Rapid Assessment of Opioid Exposure and Treatment in Cities Through Robotic Collection and Chemical Analysis of Wastewater.

Publication date: Jan 09, 2020

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.

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.

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.

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.

Endo, N., Ghaeli, N., Duvallet, C., Foppe, K., Erickson, T.B., Matus, M., and Chai, P.R. Rapid Assessment of Opioid Exposure and Treatment in Cities Through Robotic Collection and Chemical Analysis of Wastewater. 04494. 2020 J Med Toxicol.

Concepts Keywords
Accounting Sewer network
Buprenorphine Opioids
Codeine Drugs
Demographic Psychoactive drugs
Epidemiology RTT
GIS Morphinans
Glucuronide Euphoriants
Harm Reduction Drug rehabilitation
Mass Spectrometry Ethers
Methadone Naloxone
Milligram Buprenorphine
Morphine Methadone
Municipality Morphine
Naloxone Wastewater treatment
North Carolina
Opioid
Opioid Epidemic
Opioids
Overdose
Standard Deviation
Survey
Wastewater
Wastewater Treatment

Semantics

Type Source Name
disease MESH community
drug DRUGBANK Morphine
drug DRUGBANK Pentaerythritol tetranitrate
drug DRUGBANK Naloxone
drug DRUGBANK Buprenorphine
drug DRUGBANK Codeine
disease MESH emergency
drug DRUGBANK Methadone
disease MESH Drug abuse
drug DRUGBANK Water

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