Sara Castiglioni Mario Negri Institute Department of Environmental Health Sciences Unity of Environmental Biomarkers

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1 Sara Castiglioni Mario Negri Institute Department of Environmental Health Sciences Unity of Environmental Biomarkers Lisbon ADDICTIONS Conference 2015 Lisbon, September 2015

2 Rational of the approach Almost all substances we consume are excreted unchanged or as a mixture of metabolites in urine and/faeces Excreted substances end up in sewer network Enter sewage treatment plants Raw wastewater represents anonymous urine samples of thousands of people containing traces of excretion products Raw wastewater contains multiple information on human habits in a defined population

3 Wastewater - Based Epidemiology Approach A Large Urine Test Collection of raw wastewater samples Composite 24 h samples Mass spectrometric analyses Concentrations of Target Residues Daily flow rate Amount of target residues entering a sewage treatment plant per day (g/day) Human metabolism Amounts of each parent substance consumed by the population served by the plant

4 Potentials of the WBE Approach Ability to provide: Objective estimates of use Real time estimates updated information Rapid reporting on changes in the use at the population level Spatial and temporal trends at different geographical scales Identification of the use of novel substances A pre and post measure for intervention studies WBE approach was proposed as a complementary indicator of drug use

5 Sewage analysis CORE group (SCORE) Activities European Research Institutes joined and a European Collaboration started Objectives Organize the first Europe wide monitoring Establish a common protocol Check the performance of analysis through an interlaboratory study

6 Sewage analysis CORE group (SCORE) Activities 1. How to improve data comparability? 2. How results from WBE can be used to integrate epidemiological data? Best practice protocol Identification of gaps and uncertainty Guidelines addressing sampling, storage and chemical analyses Minimize or control uncertainties Suggestions for each step of WBE

7 Sewage analysis CORE group (SCORE) Activities Europe wide monitoring ( ) 2015) Results available at: water analysis Interlaboratory test ( ) 2015) 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

8 Europe-wide monitoring Regional differences Thomas et al., STOTEN, 2012

9 Results from Europe-wide monitoring LOADS mg/day/1000 people

10 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 Ettore Zuccato, Sara Castiglioni, et al. Submitted DAD Multidisciplinary collaboration Collaboration with epidemiologists is essential : European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) EMCDDA Publications, Demonstration Projects and international conferences New Insight publication on WBE will be presented next month by EMCDDA analysis

11 Wastewater-Based Epidemiology Current applications Estimation of illicit drugs consumption cocaine, amphetamines, ecstasy, cannabis, heroin Monitoring drinking habits ethyl sulphate and ethyl glucuronide Monitoring smoking habits cotinine and trans 3 hydroxycotinine Identify the use of new synthetic recreational drugs synthetic cannabinoids, cathinones (NPS) Other potential applications related to lifestyle, health and diet and environment (Thomas and Reid, ES&T, 2011, 45:7611)

12 Monitoring of drinking habits Oslo September 2009 (Reid et al., Alcohol Clin. Exp. Res. 2011)

13 Monitoring of smoking habits Italy 2013 (Castiglioni et al., Tobacco Control, 2015) 2.5 North ITALY Centre ITALY South ITALY Loads (g/day/1000 inhabitants) ** *** * *** ** **** Nicotine Cotinine trans 3' hydroxycotinine Back calculation using cotinine + trans 3 hydroxycotinine Number of cigarettes smoked Wastewater analysis Epidemiological survey data Difference (%) Northern Italy Central Italy Southern Italy %

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

15 Conclusions Wastewater based epidemiology is a promising novel indicator to measure substances use in a population The approach gives objective and updated information The approach has been refined by developing a best practice protocol Several attempts were a done to integrate data WBE and epidemiological indicators Interdisciplinary collaboration Interdisciplinary collaboration is essential to improve the methodologies and their integration

16 SCORE Group Sara Castiglioni Lubertus Bijlsma, Adrian Covaci, Erik Emke Félix Hernández, Malcolm Reid, Christoph Ort, Kevin V Thomas, Alexander LN van Nuijs, Pim de Voogt, Ettore Zuccato Thanks EMCDDA Paul Griffith, Jane Mounteney, Danica Thanki, Liesbeth Vandam COST Action ES1307 Thanks for your attention!

17 Compare WBE with epidemiological data

18 Wastewater-Based Epidemiology: a large urine test The route of the drugs: from the consumer to the STP Illicit Drugs cocaine cannabis CONSUMER Excretes residues of the drugs with urine after the intake heroin amphetamines TREATMENT PLANT The residues of the drugs are transported to the STP with the wastewater DRUG RESIDUES QUANTIFICATION Wastewater is sampled and the residues of the drugs at the STP are quantified CONSUMPTION ESTIMATE Amounts of the residues (g/day) are used to backcalculate drug consumption in the population served by the STP (g/day of the parent drug)