Basketball and drugs: Wastewater-based epidemiological estimation of discharged drugs during basketball games in Kentucky

The cutting edge of surveillance: Exploring high-resolution mass spectrometry in wastewater-based epidemiology for monitoring forensic samples

Criminal activity has always been detected through forensic evidence. However, the potential for using such evidence to stop crimes in their tracks or slow them down has not yet been completely realized. There is a lot of potential for assessing trace quantities of chemicals in wastewater systems to provide effective forensic information. Wastewater-based epidemiology (WBE) has emerged in the last decades as a crucial epidemiological information source for collecting data on community-wide health. It can add important knowledge about illicit drug consumption and/or disposal, exposure to pathogens, infectious diseases, industrial pollutants, and antibiotic resistance. The use of high-resolution mass spectrometry (HRMS) in WBE has revolutionized the field by enabling the detection and quantification of these compounds. This review article explores the cutting edge of surveillance in WBE through applying HRMS techniques for forensic sample monitoring. It delves into the most recent WBE applications, examining their advantages and disadvantages. It also explores the potential for obtaining a more comprehensive evaluation of forensic samples. Furthermore, the application of these approaches to generate "forensic intelligence" for surveillance and criminal interruption is discussed, with examples of how this data can be integrated into future work.

Assessing pharmaceutical and illicit drugs abuse in a university environment through wastewater analysis

Monitoring the presence of illicit and pharmaceutical drugs in wastewater has emerged as a powerful tool for determining drug consumption patterns and trends within a specific population group. In this study, an analytical method has been developed to determine the presence of forty psychoactive substances, including stimulants, benzodiazepines, antidepressants, and opioids, in wastewater. The proposed approach combines in-situ wastewater single sampling, solid-phase extraction, and ultra-high performance liquid chromatography coupled with tandem mass spectrometry determination. Extraction conditions were evaluated to obtain the best extraction efficiencies and sensitivity. The developed method provided limits of quantification ranging from 1.7 (LSD) to 73.1 (5-EAPB) ng L-1, recoveries from 81 (butylone) to 118 % (diphenhydramine), and relative standard deviations lower than 17 %. More than one hundred wastewater samples were collected at different locations from Campus of Valencia University between 2023 and 2024 for estimating substance consumption by the university community and evaluation of ongoing awareness actions. The results showed the presence of 21 substances in at least one site. Venlafaxine and its main metabolite, escitalopram, and clorazepate were the pharmaceuticals found with the highest occurrence, with concentrations ranging from 15 (clorazepate) to 11,309 ng L-1 (O-desmethylvenlafaxine). Regarding the illicit drugs, cocaine and benzoylecgonine were found in the greatest proportion, with concentrations ranging from 6 to 980 ng L-1 and from 19 to 5699 ng L-1, respectively. From these concentrations the population consumption was calculated, providing the highest mean consumption for venlafaxine and O-desmethylvenlafaxine (489.0 and 37.2 mg day-1 1000 people-1), followed by cocaine, tramadol, MDMA and amphetamine with consumption values of 40.8, 30.9, 30.8 and 17.0 mg day-1 1000 people-1, respectively. The proposed analytical strategy has been demonstrated to be suitable for monitoring the detection frequency of psychoactive substances, providing insight into temporal and spatial trends of drug use through wastewater surveillance.

Illicit drugs in Brazil: environmental consequences and consumption patterns

This article reviews the literature on the consumption, street drug analysis, distribution, and main environmental impacts of illicit drugs in Brazil and analyzes the III National Survey on Drug Use by the Brazilian Population. The literature review is based on articles published in national and international journals between 2018 and 2023. This review consists of two analyses, the first of which addresses publications from the last 6 years on the monitoring of illicit drugs in Brazil and a second analysis based on the III National Survey on Drug Use that addresses the different possibilities of contact with drugs. The results revealed that the Southeast region of Brazil has the highest number of studies on the subject, especially in the state of São Paulo, while the North and Northeast regions have the lowest number of studies. The Midwest regions only have studies in the federal capital city, Brasília, while no studies were found in states bordering countries that produce illicit drugs, such as Paraguay and Bolivia. Analytical methods that use the concept of miniaturization, green chemistry, and the adoption of acceptance methods are frequent in most articles. Chemometric and statistical tools are widely used for the analysis, development, and conclusion of identification and quantification methods. Among the articles studied, there was a predominance in the analysis of cocaine metabolites and cannabis metabolites in the aquatic environment, where their concentrations ranged from 0.01 to 2000 ng L-1. Studies also reported bioaccumulation in marine biota with concentrations of up to 4.58 µg kg-1 for mussels and sediments, posing a risk to algae, crustaceans, and fish. Furthermore, the data show that the consumption of illicit drugs is increasing in Brazil, especially among young people.

