Monitoring Illicit Drug Use Research Articles

A cluster of multi-drug intoxications involving xylazine, benzimidazole opioids (nitazenes) and novel benzodiazepines in South Australia.

To highlight the detection of xylazine and nitrazolam in conjunction with benzimidazole opioids (nitazenes) and other novel benzodiazepines in a cluster of patients after putative heroin use. Deidentified clinical and analytical data were gathered from patients enrolled in the Emerging Drugs Network of Australia system. In December 2023, three adults presented to the ED with sedation following putative use of heroin. Toxicological analysis of blood samples identified xylazine, protonitazene, metonitazene, bromazolam and nitrazolam. Local health authorities subsequently issued an alert. This is the first signal of xylazine and nitrazolam use in Australia. These results demonstrate toxico-surveillance programmes with analytical confirmation of drugs are invaluable in monitoring illicit drug use.

Wastewater-Based Epidemiology: Assessing Illicit Drug Usage and Impact through an Innovative Approach

The abuse of illicit drugs, which is usually associated with violent crimes and public health issues, has evolved into a significant problem that the whole of society must address collectively. With the benefits of high productivity, convenience, objectivity, and semi-real time, wastewater-based epidemiology (WBE) has been demonstrated to be a powerful tool and has been utilized on a global scale for monitoring illicit drug use. In this review, we briefly introduce the development and application of WBE. Then, the stability of biomarkers is summarized, and methods to improve stability are introduced. We highlight recent advances in analytical techniques, from three aspects of chromatography–mass spectrometry, optical methods, and electrochemical strategies. The research progress of illicit drug abuse assessment based on WBE is summarized. Finally, we summarize the research hotspots and challenges on illicit drug abuse assessment based on WBE.

Establishing an Approach for Designation of Evolving and Emerging Drug Threats.

Establishing an Approach for Designation of Evolving and Emerging Drug Threats.

Evaluation of Illicit Drug Consumption by Wastewater Analysis Using Polar Organic Chemical Integrative Sampler as a Monitoring Tool.

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.

Testing wastewater from a music festival in Switzerland to assess illicit drug use

This article describes the application of a recently proposed framework for deploying wastewater-based epidemiology (WBE) to monitor illicit drug use within festivals (Benaglia et al., 2019). The festival under study was a week-long music festival in Switzerland (Swiss Festival) which attracted around 50,000 people daily. Wastewater sampling was performed during its 2014 and 2015 editions. As the Swiss Festival’s wastewater is conveyed to the sewage treatment plant (STP) of the nearby city, to assess illicit drug use when there is no festival (i.e. the background consumption) wastewater sampling was also carried out during an off-festival week in 2015. During the 2014 and 2015 editions of the Swiss Festival, WBE highlighted that the most consumed illicit drugs were cannabis, MDMA, cocaine and amphetamine. Excluding cannabis, the means per capita loads of all illicit drugs were not statistically different between both editions of the Swiss Festival. The results were then compared to those of an Australian festival which had also been subject of a quantitatively assessed illicit drug use study (Lai et al., 2013). This comparison confirmed that MDMA is highly prevalent, as well as amphetamine, although to a lesser extent. Consumption of cocaine (in Switzerland) and methamphetamine (in Australia) is also high, but their use seems to be related to their availability (i.e. to the country where the festival takes place). Furthermore, it was observed that MDMA and amphetamine are more consumed during the festival compared to normal times, when there is no festival. This might suggest that their availability is increased and therefore, that a market for these substances potentially exists during the festival. This last hypothesis was assessed by consulting drug seizures made by the police during the 2015 Swiss Festival. Despite very limited data, police records suggested that most of the drugs were purchased at the festival, which supports the previous hypothesis. Results validate, on the one hand, WBE as a useful indicator to monitor illicit drug use within festivals and on the other hand, the suggested framework for deploying WBE in such environment. In addition, this study suggests the need for prevention and harm reduction measures targeted on MDMA and amphetamine during the Swiss Festival, such as drug checking laboratories.

