Long-term tracking of opioid consumption in two United States cities using wastewater-based epidemiology approach

Access to near-real time opioid use data is essential to the effective management of the U.S. opioid crisis. Current narcotic data collection methods are limited by time delay and would be complimented by a rapid data acquisition technique. Use of wastewater-based epidemiology (WBE) analysis may offer access to near real-time data on opioid consumption but application in the United States has been limited. From 2015 to 2017, monthly 24-h time-weighted composite samples of municipal raw wastewater from two Midwestern U.S. cities were routinely analyzed using liquid chromatography-tandem mass spectrometry for morphine, codeine, oxycodone, heroin, fentanyl, and select opioid metabolites. Concentrations of opioids (ng/L) in raw wastewater from City 1 and 2, respectively, were: morphine (713 ± 38; 306 ± 29; detection frequency (DF): 100%), oxycodone (17.8 ± 1.1; 78 ± 6; DF: 100%), codeine (332 ± 37; 100 ± 27; DF: 93%), heroin (41 ± 16; 9 ± 11; DF: 81%), and fentanyl (1.7 ± 0.2; 1.0 ± 0.5; DF: 62%). Average opioid consumption rates estimated using WBE ranged between 9 and 2590 mg/day/1000 persons. Anticipated overdoses and overdose-deaths calculated from analyte concentrations in wastewater forecasted 200 opioid-related overdoses/year and 39 opioid related overdose-deaths/year across the two cities during the year 2016, which aligned well with observed coroner-reported opioid deaths. This long-term U.S. screening study of opioids in wastewater was the first to utilize wastewater epidemiological data to estimate the number of expected overdose and overdose-deaths, and to identify detectable levels of the powerful synthetic opioid fentanyl in community wastewater consistently over the course of one whole year.