Helping you stay current in drug monitoring

Monitoring community drug use trends through wastewater analysis

Wastewater is loaded with many things, but one that is often overlooked is information. Wastewater-based epidemiology (WBE) has become better known recently through its use to track COVID-19 spread, but the utility of WBE doesn’t stop there. “WBE can provide insights into dynamic drug consumption trends as well as environmental and toxicological contaminants,” note Timothy Erickson and colleagues, author of a new review of WBE in the Journal of Medical Toxicology. “Applications of WBE include monitoring policy changes with cannabinoid legalization, tracking emerging illicit drugs, and early warning systems for potent fentanyl analogues along with the resurging wave of stimulants (eg, methamphetamine, cocaine).”

Sampling can be done at the wastewater treatment plant, to understand community-wide trends, or further “upstream,” to understand usage patterns in neighborhoods or even individual buildings. “WBE may function in two major modalities in responding to these epidemics [of drug use],” they write. “First, it can be used as a method to understand the prevalence of substance use. This data can be utilized to understand the effectiveness of community-based substance use disorder interventions. Second, WBE can serve as an early warning sentinel system to detect the emergence of drug use epidemics.”

There are ethical and privacy concerns that arise with WBE, especially as the collection points move further upstream. “Although wastewater-based surveillance data is deidentified, inclusive, and unbiased, it could add to increased surveillance scrutiny already faced by certain groups, if not designed explicitly to avoid these issues,” the authors note. “Upstream sampling can be designed to collect aggregate, but not household-level data, so as not to target demographics consistent with existing socioeconomic variability. Otherwise, these populations may be subject to oversurveillance, profiling, and restriction policies.”


Erickson TB, Endo N, Duvallet C, et al. “Waste not, want not” — leveraging sewer systems and wastewater-based epidemiology for drug use trends and pharmaceutical monitoring. J Med Toxicol. 2021:1-14. doil:10.1007/s13181-021-00853-4