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WastewaterWastewater--based epidemiology as a novel … · WastewaterWastewater--based epidemiology as a novel based

Mar 22, 2018




  • WastewaterWastewater--based epidemiology as a novel based epidemiology as a novel

    tool to evaluate illicit drugs, alcohol and tool to evaluate illicit drugs, alcohol and

    Sara Castiglioni Sara Castiglioni Mario Negri InstituteMario Negri Institute

    Department of Environmental Health Sciences Department of Environmental Health Sciences

    Unity of Environmental BiomarkersUnity of Environmental Biomarkers

    tool to evaluate illicit drugs, alcohol and tool to evaluate illicit drugs, alcohol and

    tobacco use in a populationtobacco use in a population

    Lisbon ADDICTIONS Conference 2015 Lisbon, 23-25 September 2015

  • Rational of the approach

    Almost all substances substances we consume consume

    are excretedare excreted unchanged or as a

    mixture of metabolites in urine in urine

    and/faeces and/faeces

    Excreted substances end up in sewer sewer networknetwork

    Enter sewagesewage treatment treatment plantsplants

    Raw wastewater Raw wastewater represents anonymous urine

    samples of thousands of people containing

    traces of excretion products

    Raw wastewater Raw wastewater contains multiple information

    on human habitshuman habits in a defined population

  • Wastewater - Based Epidemiology ApproachA Large Urine Test

    Mass spectrometric analyses Mass spectrometric analyses

    Concentrations of Target


    Daily flow


    Collection of rawraw wastewater wastewater

    samplesComposite 24 h samples


    Amount of target residues Amount of target residues entering a

    sewage treatment plant per day (g/day)


    AmountsAmounts of each parent substance parent substance

    consumed by the population served by

    the plant



  • Wastewater-Based Epidemiology: a large urine testThe route of the drugs: from the consumer to the STP

    Illicit DrugsIllicit Drugs






    Excretes residues of

    the drugs with urine

    after the intake



    Amounts of the residues

    (g/day) are used to back-

    calculate drug consumption in

    the population served by the

    STP (g/day of the parent drug)


    The residues of the drugs

    are transported to the STP

    with the wastewater



    Wastewater is sampled and

    the residues of the drugs at

    the STP are quantified

  • Ability to provide:

    Objective Objective estimates of consumption

    Rapid reporting on changes in illicit drug use on changes in illicit drug use at the population level

    RealReal--time time estimates

    Potentials of the WBE Approach

    Spatial and temporal Spatial and temporal trends at different geographical scales

    Identification of the use of novel substancesthe use of novel substances

    A pre- and post-measure for intervention studiesmeasure for intervention studies

    Spatial and temporal Spatial and temporal trends at different geographical scales

    WBE approach was proposed as a complementary complementary

    indicator indicator of drug use

  • Sewage analysis CORE group (SCORE) Activities

    2010 8 European Research Institutes joinedand a European Collaboration started


    Organize the first Organize the first EuropeEurope--wide monitoringwide monitoring

    Establish a Establish a common protocolcommon protocol

    Check the Check the performance of analysisperformance of analysis through an through an

    interlaboratory studyinterlaboratory study

  • Sewage analysis CORE group (SCORE) Activities

    EuropeEurope--wide monitoring (2011wide monitoring (2011--2015)2015)Results available at:

    Interlaboratory test (2011Interlaboratory test (2011--2015) to check the quality of results2015) to check the quality of results

    Each laboratory is required to analyze standards and samples analyze standards and samples spiked

    at known levels and distributed by one lab paper in preparation

  • European study Regional differences

    Thomas et al., STOTEN, 2012

  • Results from Europe-wide monitoring

    LOADS mg/day/1000 people

  • 1. How to improve data comparability data comparability ?

    2. How results from WBE can be used to

    integrate integrate epidemiological data?

    Sewage analysis CORE group (SCORE) Activities

    Best practice protocolGuidelines addressing sampling,

    storage and chemical analyses

    Identification of gaps

    and uncertaintyMinimize or control uncertainties

    Suggestions for each step of WBE

  • Integrate WBE results with epidemiological data

    WBE: Amount of drug used Surveys: Prevalence of drug used

    Population surveys compared with wastewater analysis for monitoring illicit drug consumption in Italy in 2010-2014

    Ettore Zuccato, Sara Castiglioni, et al. Submitted DAD

    Multidisciplinary collaborationMultidisciplinary collaboration

    Collaboration with epidemiologistsepidemiologists is essential

    New Insight publication New Insight publication on WBE will be presented next month by EMCDDA

    20072007--8: 8: European Monitoring Centre for Drugs and Drug

    Addiction (EMCDDA) EMCDDA Publications, Demonstration

    Projects and international conferences

  • Estimation of illicit drugs consumptioncocaine, amphetamines, ecstasy, cannabis, heroin

    Monitoring drinking habitsethyl sulphate and ethyl glucuronide

    Monitoring smoking habitscotinine and trans-3-hydroxycotinine

    Wastewater-Based EpidemiologyCurrent applications

    cotinine and trans-3-hydroxycotinine

    Identify the use of new synthetic recreational drugssynthetic cannabinoids, cathinones (NPS)

    Other potential applications related to lifestyle, health and

    diet and environment (Thomas and Reid, ES&T, 2011, 45:7611)

  • Monitoring of drinking habitsOslo September 2009 (Reid et al., Alcohol Clin. Exp. Res. 2011)

  • Monitoring of smoking habitsCastiglioni et al., Tobacco Control, 2015

















    North ITALY Centre ITALY South ITALY





    Back-calculation using

    cotinine + trans-3-0.0

    Nicotine Cotinine trans-3'-hydroxycotinine



    Number of cigarettes smoked

    Wastewater analysis Epidemiological survey data Difference (%)Difference (%)

    Northern Italy 1695538 1701190 +0.3+0.3

    Central Italy 2987243 3114850 +4+4

    Southern Italy 1207092 1112987 --8%8%

    cotinine + trans-3-


  • Novel synthetic stimulants

    Drug Use in Adelaide, Australia (Chen et al., Forensic Science International, 2013)

  • Conclusions

    Wastewater Wastewater -- based epidemiology based epidemiology is a promising novel

    indicator to measure drug use in a population

    The approach gives objective and updated information objective and updated information

    The approach has been refined by developing a

    best practice protocolbest practice protocolbest practice protocolbest practice protocol

    Several attempts were a done to compare data

    WBE versus epidemiological data WBE versus epidemiological data

    Interdisciplinary collaboration Interdisciplinary collaboration is essential to improve

    the methodologies and their comparison

  • ThanksSCORE GroupSCORE GroupSara Castiglioni

    Lubertus Bijlsma, Adrian Covaci,

    Erik EmkeFlix Hernndez,

    Malcolm Reid, Christoph Ort,

    EMCDDAEMCDDAPaul Griffith,

    Jane Mounteney, Danica Thanki, Liesbeth Vandam

    COST Action ES1307

    Thanks for your attention!Thanks for your attention!

    Christoph Ort, Kevin V Thomas,

    Alexander LN van Nuijs, Pim de Voogt, Ettore Zuccato

  • Compare WBE with epidemiological data

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