Abstract
Background and aimsWastewater‐based epidemiology is an additional indicator of drug use that is gaining reliability to complement the current established panel of indicators. The aims of this study were to: (i) assess spatial and temporal trends of population‐normalized mass loads of benzoylecgonine, amphetamine, methamphetamine and 3,4‐methylenedioxymethamphetamine (MDMA) in raw wastewater over 7 years (2011–17); (ii) address overall drug use by estimating the average number of combined doses consumed per day in each city; and (iii) compare these with existing prevalence and seizure data.DesignAnalysis of daily raw wastewater composite samples collected over 1 week per year from 2011 to 2017.Setting and ParticipantsCatchment areas of 143 wastewater treatment plants in 120 cities in 37 countries.MeasurementsParent substances (amphetamine, methamphetamine and MDMA) and the metabolites of cocaine (benzoylecgonine) and of Δ9‐tetrahydrocannabinol (11‐nor‐9‐carboxy‐Δ9‐tetrahydrocannabinol) were measured in wastewater using liquid chromatography–tandem mass spectrometry. Daily mass loads (mg/day) were normalized to catchment population (mg/1000 people/day) and converted to the number of combined doses consumed per day. Spatial differences were assessed world‐wide, and temporal trends were discerned at European level by comparing 2011–13 drug loads versus 2014–17 loads.FindingsBenzoylecgonine was the stimulant metabolite detected at higher loads in southern and western Europe, and amphetamine, MDMA and methamphetamine in East and North–Central Europe. In other continents, methamphetamine showed the highest levels in the United States and Australia and benzoylecgonine in South America. During the reporting period, benzoylecgonine loads increased in general across Europe, amphetamine and methamphetamine levels fluctuated and MDMA underwent an intermittent upsurge.ConclusionsThe analysis of wastewater to quantify drug loads provides near real‐time drug use estimates that globally correspond to prevalence and seizure data.
Highlights
The global illicit drug market is estimated to be a hundredbillion activity that facilitates corruption, affects the economic development of certain regions in the world [1,2], and contributes to the global burden of disease [3]
The aims of this study were to: (i) assess spatial and temporal trends in drug use by measuring benzoylecgonine, amphetamine, methamphetamine and MDMA mass loads in raw wastewater throughout 7 years; and (ii) address overall drug use by estimating the average number of combined doses consumed per day in each city
Benzoylecgonine, a biomarker of cocaine consumption, was one of the substances measured at highest levels in European wastewaters during the 7 years
Summary
The global illicit drug market is estimated to be a hundredbillion activity that facilitates corruption, affects the economic development of certain regions in the world [1,2], and contributes to the global burden of disease [3]. Determining the scale of the illicit drug market and its temporal dynamics is an important but challenging task for law and drug enforcement agencies to assess the efficacy of drug-related policy and control/prevention measures. This has been established through a combination of seizures, surveys, drug treatment demands, drug-related hospital admissions and arrest data. The aims of this study were to: (i) assess spatial and temporal trends of population-normalized mass loads of benzoylecgonine, amphetamine, methamphetamine and 3,4methylenedioxymethamphetamine (MDMA) in raw wastewater over 7 years (2011–17); (ii) address overall drug use by estimating the average number of combined doses consumed per day in each city; and (iii) compare these with existing prevalence and seizure data. Benzoylecgonine loads increased in general across Europe, amphetamine and methamphetamine levels fluctuated and MDMA underwent an intermittent upsurge
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