The spatial epidemiology of cocaine, methamphetamine and 3,4‐methylenedioxymethamphetamine (MDMA) use: a demonstration using a population measure of community drug load derived from municipal wastewater

Wastewater from 96 Oregon municipalities, covering 65% of the state's population, was analyzed for metabolites of cocaine, methamphetamine, and MDMA. Cocaine metabolite levels were significantly higher in urban areas and often undetectable in rural ones. Methamphetamine was present in all communities, with no difference by urbanicity. MDMA was detected in fewer than half the communities, with higher levels in more urban areas. The findings suggest wastewater analysis can measure community drug use patterns and may provide more comprehensive data than traditional surveys.

Study at a glance

Abstract

ABSTRACT Aims To determine the utility of community‐wide drug testing with wastewater samples as a population measure of community drug use and to test the hypothesis that the association with urbanicity would vary for three different stimulant drugs of abuse. Design and participants Single‐day samples were obtained from a convenience sample of 96 municipalities representing 65% of the population of the State of Oregon. Measurements Chemical analysis of 24‐hour composite influent samples for benzoylecgonine (BZE, a cocaine metabolite), methamphetamine and 3,4‐methylenedioxymethamphetamine (MDMA). The distribution of community index drug loads accounting for total wastewater flow (i.e. dilution) and population are reported. Findings The distribution of wastewater‐derived drug index loads was found to correspond with expected epidemiological drug patterns. Index loads of BZE were significantly higher in urban areas and below detection in many rural areas. Conversely, methamphetamine was present in all municipalities, with no significant differences in index loads by urbanicity. MDMA was at quantifiable levels in fewer than half the communities, with a significant trend towards higher index loads in more urban areas. Conclusion This demonstration provides the first evidence of the utility of wastewater‐derived community drug loads for spatial analyses. Such data have the potential to improve dramatically the measurement of the true level and distribution of a range of drugs. Drug index load data provide information for all people in a community and are potentially applicable to a much larger proportion of the total population than existing measures.