Data triangulation in the context of opioids monitoring via wastewater analyses.

BACKGROUND The need to contextualise wastewater-based figures about illicit drug consumption by comparing them with other indicators has been stressed by numerous studies. The objective of the present study was to further investigate the possibility of combining wastewater data to conventional statistics to assess the reliability of the former method and obtain a more balanced picture of illicit drug consumption in the investigated area. METHODS Wastewater samples were collected between October 2013 and July 2014 in the metropolitan area of Lausanne (226,000 inhabitants), Switzerland. Methadone, its metabolite 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP), the exclusive metabolite of heroin, 6-monoacetylmorphine (6-MAM), and morphine loads were used to estimate the amounts of methadone and heroin consumed. RESULTS Methadone consumption estimated from EDDP was in agreement with the expectations. Heroin estimates based on 6-MAM loads were inconsistent. Estimates obtained from morphine loads, combined to prescription/sales data, were in agreement with figures derived from syringe distribution data and general population surveys. CONCLUSIONS The results obtained for methadone allowed assessing the reliability of the selected sampling strategy, supporting its ability to capture the consumption of a small cohort (i.e., 743 patients). Using morphine as marker, in combination with prescription/sales data, estimates in accordance with other indicators about heroin use were obtained. Combining different sources of data allowed strengthening the results and suggested that the different indicators (i.e., administration route, average dosage and number of consumers) contribute to depict a realistic representation of the phenomenon in the investigated area. Heroin consumption was estimated to approximately 13 gd ay(-1) (118 g day(-1) at street level).

[1]  Daniel A. Burgard,et al.  Working upstream: how far can you go with sewage-based drug epidemiology? , 2014, Environmental science & technology.

[2]  Ronny Blust,et al.  The stability of illicit drugs and metabolites in wastewater, an important issue for sewage epidemiology? , 2012, Journal of hazardous materials.

[3]  Barbara Kasprzyk-Hordern,et al.  Critical evaluation of methodology commonly used in sample collection, storage and preparation for the analysis of pharmaceuticals and illicit drugs in surface water and wastewater by solid phase extraction and liquid chromatography-mass spectrometry. , 2011, Journal of chromatography. A.

[4]  Jason M. White,et al.  Evaluation of pre-analysis loss of dependent drugs in wastewater: stability and binding assessments. , 2013, Drug testing and analysis.

[5]  Usman Khan,et al.  Refined sewer epidemiology mass balances and their application to heroin, cocaine and ecstasy. , 2011, Environment international.

[6]  H. Neels,et al.  A one year investigation of the occurrence of illicit drugs in wastewater from Brussels, Belgium. , 2011, Journal of environmental monitoring : JEM.

[7]  Christoph Ort,et al.  Sampling for pharmaceuticals and personal care products (PPCPs) and illicit drugs in wastewater systems: are your conclusions valid? A critical review. , 2010, Environmental science & technology.

[8]  B. Kasprzyk-Hordern,et al.  Drugs of abuse in wastewater and suspended particulate matter--further developments in sewage epidemiology. , 2012, Environment international.

[9]  W Gujer,et al.  Sampling for representative micropollutant loads in sewer systems. , 2006, Water science and technology : a journal of the International Association on Water Pollution Research.

[10]  S. Rudaz,et al.  Population normalization with ammonium in wastewater-based epidemiology: application to illicit drug monitoring. , 2014, Environmental science & technology.

[11]  A. Jeannin,et al.  Trends in drug consumption and risk of transmission of HIV and hepatitis C virus among injecting drug users in Switzerland, 1993-2006. , 2008, Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin.

[12]  Barbara Kasprzyk-Hordern,et al.  Illicit and pharmaceutical drug consumption estimated via wastewater analysis. Part A: chemical analysis and drug use estimates. , 2014, The Science of the total environment.

[13]  F Taroni,et al.  A methodology for illicit heroin seizures comparison in a drug intelligence perspective using large databases. , 2003, Forensic science international.

[14]  Steven Edward Kern,et al.  Pharmacokinetics of Methadone , 2005, Journal of pain & palliative care pharmacotherapy.

