Spatio-temporal assessment of illicit drug use at large scale: evidence from 7 years of international wastewater monitoring

Iria González-Mariño*, Jose Antonio Baz-Lomba, Nikiforos A Alygizakis, Maria Jesús Andrés-Costa, Richard Bade, Leon P Barron, Frederic Been, Jean-Daniel Berset, Lubertus Bijlsma, Igor Bodík, Asher Brenner, Andreas Libonati Brock, Daniel A Burgard, Erika Castrignanò, Christophoros E Christophoridis, Adrian Covaci, Pim de Voogt, Damien A Devault, Mário J Dias, Erik EmkeDespo Fatta-Kassinos, Ganna Fedorova, Konstantinos Fytianos, Cobus Gerber, Roman Grabic, Stefan Grüner, Teemu Gunnar, Evroula Hapeshi, Ester Heath, Björn Helm, Félix Hernández, Aino Kankaanpaa, Sara Karolak, Barbara Kasprzyk-Hordern, Ivona Krizman-Matasic, Foon Yin Lai, Wojciech Lechowicz, Alvaro Lopes, Miren López de Alda, Ester López-García, Arndís S C Löve, Nicola Mastroianni, Gillian L McEneff, Rosa Montes, Kelly Munro, Thomas Nefau, Herbert Oberacher, Jake W O'Brien, Kristin Olafsdottir, Yolanda Picó, Benedek G. Plósz, Fabio Polesel, Cristina Postigo, José Benito Quintana, Pedram Ramin, Malcolm J Reid, Jack Rice, Rosario Rodil, Ivan Senta, Susana M Simões, Maja M Sremacki, Katarzyna Styszko, Senka Terzic, Nikolaos S Thomaidis, Kevin V Thomas, Ben J Tscharke, Alexander L N van Nuijs, Viviane Yargeau, Ettore Zuccato, Sara Castiglioni, Christoph Ort

*Corresponding author for this work

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Wastewater-based epidemiology is an additional indicator of drug use that is gaining reliability to complement the current established panel of indicators. The aims of this study were to: (i) assess spatial and temporal trends of population-normalized mass loads of benzoylecgonine, amphetamine, methamphetamine and 3,4-methylenedioxymethamphetamine (MDMA) in raw wastewater over 7 years (2011-17); (ii) address overall drug use by estimating the average number of combined doses consumed per day in each city; and (iii) compare these with existing prevalence and seizure data. Analysis of daily raw wastewater composite samples collected over 1 week per year from 2011 to 2017. Catchment areas of 143 wastewater treatment plants in 120 cities in 37 countries. Parent substances (amphetamine, methamphetamine and MDMA) and the metabolites of cocaine (benzoylecgonine) and of Δ9 -tetrahydrocannabinol (11-nor-9-carboxy-Δ9 -tetrahydrocannabinol) were measured in wastewater using liquid chromatography-tandem mass spectrometry. Daily mass loads (mg/day) were normalized to catchment population (mg/1000 people/day) and converted to the number of combined doses consumed per day. Spatial differences were assessed world-wide, and temporal trends were discerned at European level by comparing 2011-13 drug loads versus 2014-17 loads. Benzoylecgonine was the stimulant metabolite detected at higher loads in southern and western Europe, and amphetamine, MDMA and methamphetamine in East and North-Central Europe. In other continents, methamphetamine showed the highest levels in the United States and Australia and benzoylecgonine in South America. During the reporting period, benzoylecgonine loads increased in general across Europe, amphetamine and methamphetamine levels fluctuated and MDMA underwent an intermittent upsurge. The analysis of wastewater to quantify drug loads provides near real-time drug use estimates that globally correspond to prevalence and seizure data.
Original languageEnglish
Issue number1
Publication statusPublished - 2020


  • Amphetamine
  • Cocaine
  • Ecstasy/MDMA
  • Illicit drugs
  • Methamphetamine
  • Wastewater-based epidemiology


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