
Wastewater-Based Epidemiology: Estimation of Community Consumption of Drugs and Diets
Understanding Community Health by Analyzing Wastewater. Evaluating wastewater contaminants can enable a community to understand drug consumption, from antibiotics to illegal substances, and even diet. Wastewater-based epidemiology has emerged as a cost‐ and time-effective monitoring tool. The contributed chapters cover the methodological challenges and applications of wastewater-based epidemiology. In addition to public health professionals, wastewater and chemical engineers, students, educators, and administrators will find these topics useful.
Title, Copyright, Foreword
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Preface
Bikram Subedi - ,
Daniel A. Burgard - , and
Bommanna G. Loganathan
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Methodology
Wastewater-Based Epidemiology as a Complementary Approach to the Conventional Survey-Based Approach for the Estimation of Community Consumption of Drugs
Bikram Subedi - and
Dan Burgard
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Wastewater-based epidemiology (WBE) is a rapidly expanding approach that utilizes the concentration of a target chemical in raw wastewater to determine its communitywide exposure or consumption. In this chapter, the methodological and strategic challenges associated with the WBE approach are addressed. WBE’s potential to establish a cost- and time-effective early warning system for established drugs, new psychoactive substances, and public health biomarkers, as well as its potential as a tool for the evaluation of drug control policies are discussed.
Analytical Techniques for the Identification and Quantification of Drugs and Metabolites in Wastewater Samples
Nicole Centazzo - and
Marta Concheiro-Guisan
The qualitative and quantitative analysis of drugs and metabolites in wastewater samples constitutes a real challenge for wastewater-based epidemiology applications. Wastewater samples are extremely complex matrices of variable composition, the expected concentrations of the analytes of interest are low, in the nanogram per liter range, and the number of compounds to be analyzed is high, including drugs of abuse, pharmaceuticals, and metabolites, among others. In this chapter, we critically describe the current workflow in the analysis of wastewater samples, including filtration or centrifugation, extraction, chromatographic separation, and mass spectrometric analysis. We also review the currently available data on in-sample stability, method validation, and confirmation criteria.
GC-MS Methods for Monitoring Illicit Drug Biomarkers in Wastewater: A Critical Review
Kevin J. Bisceglia - ,
Gianna Kroening - , and
Bikram Subedi
Wastewater-based epidemiology (WBE), the practice of using wastewater monitoring to track patterns in community-level public health, is a promising technique for monitoring trends in illicit drug use within municipalities. To date, most analytical methods developed for WBE employ liquid chromatography–tandem mass spectrometry (LC-MS/MS) for separation and quantitation of drug biomarkers. In contrast, very little attention has been devoted to exploring gas chromatography–mass spectrometry (GC-MS) as an analytical technique for WBE. Though less convenient, GC-MS is both more affordable and more widely available than LC-MS/MS, particularly at smaller institutions. This review summarizes published GC-MS methods that have been used for the determination of illicit drug biomarkers in municipal wastewater. It also draws insights from comparable methods that have been developed to monitor illicit drug biomarkers in urine. In doing so, it provides a biomarker-specific resource for researchers wishing to use GC-MS as part of a WBE investigation.
Uncertainties Associated with Wastewater-Based Epidemiology for the Estimation of Community Consumption of Drugs
Bikram Subedi
Wastewater-based epidemiology utilizes the level of residual parent drugs or metabolites in raw wastewater, total wastewater inflow during sampling, and rate of wastewater inflow as well as data on the population served by the wastewater treatment plant, human pharmacokinetics, and the stability of the drug residues in the sewer network and in the collected wastewater to estimate the consumption rate of drugs in a community. Despite opportunities for wastewater-based epidemiology, there are several analytical uncertainties associated with the sampling, sample preparation, instrumental analysis, analytical data treatment, and postanalysis calculations. Analytical uncertainties primarily result from the complexity of the sample and the unavailability of a standard protocol for sample preparation, analyses, and treatment of nondetects or statistically nonsignificant data points. Very few studies have accounted for the variability of the stability of drugs in wastewater, the unpredictable patterns of human consumption of drugs, the population dynamicity in the catchment area, and the differences in the excretion rate of drug residues. This chapter highlights the major uncertainties associated with the application of wastewater-based epidemiology.
