Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Apr;16(2):195-203.
doi: 10.1007/s13181-019-00756-5. Epub 2020 Jan 9.

Rapid Assessment of Opioid Exposure and Treatment in Cities Through Robotic Collection and Chemical Analysis of Wastewater

Norkio Endo  1 , Newsha Ghaeli  1 , Claire Duvallet  1 , Katelyn Foppe  1 , Timothy B Erickson  2   3 , Mariana Matus  4 , Peter R Chai  2   5   6   7
Affiliations

Rapid Assessment of Opioid Exposure and Treatment in Cities Through Robotic Collection and Chemical Analysis of Wastewater

Norkio Endo et al. J Med Toxicol. 2020 Apr.

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.

PubMed Disclaimer

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

Fig. 1
Fig. 1
Schematics of upstream wastewater-based epidemiology platform. a Sampling sites and associated catchments. As compared with sampling at a wastewater treatment plant (WWTP), sampling at upstream sites with smaller catchments (site A, B) can achieve smaller hydraulic retention time and higher spatial resolution. b Installation of sampling device in manhole. Our sampling device is installed in a manhole using a suspension cable. c Robotic wastewater sampling and in situ solid phase extraction. The sampling device consists of two peristaltic pumps, a filter, a water receptacle, and a SPE cartridge. d Data analytics and main parameters used. See Methods for details.
Fig. 2
Fig. 2
a Reported opioid overdoses compared with b wastewater measured opioid exposure, c naloxone, and d buprenorphine use in selected 10 sampling sites (a-j). Overdose rate per site was calculated based on the fatal and non-fatal overdose incidents recorded from calls to the local EMS services and the residential population in each catchment for 2018. Average opioid exposure rate (MME/day/1000-people) was obtained by averaging the total opioid exposure rate, except for methadone and buprenorphine (see Methods), over successful sampling points for each site. Detection rates for buprenorphine and naloxone were obtained by calculating the detection frequency of those drugs inferred from their respective metabolites (see Table 2 and Methods). Detection rate per site was calculated based on the total successful samples in each site (59 samples: site a (n = 7), Site b (n = 7), site c (n = 4), site d (n = 6), site e (n = 7), site f (n = 6), site g (n = 5), site h (n = 7), site i (n = 4), site j (n = 6)). The maps were reproduced to maintain the spatial relationship between the sampling sites, but do not represent their actual geospatial locations or the actual city-wide boundary.
Fig. 3
Fig. 3
Detection rate of opioids, treatment, and overdose reversal drugs per site. Exposure to parent drugs (y-axis) was inferred from detection of their respective metabolites (see Table 2 and Methods). Detection rate per site was calculated based on the total successful samples in each site (59 samples: site a (n = 7), site b (n = 7), site c (n = 4), site d (n = 6), site e (n = 7), site f (n = 6), site g (n = 5), site h (n = 7), site i (n = 4), site j (n = 6)).
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Scholl L, Seth P, Kariisa M, Wilson N, Baldwin G. Drug and opioid-involved overdose deaths — United States, 2013–2017. MMWR Morb Mortal Wkly Rep. 2019;67:1419–1427. - PMC - PubMed
    1. 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
    1. United States Department of Health and Human Services. Strategy to combat opioid abuse, misuse, and overdose. 2018 Aug pp. 1–8.
    1. 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.
    1. Keshaviah A, editor. The potential of wastewater testing for public health and safety. Washington: Mathematica Policy Research; 2017.

Publication types

MeSH terms