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 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 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 on human habits human habits in a defined population
Wastewater - Based Epidemiology Approach A Large Urine Test Collection of raw raw wastewater wastewater samples Composite 24 h samples Mass spectrometric analyses Mass spectrometric analyses Daily flow Concentrations of Target rate rate Residues Residues Amount of target residues Amount of target residues entering a sewage treatment plant per day (g/day) Human metabolism Amounts Amounts of each parent substance parent substance consumed by the population served by the plant
Wastewater-Based Epidemiology: a large urine test The route of the drugs: from the consumer to the STP Illicit Drugs Illicit Drugs CONSUMER Excretes residues of -cocaine the drugs with urine -cannabis after the intake -heroin -amphetamines TREATMENT PLANT TREATMENT PLANT The residues of the drugs are transported to the STP with the wastewater CONSUMPTION ESTIMATE DRUG RESIDUES Amounts of the residues QUANTIFICATION (g/day) are used to back- Wastewater is sampled and calculate drug consumption in the residues of the drugs at the population served by the the STP are quantified STP (g/day of the parent drug )
Potentials of the WBE Approach Ability to provide: � Objective Objective estimates of consumption � Rapid reporting on changes in illicit drug use on changes in illicit drug use at the population level � Real Real- -time time estimates � Spatial and temporal � Spatial and temporal Spatial and temporal trends at different geographical scales 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 WBE approach was proposed as a complementary complementary indicator indicator of drug use
Sewage analysis CORE group (SCORE) Activities 8 European Research Institutes joined 2010 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
Sewage analysis CORE group (SCORE) Activities 1. How to improve data comparability data comparability ? 2. How results from WBE can be used to integrate integrate epidemiological data? Guidelines addressing sampling, Best practice protocol storage and chemical analyses Identification of gaps Minimize or control uncertainties and uncertainty 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 2007 2007- -8: 8: European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) EMCDDA Publications, Demonstration Projects and international conferences New Insight publication New Insight publication on WBE will be presented next month by EMCDDA http://www.emcdda.europa.eu/wastewater-analysis
Wastewater-Based Epidemiology Current applications � 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 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 North ITALY Centre ITALY South ITALY 2.5 ads (g/day/1000 inhabitants) 2.0 *** * *** 1.5 ** 1.0 ** **** Back-calculation using 0.5 Loads cotinine + trans -3’- cotinine + trans -3’- 0.0 hydroxycotinine Nicotine Cotinine trans-3'-hydroxycotinine 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%
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 objective 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, EMCDDA EMCDDA COST Action ES1307 Adrian Covaci, Paul Griffith, Erik Emke Jane Mounteney, Félix Hernández, Danica Thanki, Malcolm Reid, Liesbeth Vandam Christoph Ort, Christoph Ort, Kevin V Thomas, Alexander LN van Nuijs, Pim de Voogt, Ettore Zuccato Thanks for your attention! Thanks for your attention!
Compare WBE with epidemiological data
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