{"id":31699,"date":"2019-06-03T10:12:21","date_gmt":"2019-06-03T14:12:21","guid":{"rendered":"https:\/\/www.fondriest.com\/news\/?p=31699"},"modified":"2025-01-20T15:36:43","modified_gmt":"2025-01-20T19:36:43","slug":"tracking-opioids-in-municipal-wastewater","status":"publish","type":"post","link":"https:\/\/www.fondriest.com\/news\/tracking-opioids-in-municipal-wastewater.htm","title":{"rendered":"Tracking Opioids in Municipal Wastewater"},"content":{"rendered":"

By 2016,<\/span> tens of thousands<\/span><\/a> of Americans were dying with<\/span> opioids as the primary cause of death<\/span><\/a>. This has prompted officials to search for new ways to intervene, producing a need to monitor and track how and where people become addicted to opioids. However, due to legal risk and social stigma, self-reported opioid use is not always accurate, leaving public health officials hungry for good data. Moreover, the typical data sources used to monitor community drug use have serious time lags that hamper real-time decision-making. <\/span><\/p>\n

This issue has inspired<\/span> recent work<\/span><\/a> into tracking opioids in municipal wastewater from researchers at<\/span> Mathematica<\/span><\/a>, an employee-owned company dedicated to improving public health and wellbeing.<\/span> Aparna Keshaviah, Sc.M.<\/span><\/a>, a senior statistician at Mathematica, spoke to <\/span>EM<\/span><\/i> about the work.<\/span><\/p>\n

\u201cIn 2016, a group of us started looking at the opioid epidemic,\u201d explains Ms. Keshaviah. \u201cIt had been in the news for a long time, and we realized that the traditional ways of tackling the problem weren\u2019t working, from the way we\u2019re asking questions to the data sources that we\u2019re using. We came across this idea for wastewater testing, which had been used to track other illicit drugs like cocaine, and even things like pharmaceutical and personal care products. Yet there hadn\u2019t been a lot of talk about using wastewater testing for opioids.\u201d<\/span><\/p>\n

But more addicts, patients, and overdose deaths have forced policymakers to look for better, more timely answers, and the team was hoping to provide them with some.<\/span><\/p>\n

\u201cWe started looking for better data sources because through our behavioral health work with SAMHSA [the Substance Abuse and Mental Health Services Administration, within the U.S. Department of Health and Human Services], we saw that traditional drug surveillance data has terrible lags and some serious limitations,\u201d details Ms. Keshaviah. \u201cThe most common data sources are national population surveys, which are typically not available until one to two years after the data are collected. We\u2019re always playing catch-up with these surveys, which also lack resolution geographically, and present problems because of biases and underreporting of a stigmatized behavior.\u201d<\/span><\/p>\n

Adding in the healthcare data from first responders and emergency rooms\u2014known as \u201cconsequence data\u201d because it\u2019s frequently collected after an overdose when it\u2019s too late to intervene\u2014reveals biases as well.<\/span><\/p>\n

\"wastewater\"

The program from A Symposium on the Potential of Wastewater Testing for Public Health and Safety. (Credit: Aparna Keshaviah)<\/p><\/div>\n

\u201cThese data miss people who are outside of the healthcare system, which can really be a substantial portion of people who use illicit drugs,\u201d Ms. Keshaviah describes. \u201cWe realized that there is a need for a better, more real-time, and objective data source that isn\u2019t prone to problems because an individual misremembers or misreports their substance use. So we started looking into whether wastewater monitoring could be used to provide a real-time measure of opioid use in a community.\u201d<\/span><\/p>\n

The need for wastewater monitoring data<\/span><\/h3>\n

Tracking a community\u2019s drug use through wastewater testing, offers rich data that can yield geographically precise measures, usually at the county level.<\/span><\/p>\n

\u201cBecause of the infrastructure put into place as a result of the Clean Water Act in the 1970s, we actually have fairly routine and consistent processes for sampling that are already being used across the country,\u201d states Ms. Keshaviah. \u201cTapping into that to get data on community drug use started our thinking.\u201d<\/span><\/p>\n

The team noted a gap in the literature that was probably hampering the work of policymakers.<\/span><\/p>\n

\u201cMany of the publications we saw were not focused on opioids, and most were also within the academic realm, published in peer-reviewed journals only,\u201d comments Ms. Keshaviah. \u201cMany people on Capitol Hill weren\u2019t even aware of this methodology. We saw the perfect opportunity to bridge the silos that exist in this work.\u201d<\/span><\/p>\n

This research was shaped not just by questions about opioid use, but also by who has a need for that data.<\/span><\/p>\n

