Análisis de aguas residuales con fines epidemiológicos: aplicaciones a la estimación del consumo de sustancias de abuso y en salud pública en general. Red española ESAR-Net (*)  <span class="so-article-trans-title" dir="auto"> Translated title: Wastewater-based epidemiology: applications towards the estimation of drugs of abuse consumption and public health in general. The Spanish network ESAR-Net </span>

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RESUMEN

En este artículo se presenta la metodología de análisis de aguas residuales con fines epidemiológicos ( wastewater-based epidemiology, WBE) y su potencial para abordar diversos aspectos relacionados con la salud pública. Esta metodología permite obtener datos a una escala temporal y espacial relativamente pequeña (típicamente datos diarios-semanales sobre un municipio) de hábitos de consumo de sustancias de abuso, ilegales (como la cocaína o el cannabis) o legales (como el alcohol) a través de la determinación de biomarcadores de consumo (el compuesto original no metabolizado o alguno de sus metabolitos) en el agua residual. Aparte de discutir los fundamentos, ventajas y limitaciones de WBE, se comentan los precedentes más relevantes a nivel internacional, y las actividades más destacables en España en este ámbito. Finalmente, se exponen, los objetivos de la Red Española de Análisis de Aguas Residuales con Fines Epidemiológicos (ESAR-Net), una “Red de Excelencia” que agrupa a investigadores españoles con amplia experiencia en el área de WBE, así como las perspectivas de futuro de esta metodología puede tener para mejorar las competencias de la Salud Pública en España.

ABSTRACT

This manuscript introduces Wastewater-Based Epidemiology (WBE) and its potential in the assessment of diverse aspects related to public health. This methodology can provide data in a relatively short temporal and local scale (typically dialy-weekly at the municipal level) on consumption patterns of illicit drugs (e.g. cocaine or cannabis), licit substances of abuse (e.g. alcohol) by measuring their consumption biomarkers (i.e. the original unmetabolized substance or some of its metabolite) in wastewater. Besides discussing the fundaments, advantages and shortcomings of WBE, it reviews some of the main precedents at international level and most remarkable activities that have been taken place in this field in Spain. Finally, the Spanish Network of Wastewater-Based Epidemiology (ESAR-Net) as is presented. ESAR-Net is an Excellence Network that sums up the efforts of the most relevant Spanish researchers in the field of WBE, aiming to investigate future perspectives of this methodology and its impact on Public Health competences in Spain.

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Most cited references 28

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Cocaine in surface waters: a new evidence-based tool to monitor community drug abuse

Ettore Zuccato, Chiara Chiabrando, Sara Castiglioni … (2005)

Background Cocaine use seems to be increasing in some urban areas worldwide, but it is not straightforward to determine the real extent of this phenomenon. Trends in drug abuse are currently estimated indirectly, mainly by large-scale social, medical, and crime statistics that may be biased or too generic. We thus tested a more direct approach based on 'field' evidence of cocaine use by the general population. Methods Cocaine and its main urinary metabolite (benzoylecgonine, BE) were measured by mass spectrometry in water samples collected from the River Po and urban waste water treatment plants of medium-size Italian cities. Drug concentration, water flow rate, and population at each site were used to estimate local cocaine consumption. Results We showed that cocaine and BE are present, and measurable, in surface waters of populated areas. The largest Italian river, the Po, with a five-million people catchment basin, steadily carried the equivalent of about 4 kg cocaine per day. This would imply an average daily use of at least 27 ± 5 doses (100 mg each) for every 1000 young adults, an estimate that greatly exceeds official national figures. Data from waste water treatment plants serving medium-size Italian cities were consistent with this figure. Conclusion This paper shows for the first time that an illicit drug, cocaine, is present in the aquatic environment, namely untreated urban waste water and a major river. We used environmental cocaine levels for estimating collective consumption of the drug, an approach with the unique potential ability to monitor local drug abuse trends in real time, while preserving the anonymity of individuals. The method tested here – in principle extendable to other drugs of abuse – might be further refined to become a standardized, objective tool for monitoring drug abuse.

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Evaluation of uncertainties associated with the determination of community drug use through the measurement of sewage drug biomarkers.

Sara Castiglioni, Lubertus Bijlsma, Adrian Covaci … (2013)

The aim of this study was to integrally address the uncertainty associated with all the steps used to estimate community drug consumption through the chemical analysis of sewage biomarkers of illicit drugs. Uncertainty has been evaluated for sampling, chemical analysis, stability of drug biomarkers in sewage, back-calculation of drug use (specific case of cocaine), and estimation of population size in a catchment using data collected from a recent Europe-wide investigation and from the available literature. The quality of sampling protocols and analytical measurements has been evaluated by analyzing standardized questionnaires collected from 19 sewage treatments plants (STPs) and the results of an interlaboratory study (ILS), respectively. Extensive reviews of the available literature have been used to evaluate stability of drug biomarkers in sewage and the uncertainty related to back-calculation of cocaine use. Different methods for estimating population size in a catchment have been compared and the variability among the collected data was very high (7-55%). A reasonable strategy to reduce uncertainty was therefore to choose the most reliable estimation case by case. In the other cases, the highest uncertainties are related to the analysis of sewage drug biomarkers (uncertainty as relative standard deviation; RSD: 6-26% from ILS) and to the back-calculation of cocaine use (uncertainty; RSD: 26%). Uncertainty can be kept below 10% in the remaining steps, if specific requirements outlined in this work are considered. For each step, a best practice protocol has been suggested and discussed to reduce and keep to a minimum the uncertainty of the entire procedure and to improve the reliability of the estimates of drug use.