Wastewater-Based Epidemiological Engineering—Modeling Illicit Drug Biomarker Fate in Sewer Systems as a Means To Back-Calculate Urban Chemical Consumption Rates
Benedek Gy. Plósz - and
Pedram Ramin
In this chapter, we present the Activated Sludge Model for Xenobiotics (ASM-X), which offers the largest systematic and consistent database to predict illicit drug and pharmaceutical biomarker fate in wastewater conveyed in sewer pipes. ASM-X was originally developed for predicting the removal of trace organic pharmaceutical chemical pollutants (micropollutants), notably antibiotics in biological wastewater treatment. Here, we present the identification of simulation models in the ASM-X framework for illicit biomarker transformation, physicochemical partitioning onto particulate matter, and diffusive transport in biofilms. Model parameters were estimated using experimental data obtained with in-sewer biocatalytic environments represented by suspended solids and biofilm. A systematic methodology for inferring reliable estimates of unique parameter sets in tandem with chemical transformation pathways was developed using Bayesian optimization. This is a method that can be generalized to any other chemodynamics problems focusing on quantifying chemical biotransformation using external prior metabolic information. The method developed can offer a platform to promote a more effective interaction between analytical chemists and modelers to develop smart experimental designs conducive to effective model development. Additionally, the identification method developed can be used in conjunction with optimal experimental designs to effectively identify model structures and parameters.
Applications
Application of Wastewater-Based Epidemiology in China—From Wastewater Monitoring to Drug Control Efforts
Xiqing Li - ,
Peng Du - , and
Wei Zhang
Wastewater-based epidemiology (WBE) studies have been carried out in China since 2011. Since 2014, WBE has been used to compare primary drug use in major cities across the country. The occurrence of some new psychoactive substances in wastewater from Chinese cities was also examined. WBE monitoring has also drawn strong interest from drug control authorities at all levels in China. In this chapter, the monitoring results, including some new data, on abuse of primary drugs (methamphetamine and ketamine) in China in recent years are summarized. The progress in using wastewater monitoring to support drug control efforts and the wastewater-based monitoring programs launched by drug control authorities in China are also reviewed. Application of WBE in China has demonstrated that this approach holds great promise for evaluating the effectiveness of drug control campaigns, initiatives, and policies.
Wastewater-Based Epidemiology as an Input to National Statistics on Recreational Drug Use: A Canadian Pilot Study
Viviane Yargeau - and
Tim Werschler
Legalization of cannabis production, sale, and use in Canada in 2018 serves as the context for the formulation and implementation of the largest wastewater-based epidemiology (WBE) pilot test conducted to date in North America (8.4 million people) and the first by a national statistical agency. Matters of design, sampling, and chemical analysis are discussed. Key findings from the first six months of collection are presented, but more importantly, several counterintuitive findings are used to demonstrate priority areas requiring further research. The authors call for collaboration across several related disciplines in order to improve the utility of WBE for applications in public and environmental health.
Utilizing Wastewater-Based Epidemiology To Determine Temporal Trends in Illicit Stimulant Use in Seattle, Washington
Rosie Rushing - and
Daniel A. Burgard
Wastewater-based epidemiology (WBE) has proven to be a useful tool in estimating illicit drug consumption of a community or population. WBE can determine near real-time drug use without the bias of surveys, making it an invaluable, complementary tool in determining community drug use and public health. Seattle wastewater has been collected and measured from 2015–2018, encompassing Seattle Pride in June. This event brings thousands of visitors to Seattle to participate in a variety of events, concerts, and parades. In 2017, more than 200,000 people were estimated to have participated in Seattle Pride on June 24 and 25. Previous studies have shown that illicit drug use, specifically 3,4-methylenedioxymethamphetamine (MDMA), is frequent at festivals in the United States and internationally. Wastewater was collected as daily 24-h composites for two consecutive weeks from the Westpoint treatment plant in Seattle. MDMA, amphetamine, methamphetamine, cocaine and its metabolite (benzoylecgonine) were extracted from wastewater using solid phase extraction and analyzed using a liquid chromatography–mass spectrometry (LC-MS/MS). Daily drug consumption estimates show that the days surrounding Seattle Pride contained increased loads of illicit stimulants, specifically MDMA.