Wastewater Surveillance for Xylazine in Kentucky

Introduction

In the U.S., xylazine, the veterinary non-opioid sedative, has emerged as a major threat to people who use illicitly manufactured fentanyl and other drugs. The aim of this study was to compare wastewater detection of xylazine with other public health and safety surveillance data from 2019 to 2023 in Kentucky.

Methods

Wastewater samples from 5 rest areas, 2 truck weigh stations, and 4 wastewater treatment plants were tested for xylazine. Wastewater xylazine positivity rates were compared with xylazine-positive submission rates from the National Forensic Laboratory Information System and Kentucky's fatal overdoses in 6-month periods (Period 1=January-June; Period 2=July-December).

Results

Xylazine was detected in 61.6% (424 of 688) of daily wastewater samples from roadway sites/wastewater treatment plants. For roadways, detection increased from 55% (Period 1, 2021) to 94% (Period 1, 2023), and wastewater treatment plants had an overall detection of 25.8% (n=66 samples, Periods 1 and 2, 2022). Increasing roadway positivity corresponded to trends in National Forensic Laboratory Information System xylazine-positive submission rates: from 0.19 per 1,000 submissions (Period 1, 2019) to 2.9 per 1,000 (Period 2, 2022, latest available). No deaths from xylazine were reported publicly in Kentucky, although this study's authors identified 1-4 deaths (true count suppressed) in the overdose surveillance system, which, in back-of-the-envelope comparisons with other states, is far fewer than expected.

Conclusions

Wastewater signals indicate broad geographic exposure to xylazine in Kentucky, yet health outcomes data suggest otherwise. These findings may inform regional, national, and international efforts to incorporate wastewater-based drug surveillance. Harm-reduction activities along roadways and other suitable locations may be needed.

Non-target analysis for water characterization: wastewater treatment impact and selection of relevant features

Non-target analyses were conducted to characterize and compare the molecular profiles (UHPLC-HRMS fingerprint) of water samples from a wastewater treatment plant (WWTP). Inlet and outlet samples were collected from three campaigns spaced 6 months apart in order to highlight common trends. A significant impact of the treatment on the sample fingerprints was shown, with a 65-70% abatement of the number of features detected in the effluent, and more polar, smaller and less intense molecules found overall compared to those in WWTP influent waters. Multivariate analysis (PCA) associated with variations of the features between inlets and outlets showed that features appearing or increasing were correlated with effluents while those disappearing or decreasing were correlated with influents. Finally, effluent features considered as relevant to a potentially adverse effect on aqueous media (i.e. those which appeared or increased or slightly varied from the influent) were highlighted. Three hundred seventy-five features common with the 3 campaigns were thus selected and further characterized. For most of them, elementary composition was found to be C, H, N, O (42%) and C, H, N, O, P (18%). Considering the MS2 spectra and several reference MS2 databases, annotations were proposed for 35 of these relevant features. They include synthetic products, pharmaceuticals and metabolites.

A green method for the determination of illicit drugs in wastewater and surface waters-based on a semi-automated liquid-liquid microextraction device

Liquid-phase microextraction (LPME) is a simple, low-cost, and eco-friendly technique that enables the detection of trace concentrations of organic contaminants in water samples. In this work, a novel customized microextraction device was developed for the LPME extraction and preconcentration of nine illicit drugs in surface water and influent and effluent wastewater samples, followed by analysis by GC-MS without derivatization. The customized device was semi-automated by coupling it with a peristaltic pump to perform the collection of the upper layer of the organic phase. The extraction parameters affecting the LPME efficiency were optimized. The optimized conditions were: 100 µL of a toluene/DCM/EtAc mixture as extractor solvent; 30min of extraction time under vortex agitation (500rpm) and a solution pH of 11.6. The limits of detection and quantification ranged from 10.5ng L-1 (ethylone) to 22.0ng L-1 (methylone), and from 34.9ng L-1 to 73.3ng L-1 for these same compounds, respectively. The enrichment factors ranged from 39.7 (MDMA) to 117 (cocaethylene) and the relative recoveries ranged from 80.4% (N-ethylpentylone) to 120% (cocaine and cocaine-d3). The method was applied to real surface water, effluent, and influent wastewater samples collected in Salvador City, Bahia, Brazil. Cocaine was the main drug detected and quantified in wastewater samples, and its concentration ranged from 312ng L-1 to 1,847ng L-1. Finally, the AGREE metrics were applied to verify the greenness of the proposed method, and an overall score of 0.56 was achieved, which was considered environmentally friendly.

