Estimation of Community Usage of Drugs Utilizing Sewage Epidemiology

Abstract

Drug abuse is considered to be a national epidemic in many countries including the USA, and is associated with impaired social indicators including economic loss and adverse public health. The conventional methods of estimation of drug usage in communities are based on self-reported surveys, overdose or toxicological reports, drug-related crime statistics, and hospital admissions. Conventional methods suffer from several shortcomings including cost and time intensiveness, nonresponse bias, bias in the selection of sample population, and consumer’s unawareness on the actual composition of used drugs. Sewage epidemiology utilizes the mass load of drugs in wastewater influent to estimate the drug usage in a community. Despite several challenges to the determination of the human excretion profile of drugs, the stability of drugs in wastewater, the dynamics of the population, sewage epidemiology provides several opportunities, including a cost-effective, comprehensive, noninvasive, and nearly real-time measure of trends of drug use over time.