Sara Castiglioni Sara Castiglioni Mario Negri Institute Mario - - PowerPoint PPT Presentation

Wastewater Wastewater-

• based epidemiology as a novel

based epidemiology as a novel tool to evaluate illicit drugs, alcohol and tool to evaluate illicit drugs, alcohol and Sara Castiglioni Sara Castiglioni

Mario Negri Institute Mario Negri Institute

Department of Environmental Health Sciences Department of Environmental Health Sciences Unity of Environmental Biomarkers Unity of Environmental Biomarkers

tool to evaluate illicit drugs, alcohol and tool to evaluate illicit drugs, alcohol and tobacco use in a population tobacco use in a population

Lisbon ADDICTIONS Conference 2015 – Lisbon, 23-25 September 2015

Rational of the approach

Almost all substances

substances we consume consume are excreted are excreted unchanged or as a mixture of metabolites in urine in urine and/faeces and/faeces

Excreted substances end up in sewer sewer network network Enter sewage sewage treatment treatment plants plants

Raw wastewater Raw wastewater represents anonymous urine samples of thousands of people containing traces of excretion products Raw wastewater Raw wastewater contains multiple information

• n human habits

human habits in a defined population

Wastewater - Based Epidemiology Approach

A Large Urine Test Mass spectrometric analyses Mass spectrometric analyses Concentrations of Target Residues

Daily flow rate

Collection of raw raw wastewater wastewater samples

Composite 24 h samples

Residues Amount of target residues Amount of target residues entering a sewage treatment plant per day (g/day)

rate

Amounts Amounts of each parent substance parent substance consumed by the population served by the plant

Human metabolism

Wastewater-Based Epidemiology: a large urine test

The route of the drugs: from the consumer to the STP

Illicit Drugs Illicit Drugs

• cocaine
• cannabis
• heroin
• amphetamines

CONSUMER Excretes residues of the drugs with urine after the intake TREATMENT PLANT CONSUMPTION ESTIMATE Amounts of the residues (g/day) are used to back- calculate drug consumption in the population served by the STP (g/day of the parent drug) TREATMENT PLANT The residues of the drugs are transported to the STP with the wastewater DRUG RESIDUES QUANTIFICATION Wastewater is sampled and the residues of the drugs at the STP are quantified

Ability to provide:

Objective

Objective estimates of consumption

Rapid reporting on changes in illicit drug use

• n changes in illicit drug use at the population level

Real

Real-

• time

time estimates

Potentials of the WBE Approach Spatial and temporal

Spatial and temporal trends at different geographical scales

Identification of the use of novel substances

the use of novel substances

A pre- and post-measure for intervention studies

measure for intervention studies

Spatial and temporal

Spatial and temporal trends at different geographical scales

WBE approach was proposed as a complementary complementary indicator indicator of drug use

Sewage analysis CORE group (SCORE) Activities 2010

8 European Research Institutes joined and a European Collaboration started Objectives

Organize the first

Organize the first Europe Europe-

• wide monitoring

wide monitoring

Establish a

Establish a common protocol common protocol

Check the

Check the performance of analysis performance of analysis through an through an interlaboratory study interlaboratory study

Sewage analysis CORE group (SCORE) Activities

Europe Europe-

• wide monitoring (2011

wide monitoring (2011-

• 2015)

2015)

Results available at: http://www.emcdda.europa.eu/topics/pods/waste-water-analysis

Interlaboratory test (2011 Interlaboratory test (2011-

• 2015) to check the quality of results

2015) to check the quality of results

Each laboratory is required to analyze standards and samples analyze standards and samples spiked at known levels and distributed by one lab – paper in preparation

European study – Regional differences

Thomas et al., STOTEN, 2012

Results from Europe-wide monitoring

LOADS mg/day/1000 people

1. How to improve data comparability data comparability ? 2. How results from WBE can be used to integrate integrate epidemiological data?

Sewage analysis CORE group (SCORE) Activities Best practice protocol

Guidelines addressing sampling, storage and chemical analyses

Identification of gaps and uncertainty

Minimize or control uncertainties Suggestions for each step of WBE

Integrate WBE results with epidemiological data

WBE: Amount of drug used Surveys: Prevalence of drug used

Population surveys compared with wastewater analysis for monitoring illicit drug consumption in Italy in 2010-2014

Ettore Zuccato, Sara Castiglioni, et al. Submitted DAD

Multidisciplinary collaboration Multidisciplinary collaboration

Collaboration with epidemiologists epidemiologists is essential

New Insight publication New Insight publication on WBE will be presented next month by EMCDDA 2007 2007-

• 8:

8: European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) EMCDDA Publications, Demonstration Projects and international conferences

http://www.emcdda.europa.eu/wastewater-analysis

Estimation of illicit drugs consumption

cocaine, amphetamines, ecstasy, cannabis, heroin

Monitoring drinking habits

ethyl sulphate and ethyl glucuronide

Monitoring smoking habits

cotinine and trans-3’-hydroxycotinine

Wastewater-Based Epidemiology

Current applications cotinine and trans-3’-hydroxycotinine

Identify the use of new synthetic recreational drugs

synthetic cannabinoids, cathinones (NPS)

Other potential applications related to lifestyle, health and diet and environment (Thomas and Reid, ES&T, 2011, 45:7611)

Monitoring of drinking habits

Oslo September 2009 (Reid et al., Alcohol Clin. Exp. Res. 2011)

Monitoring of smoking habits

Castiglioni et al., Tobacco Control, 2015

0.5 1.0 1.5 2.0 2.5

ads (g/day/1000 inhabitants)

North ITALY Centre ITALY South ITALY

*** ** **** ** * ***

Back-calculation using cotinine + trans-3’-

0.0 Nicotine Cotinine trans-3'-hydroxycotinine

Loads Number of cigarettes smoked Wastewater analysis Epidemiological survey data Difference (%) Difference (%) Northern Italy 1695538 1701190 +0.3 +0.3 Central Italy 2987243 3114850 +4 +4 Southern Italy 1207092 1112987

• 8%

8%

cotinine + trans-3’- hydroxycotinine

Novel synthetic stimulants

Drug Use in Adelaide, Australia (Chen et al., Forensic Science International, 2013)

Conclusions

Wastewater Wastewater -

• based epidemiology

based epidemiology is a promising novel indicator to measure drug use in a population The approach gives objective and updated information

• bjective and updated information

The approach has been refined by developing a best practice protocol best practice protocol best practice protocol best practice protocol Several attempts were a done to compare data – WBE versus epidemiological data WBE versus epidemiological data Interdisciplinary collaboration Interdisciplinary collaboration is essential to improve the methodologies and their comparison

Thanks

SCORE Group SCORE Group Sara Castiglioni Lubertus Bijlsma, Adrian Covaci, Erik Emke Félix Hernández, Malcolm Reid, Christoph Ort, EMCDDA EMCDDA Paul Griffith, Jane Mounteney, Danica Thanki, Liesbeth Vandam

COST Action ES1307

Thanks for your attention! Thanks for your attention!

Christoph Ort, Kevin V Thomas, Alexander LN van Nuijs, Pim de Voogt, Ettore Zuccato

Compare WBE with epidemiological data