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.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3

References

  1. 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;67:1419–27. https://doi.org/10.15585/mmwr.mm675152e1.

    Article  Google Scholar 

  2. 2.

    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. https://doi.org/10.1016/j.annemergmed.2015.03.026.

    Article  PubMed  PubMed Central  Google Scholar 

  3. 3.

    United States Department of Health and Human Services. Strategy to combat opioid abuse, misuse, and overdose. 2018 Aug pp. 1–8.

  4. 4.

    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.

    Google Scholar 

  5. 5.

    Keshaviah A, editor. The potential of wastewater testing for public health and safety. Washington: Mathematica Policy Research; 2017.

    Google Scholar 

  6. 6.

    Gushgari AJ, Venkatesan AK, Chen J, Steele JC, Halden RU. Long-term tracking of opioid consumption in two United States cities using wastewater-based epidemiology approach. Water Res. 2019;161:171–80. https://doi.org/10.1016/j.watres.2019.06.003.

    CAS  Article  PubMed  Google Scholar 

  7. 7.

    Bade R, Ghetia M, Nguyen L, Tscharke BJ, White JM, Gerber C. Simultaneous determination of 24 opioids, stimulants and new psychoactive substances in wastewater. MethodsX. 2019;6:953–60. https://doi.org/10.1016/j.mex.2019.04.016.

    Article  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Matus et al. 24-hour multi-omics analysis of residential sewage reflects human activity and informs public health. bioRxiv. 2019.

  9. 9.

    Zuccato E, Chiabrando C, Castiglioni S, Bagnati R, Fanelli R. Estimating community drug abuse by wastewater analysis. Environ Health Perspect. 2008;116:1027–32. https://doi.org/10.1289/ehp.11022.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  10. 10.

    Irvine RJ, Kostakis C, Felgate PD, Jaehne EJ, Chen C, White JM. Population drug use in Australia: a wastewater analysis. Forensic Sci Int. 2011;210:69–73. https://doi.org/10.1016/j.forsciint.2011.01.037.

    CAS  Article  PubMed  Google Scholar 

  11. 11.

    Krizman-Matasic I, Kostanjevecki P, Ahel M, Terzic S. Simultaneous analysis of opioid analgesics and their metabolites in municipal wastewaters and river water by liquid chromatography-tandem mass spectrometry. J Chromatogr A. 2018;1533:102–11. https://doi.org/10.1016/j.chroma.2017.12.025.

    CAS  Article  PubMed  Google Scholar 

  12. 12.

    Schulze T, Ahel M, Ahlheim J, Aït-Aïssa S, Brion F, Di Paolo C, et al. Assessment of a novel device for onsite integrative large-volume solid phase extraction of water samples to enable a comprehensive chemical and effect-based analysis. Sci Total Environ. 2017;581–582:350–8. https://doi.org/10.1016/j.scitotenv.2016.12.140.

    CAS  Article  PubMed  Google Scholar 

  13. 13.

    Gul W, Gul SW, Stamper B, Godfrey M, ElSohly MA. LC-MS-MS method development and analysis of stimulants, opiates, synthetic opiates, PCP, and benzodiazepines in wastewater. Preponderance of these drugs during football games. Methods Mol biol. New York, NY: Springer New York; 2018;1810: 149–182. doi:https://doi.org/10.1007/978-1-4939-8579-1_15.

  14. 14.

    Celma A, Sancho JV, Salgueiro-González N, et al. Simultaneous determination of new psychoactive substances and illicit drugs in sewage: potential of micro-liquid chromatography tandem mass spectrometry in wastewater-based epidemiology. J Chromatogr A. 2019. https://doi.org/10.1016/j.chroma.2019.05.051.

  15. 15.

    Thai PK, Jiang G, Gernjak W, Yuan Z, Lai FY, Mueller JF. Effects of sewer conditions on the degradation of selected illicit drug residues in wastewater. Water Res. 2014;48:538–47. https://doi.org/10.1016/j.watres.2013.10.019.

    CAS  Article  PubMed  Google Scholar 

  16. 16.

    O'Brien JW, Banks APW, Novic AJ, Mueller JF, Jiang G, Ort C, et al. Impact of in-sewer degradation of pharmaceutical and personal care products (PPCPs) population markers on a population model. Environ Sci Technol. 2017;51(7):3816–23. https://doi.org/10.1021/acs.est.6b02755.

    CAS  Article  PubMed  Google Scholar 

  17. 17.

    Archer JRH, Hudson S, Jackson O, Yamamoto T, Lovett C, Lee HM, et al. Analysis of anonymized pooled urine in nine UK cities: variation in classical recreational drug, novel psychoactive substance and anabolic steroid use. QJM : monthly journal of the Association of Physicians. 2015;108:929–33. https://doi.org/10.1093/qjmed/hcv058.

    CAS  Article  PubMed  Google Scholar 

  18. 18.

    Ort C, Lawrence MG, Reungoat J, Mueller JF. Sampling for PPCPs in wastewater systems: comparison of different sampling modes and optimization strategies. Environ Sci Technol. 2010;44:6289–96. https://doi.org/10.1021/es100778d.

    CAS  Article  PubMed  Google Scholar 

  19. 19.

    Ort C, Gujer W. Sampling for representative micropollutant loads in sewer systems. Water Sci Technol. 2006;54:169–76.

    CAS  Article  Google Scholar 

  20. 20.

    Baker DR, Očenášková V, Kvicalova M, Kasprzyk-Hordern B. Drugs of abuse in wastewater and suspended particulate matter--further developments in sewage epidemiology. Environ Int. 2012;48:28–38. https://doi.org/10.1016/j.envint.2012.06.014.

    CAS  Article  PubMed  Google Scholar 

  21. 21.

    van Nuijs ALN, Castiglioni S, Tarcomnicu I, Postigo C, de Lopez AM, Neels H, et al. Illicit drug consumption estimations derived from wastewater analysis: a critical review. Sci Total Environ. 2011;409:3564–77. https://doi.org/10.1016/j.scitotenv.2010.05.030.

    CAS  Article  PubMed  Google Scholar 

  22. 22.

    Baker DR, Kasprzyk-Hordern B. Critical evaluation of methodology commonly used in sample collection, storage and preparation for the analysis of pharmaceuticals and illicit drugs in surface water and wastewater by solid phase extraction and liquid chromatography-mass spectrometry. J Chromatogr A. 2011;1218:8036–59. https://doi.org/10.1016/j.chroma.2011.09.012.

    CAS  Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to acknowledge Dr. Elizabeth Kujawinski from Woods Hole Oceanographic Institution and her research team for their support in the LC-MS/MS measurements.

Funding

PRC is funded by NIH K23DA044874, R01DA047236, Gilead Sciences, and the Hans and Mavis Lopater Psychosocial Foundation.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Mariana Matus.

Ethics declarations

Conflict of Interest

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

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supervising Editor: Mark B. Mycyk, MD

Electronic supplementary material

ESM 1

(DOCX 127 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Endo, N., Ghaeli, N., Duvallet, C. et al. Rapid Assessment of Opioid Exposure and Treatment in Cities Through Robotic Collection and Chemical Analysis of Wastewater. J. Med. Toxicol. 16, 195–203 (2020). https://doi.org/10.1007/s13181-019-00756-5

Download citation

Keywords

  • Waste water
  • Opioids
  • Overdose
  • Robot
  • Map
  • Data visualization
  • Drug abuse
  • Naloxone
  • Opioids