Developing an annual estimate of community excretion of drugs- Preliminary findings from the Northwest region of the U.S. Caleb Banta-Green PhD MPH MSW Research Scientist Alcohol and Drug Abuse Institute University of Washington & Jennifer Field PhD Professor Department of Environmental and Molecular Toxicology Oregon State University EMCDDA January 28, 2011
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Developing an annual
estimate of community excretion of drugs-
Preliminary findings from the Northwest region
of the U.S.
Caleb Banta-Green PhD MPH MSWResearch Scientist
Alcohol and Drug Abuse Institute
University of Washington
&
Jennifer Field PhDProfessor
Department of Environmental and Molecular Toxicology
Oregon State University
EMCDDA January 28, 2011
Outline
• Background- drug abuse epidemiology, place for WWTP testing• Study design• Annual sampling plan• Characteristics of WWTP
– Population estimates and possible variability – Composite sampling approaches of plants, sewer system
• Major data issues-– population measurement– Catchment area– error measurement– data distributions
• Preliminary data– Methadone
• Developing an annual estimate• Next steps
Drug use data sources e.g. MDMA
Data Name Population
Data
Type
# of
Events
Data
Interval Time Lag Place Terminology Major Strengths Major Limitations
Emergency Dept.,
Drug Abuse
Warning Network
E.D. patients #XXX/
X,XXXAnnual 6 months
3 County
Metro Area
Specific Drug Names
i.e. MDMA, GHB,
LSD
Population based
estimates
Hetero. Severity
Annual trend data.
Poly drug- can't assign
cause
Reporting biases
Public school
surveyStudents #
XX/
XXXXBi-annual 12 months City
MDMA,
Hallucinogens i.e..
LSD and other
psychedelics
Anonymous, self-
report survey, large
sample.
Out of school youth missing.
Inconsistent terminology.
Social desirability reporting
bias.
Drug treatment
admissions
Publicly funded
treatment #
X/
X,XXXOngoing 2 months 5 digit zip
Hallucinogens e.g.
LSD, mescaline,
peyote
Indication of
problematic use of
drugs.
Large population.
Annual trend data.
Club drugs rarely primary
drug.
Private pay missing.
Mortality-
Medical Examiner &
Toxicology Lab
All sudden,
unexpected and
unnatural
deaths
#X/
XXXOngoing 4 months 5 digit zip
Precise chemical
names.
Quantitative
chemistry.
Population based,
annual trend data.
Difficult to assign causation
to specific drug in multi-drug
cases.
Difficult to detect exogenous
GHB.
Community based
survey
Multiple sub-
groups# A
XXX/
XXXOne time 3 months Seattle Area
Specific drugs names-
detailed names &
slang terms for 11
club drugs
Patterns of use,
consequences
Convenience sample
One time survey.
Social desirability reporting
bias.
WWTP
Total
population
(on sewer)
#xxx/
xxxxx
variable/
flexiblenone Varies/City
Precise chemical
names.
Population based
Direct measure
Aggregated data
Precision ?
Accuracy ?
4
Methamphetamine- Labs and dump sites in Puget Sound Counties
0
100
200
300
400
500
600
700
1990 1992 1994 1996 1998 2000 2002 2004 2006
# o
f In
cid
en
ts (
lab
s a
nd
du
mp
sit
es) King (Seattle)
Pierce (Tacoma)
Snohomish (Everett)
5
Time and Place Displayed Together
6
Quantitative Drug Surveillance System Development
NIH National Institute on Drug Abuse R21 DA024800-01
• Small, exploratory grant
• ~54 samples in 20 Oregon and
Washington Cities in 2009
• Stratified random sample blocked on
season and day of week
• Cities vary in size, climate,
demographics
7
Aims
1. Develop and validate a sensitive and selective analytical method for quantifying the concentration of
drugs in 24 hr, [flow-normalized] composites of raw
influent entering WWTPs;
2. Develop procedures for obtaining samples from a
diverse set of WWTPs;
3. Determine the geographic and temporal (seasonal,
day of week) variability of drug excretion on a per capita and community basis in order to describe use
patterns and to develop sampling frames with optimal efficiency; and
4. Determine the correlation between measured drug
discharge estimates and other drug use indicator data.