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Can wastewater monitoring help inform future drug prevention strategies? : HEALTH-CARE

The future of illicit drug monitoring could lie in flushing your toilet in a “collective urine test”.

Wastewater drug monitoring is a rapidly developing area of ​​research, and some countries, including Canada, are using the researchers’ findings to develop policies and strategies to prevent illegal drugs.

In the largest wastewater study ever carried out researchers from 41 international institutions as part of RESULT. (Wastewater analysis CORe group Europe) followed drug use over seven years from 2011 to 2017. The samples came from 120 cities in 37 countries and measured drug residues in the urine of more than 60 million people.

Published in the magazine Addiction In October last year, the study aimed to demonstrate the efficiency and robustness of this methodology by standardizing sampling and analysis procedures.

But perhaps more remarkable, the study revealed interesting patterns, peaks and trends in illicit drug use worldwide. Wastewater analysis uses the method currently used to examine drug use at an individual level and extends it to monitor and monitor an entire population.

The study identified four active substances in the wastewater – Amphetamine, methamphetamine, ecstasy and cocaine, Regional differences in drug use were significant. Iria González-Mariño, co-director of the course and professor of chemistry at the University of Salamanca in Spain, said she was surprised by the high cocaine content in the Spanish city of Santiago de Compostela. This trend This was true across Europe, where cocaine use appears to be increasing.

Viviane Yargeau, chair of the chemical engineering department at McGill University in Montreal, who led the Canadian wastewater analysis for this study, said she was surprised in Canada Use methamphetamine. “We see that this drug is clearly preferred in Montreal as a metropolitan area compared to Europe, the United States and other places, ”she says.

The researchers’ surprise shows that such changes in drug use have not been captured by other drug monitoring methods. “This becomes valuable information for decision makers or people developing intervention strategies,” says Yargeau.

González-Mariño says this analysis can be done “almost in real time”. This is a significant time saver since traditional drug monitoring methods rely on time-consuming and expensive surveys that are also inherently biased.

Alternatively, data can be collected through hospital stays, rehab check-ins, law enforcement drug seizure, and even deaths. However, these options are limited and do not tell us which drugs are being consumed, at least not until it is too late to start an effective prevention campaign.

For this reason, countries have started to include analysis of wastewater medicines in their formal data collection agencies, including Canadian Statisticsand for policy making. The pioneer is Australia, where the National sewage medication monitoring program is funded by the Australian Criminal Intelligence Commission and has been in existence since 2016.

Kevin Thomas, who conducts research for this national program at Queensland University and is a co-founder of SCORE, says his team “covers 55 percent of the Australian population, around 13 million people and 52 wastewater treatment plants”. The program is able to track illegal drug use in addition to nicotine, alcohol and opiates, which, according to Thomas, “differentiates us from many other countries that collect”.

The data collected in Australia are used to shape policy and provide information on the effectiveness of various prevention programs. With a more comprehensive picture of the country’s drug use and the level of harm for each type of drug, more targeted awareness campaigns were created and important information on drug use made available to health authorities. The effectiveness of drug seizures in relation to national demand for any illegal drug can also be better measured using wastewater data. This could also be the future for Canada.

Yargeau has partnered with Statistics Canada track Cannabis use before and after legalization with 14 wastewater treatment plants in five cities. In addition to cannabis, the pilot project also followed cocaine, methamphetamine and opioid use. According to Yargeau, Statistics Canada was very satisfied with the effectiveness of this study in terms of cost and time efficiency and intended to continue the research.

Many researchers in the field are also keen to extend wastewater monitoring to other areas of public health analysis. “If you do all of these efforts to collect samples and send them to a laboratory, why not look for other health indicators?” Yargeau asks.

Thomas says his team is already beginning to monitor public health using wastewater. “For example, we can study urban allergy levels to see if it correlates with weather events.” Like changes in humidity, temperature, and even wind.

Yargeau says they could also investigate the use of medication and proteins in wastewater to show a population’s health and disease burden. Survival can go beyond illegal consumption to examine the use or exposure of a population. Substances including alcohol, nicotine, caffeine and even artificial sweeteners. Exposure to the environment and food continues Impurities can also be traced by pesticides, parabens and ultraviolet radiation.

However, the methodology is not without challenges.

One source of uncertainty is to ensure that the samples collected are representative of a population. Thomas says this requires comparing wastewater to census data to determine how many people actually live in the region. They also use cell phone tracking data to see how many people are in a catchment area at any given time.

There is also a risk of spikes due to drug dumping, tourist season, and false positives from some popular medications such as Vicks steam inhalers, Such drugs include a drug called levomethamphetamine, which is a legitimate ingredient in methamphetamine and can therefore trigger illegal drug alerts. Thomas also says that they can actually determine whether a drug has passed through the human body or not to avoid including drug dumps in their sampling. Researchers can too determine how the drugs were made to see if they were pharmaceutical drugs or not exam the compounds present in the drug by an immunoassay screening test.

While researchers have reached a point where they are pretty confidentceIn their sample analysis, some members of the public are concerned about their privacy. This is a real risk, says Thomas, who says there is a “problem of stigma that makes people vulnerable because their community has been identified as drug-related.”

This has even led to some Cities Refuse wastewater analysis in order not to be classified as a hotspot for illegal drugs.

Thomas tries to minimize this problem by anonymizing his data at the national level in Australia and encourages other researchers to do the same. SCORE has started ethical guidelines aimed to “minimize risks for vulnerable people and other groups and help maintain the good reputation of the field”.

From an ethical perspective, Thomas believes that this practice can be “completely non-invasive”. And the people he talked to agree that it makes sense. “If we do this to understand whether a person is taking medication, why not for an entire community?”

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Natasha Comeau is an international development expert who specializes in global health, She is a fellow in global journalism at the Dalla Lana School of Public Health.

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