[15]  I. Senta,et al.  Integrated procedure for multiresidue analysis of dissolved and particulate drugs in municipal wastewater by liquid chromatography–tandem mass spectrometry , 2013, Analytical and Bioanalytical Chemistry.

[16]  C. Banta-Green,et al.  Normalized diurnal and between-day trends in illicit and legal drug loads that account for changes in population. , 2012, Environmental science & technology.

[17]  Barbara Kasprzyk-Hordern,et al.  Illicit and pharmaceutical drug consumption estimated via wastewater analysis. Part B: Placing back-calculations in a formal statistical framework , 2014, The Science of the total environment.

[18]  Merete Grung,et al.  Estimation of cocaine consumption in the community: a critical comparison of the results from three complimentary techniques , 2012, BMJ Open.

[19]  M. Reid,et al.  Recent trends in the availability and use of amphetamine and methamphetamine in Norway. , 2015, Forensic science international.

[20]  A. Pesce,et al.  Evaluating the relationship of methadone concentrations and EDDP formation in chronic pain patients. , 2012, Journal of analytical toxicology.

[21]  Ronny Blust,et al.  Sewage epidemiology--a real-time approach to estimate the consumption of illicit drugs in Brussels, Belgium. , 2011, Environment international.

[22]  F. Dubois-Arber,et al.  Résultats de l'enquête 2011 auprès des usagers des structures à bas-seuil en Suisse , 2012 .

[23]  G. Tan,et al.  Gas chromatographic method validation for the analysis of major components in illicit heroin seized in Malaysia. , 2012, Science & justice : journal of the Forensic Science Society.

[24]  Paul Griffiths,et al.  Testing wastewater to detect illicit drugs: state of the art, potential and research needs. , 2014, The Science of the total environment.

[25]  D. Epstein,et al.  Methadone and metabolite urine concentrations in patients maintained on methadone. , 2003, Journal of analytical toxicology.

[26]  R. Braithwaite,et al.  A pilot study to determine the usefulness of the urinary excretion of methadone and its primary metabolite (EDDP) as potential markers of compliance in methadone detoxification programs. , 1999, Journal of analytical toxicology.

[27]  R. Houde,et al.  A dinical eomparison of the analgesie effects of methadone and morphine administered intramuseularly, and oforally and parenterally administered methadone , 1967, Clinical pharmacology and therapeutics.

[28]  Damià Barceló,et al.  Evaluation of drugs of abuse use and trends in a prison through wastewater analysis. , 2011, Environment international.

[29]  Y. Lévi,et al.  Drug analysis of residual content of used syringes: a new approach for improving knowledge of injected drugs and drug user practices. , 2015, The International journal on drug policy.

[30]  Christoph Mathieu,et al.  Analysis of llicit and illicit drugs in waste, surface and lake water samples using large volume direct injection high performance liquid chromatography--electrospray tandem mass spectrometry (HPLC-MS/MS). , 2010, Chemosphere.

[31]  Christoph Ort,et al.  Comparing illicit drug use in 19 European cities through sewage analysis. , 2012, The Science of the total environment.

[32]  J. Volavka,et al.  Methadone in man: Pharmacokinetic and excretion studies in acute and chronic treatment , 1975, Clinical pharmacology and therapeutics.

[33]  Paul Griffiths,et al.  UvA-DARE ( Digital Academic Repository ) Spatial differences and temporal changes in illicit drug use in Europe quantified by wastewater analysis , 2014 .

[34]  I. Senta,et al.  Illicit drugs in wastewater of the city of Zagreb (Croatia)--estimation of drug abuse in a transition country. , 2010, Environmental pollution.

[35]  Ettore Zuccato,et al.  Identification and measurement of illicit drugs and their metabolites in urban wastewater by liquid chromatography-tandem mass spectrometry. , 2006, Analytical chemistry.

[36]  M. Smolka,et al.  The influence of heroin dose and route of administration on the severity of the opiate withdrawal syndrome. , 1999, Addiction.