A GIS assisted system for monitoring illicit drug use in wastewater

A GIS assisted system for monitoring illicit drug use in wastewater

Wastewater-based monitoring of illicit drug consumption in Istanbul: Preliminary results from two districts

Wastewater-based epidemiology is a well-established and complementary approach for monitoring illicit drug use in the general population. In this study, amphetamine (AMP), methamphetamine (METH), 3,4-methylenedioxymethamphetamine (MDMA), cocaine (COC) (from benzoylecgonine), and cannabis (from THC-COOH) consumption levels were investigated for the first time in Turkey (Istanbul). A solid-phase extraction method was applied to influent wastewater samples collected from two districts, Beyoglu and Catalca. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) analysis was conducted with electrospray ionization in positive mode. Calibration curves were acquired in linear form with >0.999 correlation coefficients. Limit of detection levels were measured as 0.91–151 ng/L, and limit of quantitation levels were in the range of 3 to 500 ng/L. Solid-phase extraction recovery and repeatability experiments were achieved by spiking the mix solution to different concentrations (50, 250, 750 ng/L) in 50 mL tap water and wastewater (500, 1000 ng/L) samples in six replicates. The method was optimized, and recoveries were found to be over 80% for all six substances with up to 11.9% relative standard deviation. According to the real sample results, cannabis was found to be the most abused illicit substance among the analytes. The mean consumptions of the two districts, including seven consecutive days for AMP, METH, MDMA, COC, and cannabis, were found to be 27.2, 322, 331, 385, and 1224 mg/day/1000 inhabitants, respectively. In this presented study, all targeted compounds were analyzed simultaneously with the same analytical conditions. To the best of our knowledge, this report is the first to present illicit drug consumption data from Istanbul.

Assessment of the Use of Point-Of-Care Pregabalin Testing For Drug Monitoring, Compared to Gas Chromatography Mass- Spectrometry – A Pilot Study

Pregabalin is a structural derivative of the inhibitory neurotransmitter Gammaaminobutyric Acid (GABA) and is used in the treatment of anxiety disorder, neuropathic pain and as an anti-convulsant. The prescription of pregabalin has increased in recent years along with reports of its abuse (especially through taking high doses). Consequently, there is a need to monitor the use of pregabalin in patients prescribed the drug as well as those potentially using it without prescription. Point-of-care testing has been used for many years in monitoring illicit drug use but has only become available recently for pregabalin. In order to validate the effectiveness of this approach, a point-of-care testing device for pregabalin was compared with ‘gold standard’ gas chromatography with mass-spectrometry. The results of a pilot study involving 300 patient urine samples showed that the point-of-care pregabalin testing device was appropriate for determining instances where pregabalin had not been used, but due to the observation of 4% false positives, mass-spectrometry confirmation is recommended (as is usually the case for immunoassay-based approaches, especially in a medico-legal context).

Assessing geographical differences in illicit drug consumption—A comparison of results from epidemiological and wastewater data in Germany and Switzerland

BackgroundWastewater analysis is an innovative approach that allows monitoring illicit drug use at the community level. This study focused on investigating geographical differences in drug consumption by comparing epidemiological, crime and wastewater data. MethodsWastewater samples were collected in 19 cities across Germany and Switzerland during one week, covering a population of approximately 8.1 million people. Self-report data and consumption offences for the investigated areas were used for comparison and to investigate differences between the indicators. ResultsGood agreement between data sources was observed for cannabis and amphetamine-type stimulants, whereas substantial discrepancies were observed for cocaine. In Germany, an important distinction could be made between Berlin, Dortmund and Munich, where cocaine and particularly amphetamine were more prevalent, and Dresden, where methamphetamine consumption was clearly predominant. Cocaine consumption was relatively homogenous in the larger urban areas of Switzerland, although prevalence and offences data suggested a more heterogeneous picture. Conversely, marked regional differences in amphetamine and methamphetamine consumption could be highlighted. ConclusionsCombining the available data allowed for a better understanding of the geographical differences regarding prevalence, typology and amounts of substances consumed. For cannabis and amphetamine-type stimulants, the complementarity of survey, police and wastewater data could be highlighted, although notable differences could be identified when considering more stigmatised drugs (i.e. cocaine and heroin). Understanding illicit drug consumption at the national scale remains a difficult task, yet this research illustrates the added value of combining complementary data sources to obtain a more comprehensive and accurate picture of the situation.

Internet search and krokodil in the Russian Federation: an infoveillance study.