Detection of emerging patterns of drug misuse in sports via wastewater monitoring: A mini-review and potential strategies

Biological testing is a key component of the current anti-doping programme implemented by the authorities to detect doping in sports. Strategies such as longitudinal individualised data analysis and sport-specific analysis have been developed to increase the comprehensiveness of the testing. However, the trends of drug misuse in sports might not be effectively captured through today's testing plan. Wastewater testing, assembling individual-level data of a designated group to produce population-level results in one single aggregated sample, can be employed to as a complementary strategy offering added value for doping control. This paper presents an updated summary of the status of anti-doping testing and analytical methodologies for wastewater. The available literature on wastewater-based analyses of drugs prohibited in sports is reviewed. Publications surrounding sporting activities or competitions and others relevant to sports doping are selected. We debate between potential strategies and major limitations of using wastewater monitoring in anti-doping. Knowledge gaps and research directions, specifically on metabolites, stability, sensitivity, and ethical and legal considerations, are discussed. Choosing different wastewater sampling sites allows target sub-population that involved competing athletes and potentially reveal sport-specific or athlete-level-specific behaviour. Sampling from on-board toilets or athlete villages could target international-level athletes, sampling from the dormitories of national training centres allows monitoring of national-level athletes on a daily basis, and sampling from sports stadiums provides a full picture of drug use in the general population during an event. Confounding occurs as (i) the presence of non-athlete composition and the difficulty of analyses to be completely selective to the athlete population; and (ii) the identification of compounds prescribed legitimately with Therapeutic Use Exemptions, only banned in-competition, and naturally occurring. The practicalities of the approach are contextualised in monitoring the non-threshold substances such as anabolic agents, selective androgen receptor modulators, metabolic modulators, and hypoxia-inducible factor activators.

Festivals following the easing of COVID-19 restrictions: Prevalence of new psychoactive substances and illicit drugs

The market for illicit drugs and new psychoactive substances (NPS) has grown significantly and people attending festivals have been identified as being at high risk (high extent and frequency of substance use). Traditional public health surveillance data sources have limitations (high costs, long implementation times, and ethical issues) and wastewater-based epidemiology (WBE) can cost-effectively support surveillance efforts. Influent wastewater samples were analyzed for NPS and illicit drug consumption collected during New Year period (from 29-Dec-2021 to 4-Jan-2022) and a summer Festival (from 29-June-2022 to 12-July-2022) in a large city in Spain. Samples were analyzed for phenethylamines, cathinones, opioids, benzodiazepines, plant-based NPS, dissociatives, and the illicit drugs methamphetamine, MDA, MDMA, ketamine, heroin, cocaine, and pseudoephedrine by liquid chromatography mass spectrometry. High consumption rates of specific NPS and established illicit drugs were identified at the peak of each event. Furthermore, a dynamic change in NPS use (presence and absence of substances) was detected over a period of six months. Eleven NPS, including synthetic cathinones, benzodiazepines, plant-based NPS and dissociatives, and seven illicit drugs were found across both the New Year and summer Festival. Statistically significant differences (p < 0.05) were seen for 3-MMC (New Year vs summer Festival), eutylone (New Year vs summer Festival), cocaine (summer Festival vs normal week and summer Festival vs New Year), MDMA (New Year vs normal week and summer Festival vs normal week), heroin (summer Festival vs New Year) and pseudoephedrine (summer Festival vs New Year). This WBE study assessed the prevalence of NPS and illicit drugs at festivals following the reduction of the COVID-19 pandemic restrictions highlighting the high use of specific substances at the peak of each event. This approach identified in a cost-effective and timely manner without any ethical issues the most used drugs and changes in use patterns and, thus, can complement public health information.

