstration provides the first evidence of the utility of wastewater-derived community drug loads for spatial analyses. Such data have the potential to improve dramatically the measurement of the true level and distribution of a range of drugs. Drug index load data provide information for all people in a community and are potentially applicable to a much larger proportion of the total population than existing measures.
Cocaine is the second most-used illicit drug world-wide and its consumption is increasing significantly, especially in western Europe. Until now, the annual prevalence has been estimated indirectly by means of interviews. A recently introduced and direct nation-wide approach based on measurements of the major urinary excreted metabolite of cocaine, benzoylecgonine, in wastewater is proposed.
Wastewater samples from 41 wastewater treatment plants (WWTPs) in Belgium, covering approximately 3,700,000 residents, were collected. Each WWTP was sampled on Wednesdays and Sundays during two sampling campaigns in 2007-08. Samples were analysed for cocaine (COC) and its metabolites, benzoylecgonine (BE) and ecgonine methylester (EME) by a validated procedure based on liquid chromatography coupled with tandem mass spectrometry. Concentrations of BE were used to calculate cocaine consumption (g/day per 1000 inhabitants) for each WWTP region and for both sampling campaigns (g/year per 1000 inhabitants).
Weekend days showed significantly higher cocaine consumption compared with weekdays. The highest cocaine consumption was observed for WWTPs receiving wastewater from large cities, such as Antwerp, Brussels and Charleroi. Results were extrapolated for the total Belgian population and an estimation of a yearly prevalence of cocaine use was made based on various assumptions. An amount of 1.88 tonnes (t) per year [standard error (SE) 0.05 t] cocaine is consumed in Belgium, corresponding to a yearly prevalence of 0.80% (SE 0.02%) for the Belgian population aged 15-64 years. This result is in agreement with an earlier reported estimate of the Belgian prevalence of cocaine use conducted through socio-epidemiological studies (0.9% for people aged 15-64 years).
Wastewater analysis is a promising tool to evaluate cocaine consumption at both local and national scale. This rapid and direct estimation of the prevalence of cocaine use in Belgium corresponds with socio-epidemiological data. However, the strategy needs to be refined further to allow a more exact calculation of cocaine consumption from concentrations of BE in wastewater.
An analytical method with two extraction steps has been developed and validated for the simultaneous determination of 30 pharmaceuticals belonging to various therapeutic categories in urban wastewater. The aim was to boost the little available information on drugs' fates in sewage treatment plants (STPs) and in the receiving surface water. Aqueous samples were divided into two aliquots, each extracted by a different solid-phase extraction (SPE) method and analysed by reversed-phase liquid chromatography tandem mass spectrometry (HPLC-MS-MS). Recoveries of the pharmaceuticals were mostly greater than 70% and the overall variability of the method was below 8%. The instrumental quantification limit (IQL) varied between 30 and 400 pg injected, and the limits of quantification (LOQ) were in the low ng/L range. Nineteen pharmaceuticals were detected in concentrations between 0.5 and 2000 ng/L in effluents collected from several STPs in Italy. Atenolol, ciprofloxacin, furosemide, hydrochlorothiazide, ofloxacin, ranitidine and sulphamethoxazole were the most abundant compounds. The present analytical method was useful to check for pharmaceuticals in various Italian STPs and to identify the most abundant compounds.
Humans have always used drugs, probably as part of their evolutionary and nutritional heritage. However, this previous biological adaptation is unlikely to be so in the modern world, in which 2 billion adults (48% of the adult population) are current users of alcohol, 1.1 billion adults (29% of the adult population) are current smokers of cigarettes and 185 million adults (4.5% of the adult population) are current users of illicit drugs. The use of drugs is determined largely by market forces, with increases in affordability and availability increasing use. People with socio-economic deprivation, however measured, are at increased risk of harmful drug use, as are those with a disadvantaged family environment, and those who live in a community with higher levels of substance use. Substance use is on the increase in low-income countries which, in the coming decades, will bear a disproportionate burden of substance-related disability and premature death.
Residues of illicit drugs and their metabolites that are excreted by humans may flow into and through wastewater treatment plants. The aim of this study was to develop a method for the determination of cocaine, amphetamines, morphine, cannabinoids, methadone, and some of their metabolites in wastewater. Composite 24-h samples from urban treatment plants were enriched with deuterated internal standards before solid-phase extraction. High-pressure liquid chromatography tandem mass spectrometry with multiple reaction monitoring was used for quantitation. Recoveries were generally higher than 80%, and limits of quantifications were in the low nanograms-per-liter range for untreated and treated wastewater. The overall variability of the method was lower than 10% for untreated and 5% for treated wastewater. The method was applied to wastewater samples coming from two treatment plants in Italy and Switzerland. Quantification ranges were found to be 0.2-1 microg/L for cocaine and its metabolite benzoylecgonine, 80-200 ng/L for morphine, 10 ng/L for 6-acetylmorphine, 60-90 ng/L for 11-nor-9-carboxy-Delta9-tetrahydrocannabinol, 10-90 ng/L for methadone and its main metabolite 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine, and lower than 20 ng/L for amphetamines. As previously reported for cocaine, this method could be useful to estimate and monitor drug consumption in the population in real time, helping social scientists and authorities to combat drug abuse.
Diagnostic and statistical manual of mental disorders
American Psychiatric Association, 2013. Diagnostic and statistical manual of mental disorders. 5th ed. American Psychiatric Publishing, Arlington, VA.
European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)
European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), 2016. Insight 22.
Assessing Illicit Drugs in Wastewater. European Monitoring Center for Drugs and
Drug Addiction, Luxembourg.
United Nations Office on Drugs and Crime (UNODC)
United Nations Office on Drugs and Crime (UNODC), 2016. Word Drug Report, Vienna.
United Nations Office on Drugs and Crime (UNODC), 2017. World Drug Report (Vienna).