BackgroundKrokodil is an informal term for a cheap injectable illicit drug domestically prepared from codeine-containing medication (CCM). The method of krokodil preparation may produce desomorphine as well as toxic reactants that cause extensive tissue necrosis. The first confirmed report of krokodil use in Russia took place in 2004. In 2012, reports of krokodil-related injection injuries began to appear beyond Russia in Western Europe and the United States.ObjectiveThis exploratory study had two main objectives: (1) to determine if Internet search patterns could detect regularities in behavioral responses to Russian CCM policy at the population level, and (2) to determine if complementary data sources could explain the regularities we observed.MethodsFirst, we obtained krokodil-related search pattern data for each Russia subregion (oblast) between 2011 and 2012. Second, we analyzed several complementary data sources included krokodil-related court cases, and related search terms on both Google and Yandex to evaluate the characteristics of terms accompanying krokodil-related search queries.ResultsIn the 6 months preceding CCM sales restrictions, 21 of Russia's 83 oblasts had search rates higher than the national average (mean) of 16.67 searches per 100,000 population for terms associated with krokodil. In the 6 months following restrictions, mean national searches dropped to 9.65 per 100,000. Further, the number of oblasts recording a higher than average search rate dropped from 30 to 16. Second, we found krokodil-related court appearances were moderately positively correlated (Spearman correlation=.506, P≤.001) with behaviors consistent with an interest in the production and use of krokodil across Russia. Finally, Google Trends and Google and Yandex related terms suggested consistent public interest in the production and use of krokodil as well as for CCM as analgesic medication during the date range covered by this study.ConclusionsIllicit drug use data are generally regarded as difficult to obtain through traditional survey methods. Our analysis suggests it is plausible that Yandex search behavior served as a proxy for patterns of krokodil production and use during the date range we investigated. More generally, this study demonstrates the application of novel methods recently used by policy makers to both monitor illicit drug use and influence drug policy decision making.

Sewage epidemiology and illicit drug research: The development of ethical research guidelines

AimsTo 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. MethodDescribe 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. ResultsA 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. ConclusionsGuidelines 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.

Testing wastewater to detect illicit drugs: State of the art, potential and research needs

Illicit drug use is a global phenomenon involving millions of individuals, which results in serious health and social costs. The chemical analysis of urban wastewater for the excretion products of illicit drugs is a potent approach for monitoring patterns and trends of illicit drug use in a community. The first international and multidisciplinary conference on this topic was recently organized to present the epidemiological knowledge of patterns in drug use and the information obtained from wastewater analysis. This paper gives an overview of the main issues that emerged during the conference, focusing on the identified research gaps and requirements and on the future challenges and opportunities from bringing together wastewater analysis and drug epidemiology. The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) uses an established multi-indicator system to monitor illicit drug use and to identify the emergence of new psychoactive substances. The methodological challenges of monitoring a hidden and stigmatized behavior like drug use include the limitations of self-report data and reporting delays. An increasing evidence base suggests that wastewater analysis can address some of these problems. Specifically this technique can: monitor temporal and spatial trends in drug use at different scales, provide updated estimates of drug use, and identify changing habits and the use of new substances. A best practice protocol developed by a Europe-wide network of experts is available to produce homogeneous and comparable data at different sites. The systematic evaluation of uncertainties related to wastewater analysis has highlighted which areas require careful control and those that need further investigation to generally improve the approach. Wastewater analysis has considerable potential to complement existing approaches for monitoring drug use due to its ability to produce objective, real-time estimates of drug use and to give timely information of any change in the patterns of use.

An analysis of ethical issues in using wastewater analysis to monitor illicit drug use

To discuss ethical issues that may arise in using WWA to monitor illicit drug use in the general population and in entertainment precincts, prisons, schools and work-places. Review current applications of WWA and identify ethical and social issues that may be raised with current and projected future uses of this method. Wastewater analysis (WWA) of drug residues is a promising method of monitoring illicit drug use that may overcome some limitations of other monitoring methods. When used for monitoring purposes in large populations, WWA does not raise major ethical concerns because individuals are not identified and the prospects of harming residents of catchment areas are remote. When WWA is used in smaller catchment areas (entertainment venues, prisons, schools or work-places) their results could, possibly, indirectly affect the occupants adversely. Researchers will need to take care in reporting their results to reduce media misreporting. Fears about possible use of WWA for mass individual surveillance by drug law enforcement officials are unlikely to be realized, but will need to be addressed because they may affect public support adversely for this type of research. Using wastewater analysis to monitor illicit drug use in large populations does not raise major ethical concerns, but researchers need to minimize possible adverse consequences in studying smaller populations, such as workers, prisoners and students.

SP5-17 Monitoring illicit drug use and substance dependency among female sex workers in Europe, 2000–2009: an overview

IntroductionWorldwide, illicit drug use and substance dependency will remain important public health problems during the next decades. Clinical evidence suggests that sex workers (SW) are a high risk group with...