High resolution mass spectrometry (HRMS) determination of drugs in wastewater and wastewater based epidemiology in Cadiz Bay (Spain)

Multi-residue methods for the determination of the myriad of compounds of emerging concern (CECs) entering in the environment are key elements for further assessment on their distribution and fate. Here, we have developed an analytical protocol for the simultaneous analysis of 195 prescription, over-the-counter, and illicit drugs by using a combination of solid phase extraction (SPE) and determination by liquid chromatography coupled to high resolution mass spectrometry (LC-HRMS). The method was applied to the analysis of influent sewage samples from 3 wastewater treatment plants (WWTPs) from Cadiz Bay (SW Spain), enabling the quantification of more than 100 pharmaceuticals, 19 of them at average concentrations higher than 1 μg L^-1, including caffeine (92 μg L^-1), paracetamol (72 μg L^-1), and ibuprofen (56 μg L^-1), as well as several illicit drugs (e.g., cocaine). Wastewater based epidemiology (WBE) was applied for 27 of the detected compounds to establish their consumption in the sampling area, which has been never attempted before. Caffeine, naproxen, and salicylic acid stood out because of their high consumption (638, 51, and 20 g d^-1·1000pop^-1, respectively). Regarding illicit drugs, cocaine showed the highest frequency of detection and we estimated an average consumption of 3683 mg d^-1·1000pop^-1 in Cadiz Bay. The combination of new HRMS methods, capable of discriminating thousands of chemicals, and WBE will allow for a more comprehensive characterization of chemical substances and their consumption in urban environments in the near future.

Long-term wastewater-based surveillance and impacts of the COVID-19 pandemic on drug use trends in a U.S. Northeast rural town

Herein we discuss the findings of a two-year wastewater-based drug use surveillance from September 2018 to August 2020 and present objective evidence on the impacts of the COVID-19 pandemic on drug use in a rural community. 24-h composite wastewater samples were collected twice each month from a university town in Northeastern United States and were analyzed for ten priority opioids and stimulants: morphine, codeine, hydrocodone, methadone, fentanyl cocaine, methamphetamine, amphetamine, 3,4-methylenedioxymethamphetamine (MDMA), and 3,4-methylenedioxy-N-ethylamphetamine (MDEA). All target drugs were detected at 100 % frequency in wastewater samples. On a mass basis, the average estimated per capita drug consumption were highest for cocaine, morphine, and amphetamine, and lowest for MDMA, MDEA, and hydrocodone. Furthermore, the estimated per capita consumption of fentanyl was higher than previous reports from rural and university settings in the U.S. Generally, drug consumption was higher during the spring semesters, with year-on-year semester increases also noted over the 2-y study period. Except for methadone and cocaine, the estimated average per capita consumption of drugs increased over the pandemic period, with the highest increase noted for MDMA (286 % increase compared to baseline, p = 0.016). Estimated average consumption of methadone and cocaine decreased slightly by 6 % and 7 %, respectively. These results demonstrate the utility and strength of wastewater-based approaches in capturing long-term and evolving trends in drug use within communities. Our study findings reflect the regionwide problem with opioid-related overdoses and increasing stimulant prescription rates. Our findings also provide objective data and insights for health policymakers on the effects of the pandemic period on community drug use in a rural U.S. town.

Occurrence of Z-drugs, benzodiazepines, and ketamine in wastewater in the United States and Mexico during the Covid-19 pandemic

Z-drugs, benzodiazepines and ketamine are classes of psychotropic drugs prescribed for treating anxiety, sleep disorders and depression with known side effects including an elevated risk of addiction and substance misuse. These drugs have a strong potential for misuse, which has escalated over the years and was hypothesized here to have been exacerbated during the COVID-19 pandemic. Wastewater-based epidemiology (WBE) constitutes a fast, easy, and relatively inexpensive approach to epidemiological surveys for understanding the incidence and frequency of uses of these drugs. In this study, we analyzed wastewater (n = 376) from 50 cities across the United States and Mexico from July to October 2020 to estimate drug use rates during a pandemic event. Both time and flow proportional composite and grab samples of untreated municipal wastewater were analyzed using solid-phase extraction followed by liquid chromatography-tandem mass spectrometry to determine loadings of alprazolam, clonazepam, diazepam, ketamine, lorazepam, nordiazepam, temazepam, zolpidem, and zaleplon in raw wastewater. Simultaneously, prescription data of the aforementioned drugs were extracted from the Medicaid database from 2019 to 2021. Results showed high detection frequencies of ketamine (90 %), lorazepam (87 %), clonazepam (76 %) and temazepam (73 %) across both Mexico and United States and comparatively lower detection frequencies for zaleplon (22 %), zolpidem (9 %), nordiazepam (<1 %), diazepam (<1 %), and alprazolam (<1 %) during the pandemic. Average mass consumption rates, estimated using WBE and reported in units of mg/day/1000 persons, ranged between 62 (temazepam) and 1100 (clonazepam) in the United States. Results obtained from the Medicaid database also showed a significant change (p < 0.05) in the prescription volume between the first quarter of 2019 (before the pandemic) and the first quarter of 2021 (pandemic event) for alprazolam, clonazepam and lorazepam. Study results include the first detections of zaleplon and zolpidem in wastewater from North America.