\u201cSelf-reporting is simply not that reliable,\u201d remarks Ms. Keshaviah. \u201cEven if it is consistently under-reported so that you could track trends reliably over time, that doesn\u2019t help the police officer, the first responder, or the front line clinician know what drugs are emerging in the community.\u201d This lack of timely transparency hinders effective prevention and treatment.<\/span><\/p>\n

The recent Fentanyl scare across the country is a great example of this problem and the need for more granular data.<\/span><\/p>\n

\u201cWe started to hear about highly potent Fentanyl being mixed in with heroine a couple years ago\u2014something that water testing possibly could have picked up if used for surveillance in the way we are recommending,\u201d Ms. Keshaviah says. \u201cIt\u2019s hard to detect Fentanyl in a single individual who comes into the E.R. with an overdose because it\u2019s consumed in such small quantities. But when you\u2019re looking collectively at a community it\u2019s much easier to detect whether there is any Fentanyl there, yes or no. Law enforcement agencies then know, for example, that their officers need to be wearing protective masks when they see drugs on the street since coming into contact with even a few grains of Fentanyl can be deadly.\u201d<\/span><\/p>\n

These kinds of data can also help educate and protect public health and safety.<\/span><\/p>\n

\"wastewater\"

Dr. Jochen Mueller, a colleague from University of Queensland, Australia, speaks at the symposium. (Credit: Aparna Keshaviah)<\/span><\/p><\/div>\n

\u201cPeople often have no idea what they\u2019re taking,\u201d adds Ms. Keshaviah. \u201cThey think they\u2019re buying one drug and they\u2019re actually getting something else. So self-reported data on drug use can be problematic. But the chemical analysis doesn\u2019t lie. It will tell you what people consumed.\u201d<\/span><\/p>\n

Two methods for monitoring wastewater<\/span><\/h3>\n

There are two different ways to analyze wastewater for compounds like opioids.<\/span><\/p>\n

\u201cYou can do targeted testing for specific compounds, to see how much of a compound there is circulating in a community,\u201d explains Ms. Keshaviah. \u201cYou can also do untargeted testing if you don\u2019t know what you\u2019re looking for and want know what all is in the wastewater. You get a chemical profile for a sample and compare it manually against the signatures of known compounds in the universe.\u201d<\/span><\/p>\n

This is more labor intensive, but important because new pharmaceutical trends arise frequently, and some are dangerous.<\/span><\/p>\n

\u201cFor example, a few years ago, populations starting abusing Imodium A.D., also known as loperamide, to get high cheaply with an over-the-counter drug,\u201d Ms. Keshaviah describes. \u201cThat\u2019s something we wouldn\u2019t know to look for as a drug of abuse. And although it\u2019s labor intensive to test for unexpected compounds, you don\u2019t have to do that every day. You can do untargeted testing periodically in an area, to get an early warning as new drug threats emerge.\u201d<\/span><\/p>\n

Localities or public health agencies can also conduct targeted testing to determine whether to use of problematic compounds is decreasing, increasing, or plateauing in response to policies or programs.<\/span><\/p>\n

\u201cThere are some place-specific challenges because wastewater treatment plant designs vary,\u201d details Ms. Keshaviah. \u201cIn some locations, stormwater mixes in with sewage and industrial runoff, which can dilute concentrations of drugs and make them difficult to detect. In other places, it\u2019s more of a closed system. By understanding that kind of variability across the country, you can try to correct for its effects when developing wastewater sampling plans, back-calculating estimates of use, and comparing estimates from one region to another.\u201d<\/span><\/p>\n

The Environmental Protection Agency (EPA) generated the foundational idea to use wastewater testing for community drug use in the early 2000s. And although one of the first pilot studies was conducted in the U.S., by ONDCP [the Office of National Drug Control Policy], the methodology never fully caught on in the U.S. and was instead first adopted widely in Europe. Many protocols for sampling have been developed by a network of researchers abroad, and wastewater researchers here in the U.S. are collaborating with their international colleagues and learning from them.<\/span><\/p>\n

\u201cWastewater testing is actually being used as a routine surveillance tool around Europe, Australia, and increasingly in China,\u201d comments Ms. Keshaviah. \u201cWhile it hasn\u2019t been adopted widely in the U.S., we have seen an uptick in the number of pilot studies here in recent years. Mathematica hosted a symposium in 2017, funded by Arnold Ventures, with the goal of raising the profile of the methodology, talking through what kind of information various stakeholders need, and whether wastewater testing could address the challenges they face in their day-to-day work on the opioid epidemic. Data and lack of resources were the top two challenges that everyone mentioned.\u201d<\/span><\/p>\n

