Rapid Assessment of Opioid Exposure and Treatment in Cities Through Robotic Collection and Chemical Analysis of Wastewater
- PMID: 31919800
- PMCID: PMC7099105
- DOI: 10.1007/s13181-019-00756-5
Rapid Assessment of Opioid Exposure and Treatment in Cities Through Robotic Collection and Chemical Analysis of Wastewater
Abstract
Introduction: Accurate data regarding opioid use, overdose, and treatment is important in guiding community efforts at combating the opioid epidemic. Wastewater-based epidemiology (WBE) is a potential method to quantify community-level trends of opioid exposure beyond overdose data, which is the basis of most existing response efforts. However, most WBE efforts collect parent opioid compounds (e.g., morphine) at wastewater treatment facilities, measuring opioid concentrations across large catchment zones which typically represent an entire municipality. We sought to deploy a robotic sampling device at targeted manholes within a city to semi-quantitatively detect opioid metabolites (e.g., morphine glucuronide) at a sub-city community resolution.
Methods: We deployed a robotic wastewater sampling platform at ten residential manholes in an urban municipality in North Carolina, accounting for 44.5% of the total municipal population. Sampling devices comprised a robotic sampling arm with in situ solid phase extraction, and collected hourly samples over 24-hour periods. We used targeted mass spectrometry to detect the presence of a custom panel of opioids, naloxone, and buprenorphine.
Results: Ten sampling sites were selected to be a representative survey of the entire municipality by integrating sewer network and demographic GIS data. All eleven metabolites targeted were detected during the program. The average morphine milligram equivalent (MME) across the nine illicit and prescription opioids, as excreted and detected in wastewater, was 49.1 (standard deviation of 31.9) MME/day/1000-people. Codeine was detected most frequently (detection rate of 100%), and buprenorphine was detected least frequently (12%). The presence of naloxone correlated with city data of known overdoses reversed by emergency medical services in the prehospital setting.
Conclusion: Wastewater-based epidemiology with smart sewer selection and robotic wastewater collection is feasible to detect the presence of specific opioids, naloxone, methadone, and buprenorphine within a city. These results suggest that wastewater epidemiology could be used to detect patterns of opioid exposure and may ultimately provide information for opioid use disorder (OUD) treatment and harm reduction programs.
Keywords: Data visualization; Drug abuse; Map; Naloxone; Opioids; Overdose; Robot; Waste water.
Conflict of interest statement
MM is the CEO and co-founder of Biobot Analytics, Inc. NE, CD, and KF are employees of Biobot Analytics. NG is President and co-founder of Biobot Analytics
Figures
Similar articles
-
Wastewater-based assessment of regional and temporal consumption patterns of illicit drugs and therapeutic opioids in Croatia.Sci Total Environ. 2016 Oct 1;566-567:454-462. doi: 10.1016/j.scitotenv.2016.05.075. Epub 2016 May 24. Sci Total Environ. 2016. PMID: 27232972
-
Identification of opioids in surface and wastewaters by LC/QTOF-MS using retrospective data analysis.Sci Total Environ. 2019 May 10;664:874-884. doi: 10.1016/j.scitotenv.2019.01.389. Epub 2019 Jan 30. Sci Total Environ. 2019. PMID: 30769311
-
Preventing Opioid Overdose in the Clinic and Hospital: Analgesia and Opioid Antagonists.Med Clin North Am. 2018 Jul;102(4):621-634. doi: 10.1016/j.mcna.2018.02.005. Med Clin North Am. 2018. PMID: 29933819 Free PMC article. Review.
-
Wastewater analysis reveals regional variability in exposure to abused drugs and opioids in Finland.Sci Total Environ. 2014 Jul 15;487:688-95. doi: 10.1016/j.scitotenv.2013.11.010. Epub 2013 Nov 23. Sci Total Environ. 2014. PMID: 24275228
-
Current Best Practices for Acute and Chronic Management of Patients with Opioid Use Disorder.Med Clin North Am. 2022 Jan;106(1):61-80. doi: 10.1016/j.mcna.2021.08.009. Med Clin North Am. 2022. PMID: 34823735 Review.
Cited by
-
Utilizing a National Wastewater Monitoring Program to Address the U.S. Opioid Epidemic: A Focus on Metro Atlanta, Georgia.Int J Environ Res Public Health. 2023 Mar 28;20(7):5282. doi: 10.3390/ijerph20075282. Int J Environ Res Public Health. 2023. PMID: 37047898 Free PMC article. Review.
-
Adaptive interventions for opioid prescription management and consumption monitoring.J Am Med Inform Assoc. 2023 Feb 16;30(3):511-528. doi: 10.1093/jamia/ocac253. J Am Med Inform Assoc. 2023. PMID: 36562638 Free PMC article.
-
Wastewater network infrastructure in public health: Applications and learnings from the COVID-19 pandemic.PLOS Glob Public Health. 2021;1(12):e0000061. doi: 10.1371/journal.pgph.0000061. Epub 2021 Dec 2. PLOS Glob Public Health. 2021. PMID: 34927170 Free PMC article.
-
"Waste Not, Want Not" - Leveraging Sewer Systems and Wastewater-Based Epidemiology for Drug Use Trends and Pharmaceutical Monitoring.J Med Toxicol. 2021 Oct;17(4):397-410. doi: 10.1007/s13181-021-00853-4. Epub 2021 Aug 16. J Med Toxicol. 2021. PMID: 34402038 Free PMC article.
-
Analysis of 39 drugs and metabolites, including 8 glucuronide conjugates, in an upstream wastewater network via HPLC-MS/MS.J Chromatogr B Analyt Technol Biomed Life Sci. 2021 Jun 30;1176:122747. doi: 10.1016/j.jchromb.2021.122747. Epub 2021 May 13. J Chromatogr B Analyt Technol Biomed Life Sci. 2021. PMID: 34052556 Free PMC article.
References
-
- Hoppe JA, Nelson LS, Perrone J, Weiner SG. Prescribing Opioids Safely in the Emergency Department (POSED) Study Investigators, Prescribing Opioids Safely in the Emergency Department POSED Study Investigators. Opioid Prescribing in a cross section of US Emergency Departments. Ann Emerg Med. 2015;66:253–259.e1. - PMC - PubMed
-
- United States Department of Health and Human Services. Strategy to combat opioid abuse, misuse, and overdose. 2018 Aug pp. 1–8.
-
- Keshaviah A, Gitlin R, Cattell L, Reeves W, de Vallance J, Thornton C. The potential of wastewater testing for rapid assessment of opioid abuse (research brief) Princeton, NJ: Mathematica Policy Research; 2016.
-
- Keshaviah A, editor. The potential of wastewater testing for public health and safety. Washington: Mathematica Policy Research; 2017.
Publication types
MeSH terms
Substances
Grants and funding
LinkOut - more resources
Full Text Sources
Medical
Miscellaneous