Detection in Sewage and Community Consumption of Stimulant Drugs in Northeastern United States
Sheree Pagsuyoin - ,
Jiayue Luo - , and
Dhimiter Bello
Recent increases in drug abuse trends exert great pressure on already burdened health care systems. Addressing this problem requires appropriate intervention programs that depend on the timely availability of reliable information on drug use behaviors within communities. The present study examines the consumption of stimulant drugs in the Northeastern United States using wastewater data collected from three wastewater treatment plants (WWTPs): WWTP1 (4 mega-gallons per day, MGD) services a university town; WWTP2 (25 MGD) services a medium-sized city, and WWTP3 (380 MGD) services a large metropolitan area. Twenty-four-hour composite influent wastewater samples were collected and analyzed for five target chemicals: cocaine, benzoylecgonine (cocaine metabolite), methamphetamine, amphetamine, and ecstasy. Target analytes were extracted using solid phase extraction and analyzed in a liquid chromatograph tandem mass spectrometer. All analytes were detected in the samples; however, there were differences in the relative concentrations of each analyte across the three plants. Influent concentrations were highest for benzoylecgonine (102–103 ng/L) and lowest for ecstasy (10 ng/L). Average community consumption rates for the target drugs were also calculated using biological oxygen demand as a surrogate for population size. Estimates indicate highest consumption rate for cocaine (517–926 mg/day/1000 people) and lowest for ecstasy (4–5 mg/day/1000 people). Consumption rates were generally higher in the metropolitan area (WWTP3 service area) despite influent drug levels in WWTP3 being lower than in the other WWTPs. This may indicate higher sewage dilution in the larger WWTP, possibly due to greater infiltration in sewer lines. This study contributes to the slowly growing wastewater-based data on community drug abuse in the United States, specifically in the Northeast region, where drug abuse is high. Although the data presented are preliminary, research findings provide some perspective on consumption patterns for stimulant drugs in the WWTP service areas. They can also be used as part of baseline data in further drug abuse surveillance studies.
WBE Applications beyond Drugs
Assessing the Potential To Monitor Plant-Based Diet Trends in Communities Using a Wastewater-Based Epidemiology Approach
Arjun K. Venkatesan - ,
Jing Chen - ,
Erin Driver - ,
Adam Gushgari - , and
Rolf U. Halden
With the successful demonstration of wastewater-based epidemiology (WBE) approaches in different countries for estimating the consumption of illicit drugs, researchers are convinced of the approach’s potential to include other biomarkers of exposures to complement and expand traditional human biomonitoring efforts. To this end, for the first time, the present study tested the potential to monitor plant-based diet trends in two U.S. cities by measuring levels of phytoestrogens (plant-derived human biomarkers) in influent wastewater. We analyzed monthly samples (2015–2016) of raw wastewater from two midwestern U.S. cities using liquid chromatography-tandem mass spectrometry for three phytoestrogens: daidzein, genistein, and enterolactone. Phytoestrogens were detected in 100% (n = 23) of the samples analyzed, and the concentrations (ng/L) in raw wastewater from Cities 1 and 2, respectively, in decreasing abundance were: enterolactone at 931 ± 267 and 1016 ± 439; daidzein at 821 ± 208 and 783 ± 371; and genistein at 253 ± 90 and 174 ± 83. The relative abundance of phytoestrogens detected in wastewater mirrored their previously reported relative abundance in human urine and is in agreement with the typical plant-based diet (rich in lignans) consumed in the United States. Average phytoestrogen consumption estimated using the WBE approach ranged between 94 and 645 µg/d/capita for these compounds, with City 2 exhibiting higher plant-based consumption than City 1. These estimates were in agreement with consumption values calculated from the previously reported urinary concentration of phytoestrogen for the U.S. population. The present study showed that phytoestrogen are ideal WBE biomarkers to study plant-based diet trends in communities, provided that there is no industrial input of phytoestrogens entering the sewershed.
Editors’ Biographies
Subject Index
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