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Evaluating wastewater surveillance for estimating pharmaceutical use.

Gilbert Osena1, Jerker Fick2, Carl-Fredrik Flach1

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Environment International
|September 28, 2025
PubMed
Summary

Wastewater analysis of active pharmaceutical ingredients (APIs) can predict regional medicine use with less than 2-fold error for most drugs. This method helps fill crucial data gaps in medicine consumption, though it has limitations for detecting minor changes.

Keywords:
Active pharmaceutical ingredientsAntibioticsMedicine useSewage epidemiologyWastewater surveillance

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Area of Science:

  • Environmental Chemistry
  • Pharmaceutical Sciences
  • Public Health

Background:

  • Regional medicine use data is vital for health management but often unavailable globally.
  • Wastewater analysis offers a potential solution for estimating drug consumption where traditional data is lacking.

Purpose of the Study:

  • To assess the efficacy of analyzing active pharmaceutical ingredients (APIs) in untreated municipal wastewater for predicting regional medicine use.
  • To establish conversion factors (CFs) for estimating drug usage from wastewater data.

Main Methods:

  • Measured 53 APIs in Stockholm wastewater treatment plant (WWTP) influent from 2004-2021.
  • Correlated API measurements with comprehensive regional sales data as a proxy for medicine use.
  • Generated and evaluated conversion factors (CFs) using wastewater and sales data, assessing variability and predictive performance.

Main Results:

  • Wastewater-recovered API mass generally aligned with estimated daily use, with CFs varying significantly across APIs.
  • Estimated typical prediction error was less than 2-fold for 68% of APIs when validated on independent data.
  • CFs were stable over time for 43 APIs (variability <100%) and predictions correlated well with international studies.

Conclusions:

  • Wastewater-based estimation of medicine use is feasible for most APIs with a typical error of less than 2-fold.
  • This approach supports wastewater surveillance as a tool to address data gaps in regional drug consumption.
  • Limitations exist, particularly for detecting small changes in medicine use.