Compared with national surveys, wastewater monitoring is a fairly cost-effective technique.<\/span><\/p>\n

\"wastewater\"

Aparna Keshaviah discusses tracking opioids in municipal wastewater. (Credit: Aparna Keshaviah)<\/p><\/div>\n

\u201cThe methodology taps into infrastructure that already exists,\u201d Ms. Keshaviah says. \u201cThe wastewater plants already collect samples every day. In these pilot studies that we are helping to implement, the wastewater treatment operators are actually donating much of their time and efforts\u2014because they are already doing the work.\u201d<\/span><\/p>\n

\u201cThe opioid epidemic is not going away anytime soon, and there is now funding to help states address the issue,\u201d adds Ms. Keshaviah. \u201cBut states need ideas for new approaches. \u2018We have tried a lot of things, what else can we look at,\u2019 they ask. There is this kind of plea for better data, more help, and novel strategies to combat the problem.\u201d<\/span><\/p>\n

Better data for proactive policymaking<\/span><\/h3>\n

More interest in collaboration is fueling a need for wastewater pilot studies, especially as the full potential for the technology is explored.<\/span><\/p>\n

\u201cWe\u2019re developing a list of wastewater researchers in the U.S. so that when we get a cold call from a clinician who wants to start a pilot study, we can connect them to local wastewater researchers,\u201d explains Ms. Keshaviah. \u201cActually, you can test for many different population health markers with wastewater, including medication use, compliance with Tamiflu prescriptions during flu season, the prevalence of chronic diseases like diabetes, or trends in obesity. Increasingly, researchers are even able to parse out different types of microbiomes, which can really influence your susceptibility to different diseases. And you can track things like viruses and other pathogens, such as polio and hepatitis, to try and predict future outbreaks before they happen.\u201d <\/span><\/p>\n

Wastewater data is even more powerful when combined with other data sources. Among the reasons wastewater testing hadn\u2019t been used for opioids in the past is the fact that many different opioids convert into the same compound, morphine, over time.<\/span><\/p>\n

\u201cIn studies in Europe, we\u2019ve seen data triangulation successfully used to parse out illicit use from prescription use. Here in the U.S., we could combine wastewater data with prescription drug monitoring program data, and use information on how many prescriptions were written in the area to try to triangulate illicit opioid use,\u201d describes Ms. Keshaviah. \u201cThe methodology is even being used to estimate the size of the black market for marijuana after a state has legalized recreational use. You can use wastewater data to estimate total marijuana use, and then subtract out legal use based on marijuana sales data, to get an indication of black market sales.\u201d<\/span><\/p>\n

Up next for the team working to promote this technology?<\/span><\/p>\n

\u201cWastewater testing is such an underutilized data source that we\u2019re still trying to figure out what the real challenges are for adoption,\u201d remarks Ms. Keshaviah. \u201cIt\u2019s preliminary, but there is definitely interest from the government. For example, we\u2019ve been briefing FDA, NIH, and other agencies on the methodology since the symposium, and we learned that NIH\/NIDA just created a new funding stream for small businesses to improve wastewater testing methods.\u201d<\/span><\/p>\n

This may well be a moment for this kind of data collection, and the people who can put it to better use.<\/span><\/p>\n

\u201cThere are so many interesting questions that are of policy relevance, comments Ms. Keshaviah. \u201cThis work is so very early in the U.S., and this is really where Mathematica is trying to help bring the tool to the people who need it, who can make decisions with it to improve public health and safety. And as a statistician, I\u2019m very happy to lead this charge and make the case that we need better data! People are starting to listen now. There is a lot more receptivity to new ideas and new ways of doing things.\u201d<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

New work on monitoring wastewater for opioids reveals many new applications for the technology.<\/p>\n","protected":false},"author":31,"featured_media":31704,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[6,8,510],"tags":[1717,75,60,1720,1723,500,1721,1718,109,1722,1715,1716,1719,99],"class_list":["post-31699","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-monitoring_tech-htm","category-newsfeed","category-water-quality","tag-aparna-keshaviah","tag-epa","tag-featured","tag-fentanyl","tag-mathematica","tag-monitoring","tag-monitoring-wastewater","tag-municipal-wastewater","tag-news-ticker","tag-ondcp","tag-opioids","tag-public-health","tag-samhsa","tag-wastewater"],"remote_post_permalink":false,"remote_post_featured_image":false,"yoast_head":"\nTracking Opioids in Municipal Wastewater<\/title>\n<meta name=\"description\" content=\"New work on monitoring 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