Ten Years of Monitoring Illicit Drug Use in Prison Populations in Europe: Issues and Challenges

Abstract: The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) has been collecting aggregated data on illicit drug use among European prison populations for over a decade. Additional studies were identified in a literature search. Together, these sources yielded 53 studies reporting data during the period 2000 to 2008. Analysis of these studies reveals that the available data are scarce and patchy, with large variations in methodology. This diversity hampers comparison, and may, in part, account for the wide range of prevalence estimates for drug use and drug injecting, both prior to imprisonment and while in prison. This article concludes that a common instrument to measure drug use and its consequences in European prison populations is needed.

Excretion of Methadone in Sweat of Pregnant Women Throughout Gestation After Controlled Methadone Administration

Sweat patches (n = 350) were collected throughout gestation from 29 opioid-dependent pregnant women participating in an outpatient methadone-assisted therapy program. Volunteers provided informed consent to participate in institutional review board-approved protocols. Methadone was eluted from sweat patches with sodium acetate buffer, followed by solid-phase extraction and quantification by gas chromatography mass spectrometry (limit of quantification > or = 10 ng/patch). Methadone was present in all weekly patches (n = 311) in concentrations ranging from 10.2 to 12,129.7 nanograms per patch and in 92.3% of short-term patches (n = 39, worn for 12 or 24 hours) in concentrations up to 3303.9 nanograms per patch. Correlation between patch concentrations and total amount of drug administered (r = 0.224), and concentrations and duration of patch wear (r = 0.129) were both weak. Although there were large intra- and intersubject variations in sweat drug concentrations, sweat testing was an effective alternative technique to qualitatively monitor illicit drug use and simultaneously document methadone medication-assisted treatment.

Cocaine and heroin in waste water plants: A 1-year study in the city of Florence, Italy

The diffusion and trends in use of each substance is a basic information in policy planning of strategies aiming at deterrence of drug abuse or in the organization of the fight against drug trafficking. The actual diffusion of illicit drugs in a population is hardly measurable, but, among the various measures available, the analysis of waste water plants represents one of the most reliable source of data. We analyzed waste water in order to monitor illicit drug use by local population. We investigated the use of cocaine and heroin in the city of Florence, Italy, over a 1-year (July 2006–June 2007) period using state-of-the-art measuring techniques from waste water samples. Cocaine, benzoylecgonine, and morphine were determined in water samples by gas chromatography–mass spectrometer, and the amount of illicit substance was estimated. Data indicate for cocaine a bimodal distribution (December and March), while heroin showed a main peak in April. The heroin-to-cocaine use ratio in terms of estimated doses per month ranged from 0.11 to 0.76, representing new evidence of wider distribution of cocaine than heroin in Florence. Waste water analysis can become a valuable tool in monitoring use of illicit drugs over time. In particular, it can highlight changes in the magnitude and relative use of illicit drug at a population level thereby becoming useful to develop strategies against drug trafficking and abuse. If routinely performed, it can be part of Epidemiologic Surveillance Programmes on drug abuse.

LC-atmospheric pressure chemical ionization-MS/ MS analysis of multiple illicit drugs, methadone, and their metabolites in oral fluid following protein precipitation.

A quantitative LC-APCI-MS/MS method for simultaneous determination of multiple illicit drugs, methadone, and their metabolites in oral fluid was developed and validated. Sample pretreatment was limited to acetonitrile protein precipitation. LC separation was performed in 25.5 min, with a total analysis time of 35 min. Identification and quantitation were based on selected reaction monitoring. Calibration by linear regression analysis utilized deuterated internal standards and a weighing factor 1/x. Limits of detection and lower limits of quantitation (LOQ) were established between 0.25 and 5 ng/ mL and 0.5-10 ng/mL, respectively. linearity was obtained with an average correlation coefficient (R2) of >0.99, over a dynamic range from the LOQ up to maximum 500 ng/mL The method demonstrated good accuracy, intra- and interbatch precision, recovery, and stability for all compounds. No oral fluid matrix effect was observed throughout the chromatographic run. Protein precipitation provided a fast and simple sample pretreatment, while LC-APCI-MS/MS proved to be a sensitive and rugged quantitative method for multiple illicit and legal drugs in oral fluid. The method proved to be suitable for the evaluation of oral fluid as an alternative matrix to urine for monitoring illicit drug use and for determining oral fluid methadone concentrations in pregnant opiate and/or cocaine addicts.

Use of RAM to monitor illicit drug use in developed countries: can rapid assessment result in a rapid response?

Use of RAM to monitor illicit drug use in developed countries: can rapid assessment result in a rapid response?