Occurrence and Transformation of Ephedrine/Pseudoephedrine and Methcathinone in Wastewater in China

Previous wastewater-based epidemiology studies on methcathinone (MC), a controlled substance in many countries, attributed its occurrence in wastewater to its misuse. However, such attribution did not consider the possibility that MC may also come from the transformation of ephedrine (EPH) and pseudo-ephedrine (PEPH). In this work, EPH/PEPH and MC in wastewater of six major Chinese cities were systematically examined. EPH/PEPH concentrations in all the cities showed clear seasonal variations, with maximum and minimum concentrations observed in winter and summer, respectively. In contrast, MC concentrations were the lowest in winter, leading to minimum concentration ratios between MC and EPH/PEPH in winter. Lack of MC seizure in the cities suggests that MC abuse could not account for the ubiquitous detection of the substance in the wastewater of these cities. Batch experiments confirmed EPH/PEPH transformation into MC in wastewater. The significantly lower transformation rate at a lower temperature was consistent with low MC concentrations in winter. These results indicate that when monitoring MC through wastewater, EPH/PEPH concentrations must be determined simultaneously to avoid false identification of MC abuse. The observed ratios of MC to EPH/PEPH concentrations in this work may be used to determine MC abuse. Alternatively, other biomarkers (e.g., cathinone) may be considered to avoid interference from EPH/PEPH transformation.

Wastewater surveillance for SARS-CoV-2 to support return to campus: Methodological considerations and data interpretation

The COVID-19 pandemic has been challenging for various institutions such as school systems due to widespread closures. As schools re-open their campuses to in-person education, there is a need for frequent screening and monitoring of the virus to ensure the safety of students and staff and to limit risk to the surrounding community. Wastewater surveillance (WWS) of SARS-CoV-2 is a rapid and economical approach to determine the extent of COVID-19 in the community. The focus of this review is on the emergence of WWS as a tool for safe return to school campuses, taking into account methodological considerations such as site selection, sample collection and processing, SARS-CoV-2 quantification, and data interpretation. Recently published studies on the implementation of COVID-19 WWS on school and college campuses were reviewed. While there are several logistical and technical challenges, WWS can be used to inform decision-making at the school campus and/or building level.

Identification of biomarkers in wastewater-based epidemiology: Main approaches and analytical methods

Wastewater-based epidemiology (WBE) has become popular to estimate the use of drugs of abuse and recently to establish the incidence of CoVID 19 in large cities. However, its possibilities have been expanded recently as a technique that allows to establish a fingerprint of the characteristics of a city, such as state of health/disease, healthy/unhealthy living habits, exposure to different types of contaminants, etc. with respect to other cities. This has been thanks to the identification of human biomarkers as well as to the fingerprinting and profiling of the characteristics of the wastewater catchment that determine these circumstances. The purpose of this review is to analyze the different methodological schemes that have been developed to perform this biomarker identification as well as the most characteristic analytical techniques in each scheme, their advantages and disadvantages and the knowledge gaps identified. We also discussed the future scope for development.

Wastewater analysis of psychoactive drugs: Non-enantioselective vs enantioselective methods for estimation of consumption

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.

International snapshot of new psychoactive substance use: Case study of eight countries over the 2019/2020 new year period

There is considerable concern around the use of new psychoactive substances (NPS), but still little is known about how much they are really consumed. Analysis by forensics laboratories of seized drugs and post-mortem samples as well as hospital emergency rooms are the first line of identifying both 'new' NPS and those that are most dangerous to the community. However, NPS are not necessarily all seized by law enforcement agencies and only substances that contribute to fatalities or serious afflictions are recorded in post-mortem and emergency room samples. To gain a better insight into which NPS are most prevalent within a community, complementary data sources are required. In this work, influent wastewater was analysed from 14 sites in eight countries for a variety of NPS. All samples were collected over the 2019/2020 New Year period, a time which is characterized by celebrations and parties and therefore a time when more NPS may be consumed. Samples were extracted in the country of origin following a validated protocol and shipped to Australia for final analysis using two different mass spectrometric strategies. In total, more than 200 were monitored of which 16 substances were found, with geographical differences seen. This case study is the most comprehensive wastewater analysis study ever carried out for the identification of NPS and provides a starting point for future, ongoing monitoring of these substances.