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Spatial differences and temporal changes in illicit drug use in Europe quantified by wastewater analysis

Christoph Ort, Alexander L N van Nuijs, Jean-Daniel Berset … (2014)

Aims To perform wastewater analyses to assess spatial differences and temporal changes of illicit drug use in a large European population. Design Analyses of raw wastewater over a 1-week period in 2012 and 2013. Setting and Participants Catchment areas of wastewater treatment plants (WWTPs) across Europe, as follows: 2012: 25 WWTPs in 11 countries (23 cities, total population 11.50 million); 2013: 47 WWTPs in 21 countries (42 cities, total population 24.74 million). Measurements Excretion products of five illicit drugs (cocaine, amphetamine, ecstasy, methamphetamine, cannabis) were quantified in wastewater samples using methods based on liquid chromatography coupled to mass spectrometry. Findings Spatial differences were assessed and confirmed to vary greatly across European metropolitan areas. In general, results were in agreement with traditional surveillance data, where available. While temporal changes were substantial in individual cities and years (P ranging from insignificant to <10−3), overall means were relatively stable. The overall mean of methamphetamine was an exception (apparent decline in 2012), as it was influenced mainly by four cities. Conclusions Wastewater analysis performed across Europe provides complementary evidence on illicit drug consumption and generally concurs with traditional surveillance data. Wastewater analysis can measure total illicit drug use more quickly and regularly than is the current norm for national surveys, and creates estimates where such data does not exist.

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Author and article information

Journal

Journal ID (nlm-ta): Rev Esp Salud Publica

Journal ID (iso-abbrev): Rev Esp Salud Publica

Journal ID (publisher-id): resp

Title: Revista Española de Salud Pública

Publisher: Ministerio de Sanidad Servicios Sociales e Igualdad

ISSN (Print): 1135-5727

ISSN (Electronic): 2173-9110

Publication date (Electronic): 20 August 2018

Publication date (Electronic, collection): Jan-Dec 2018

Volume: 92

Electronic Location Identifier: e201808053

Affiliations

[1 ] originalInstituto Universitario de Plaguicidas y Aguas. Universidad Jaume I. Castellón. España. normalizedUniversitat Jaume I orgdiv1Instituto Universitario de Plaguicidas y Aguas orgnameUniversidad Jaume I Castellón Spain

[2 ] originalDepartamento de Química Analítica, Nutrición e Bromatoloxía, IIAA. Instituto de Investigacións e Análises Alimentarias. Universidade de Santiago de Compostela. Santiago de Compostela. España. normalizedUniversidad de Santiago de Compostela orgdiv2Departamento de Química Analítica, Nutrición e Bromatoloxía orgdiv1IIAA. Instituto de Investigacións e Análises Alimentarias orgnameUniversidade de Santiago de Compostela Santiago de Compostela Spain

[3 ] originalUnidad de Calidad del Agua y Suelos. Departamento de Química Ambiental. Instituto de Diagnóstico Ambiental y Estudios del Agua (IDAEA). Consejo Superior de Investigaciones Científicas (CSIC). Barcelona. España. orgdiv2Unidad de Calidad del Agua y Suelos. Departamento de Química Ambiental orgdiv1Instituto de Diagnóstico Ambiental y Estudios del Agua (IDAEA) orgnameConsejo Superior de Investigaciones Científicas (CSIC) Barcelona España

[4 ] originalGrupo de Investigación en Seguridad Alimentaria y Medioambiental (SAMA-UV). Centro de Investigaciones sobre Desertificación (CSIC-UV-GV). Facultad de Farmacia. Universitat de València. Valencia. España normalizedUniversitat de Valencia orgdiv2Grupo de Investigación en Seguridad Alimentaria y Medioambiental (SAMA-UV). Centro de Investigaciones sobre Desertificación (CSIC-UV-GV) orgdiv1Facultad de Farmacia orgnameUniversitat de València Valencia Spain

[5 ] originalGrupo de Investigación de Cromatografía. Aplicaciones Medioambientales. Facultad de Química Universitat Rovira i Virgili. Tarragona. España. orgdiv2Grupo de Investigación de Cromatografía. Aplicaciones Medioambientales orgdiv1Facultad de Química orgnameUniversitat Rovira i Virgili Tarragona España

[6 ] originalDepartment of Biology. University of Ottawa. Ontario. Canada. normalizedUniversity of Ottawa orgdiv1Department of Biology orgnameUniversity of Ottawa Ontario Canada

[7 ] originalGrupo de Investigación y Docencia en Toxicología Ambiental y Evaluación de Riesgos. Area de Medicina Preventiva y Salud Pública. Facultad de Ciencias de la Salud. Universidad Rey Juan Carlos. Madrid. España. normalizedUniversidad Rey Juan Carlos orgdiv2Grupo de Investigación y Docencia en Toxicología Ambiental y Evaluación de Riesgos. Area de Medicina Preventiva y Salud Pública orgdiv1Facultad de Ciencias de la Salud orgnameUniversidad Rey Juan Carlos Madrid Spain

Author notes

Correspondencia: José Benito Quintana Departamento de Química Analítica, Nutrición e Bromatoloxía, IIAA Instituto de Investigacións e Análises Alimentarias Universidade de Santiago de Compostela Constantino Cadeira s/n 15782, Santiago de Compostela, España jb.quintana@ 123456usc.es

Los autores declaran que no existen conflictos de intereses

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Publisher ID: e201808053

PMC ID: 11587324

PubMed ID: 30124223

SO-VID: 3f2788d9-7089-4489-8cad-71a773dda6f6

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This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. You are free to Share (copy and redistribute the material in any medium or format) under the following terms: Attribution (You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use); NonCommercial (You may not use the material for commercial purposes); NoDerivatives (If you remix, transform, or build upon the material, you may not distribute the modified material); No additional restrictions (You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits).

History

Date received : 09 February 2018

Date accepted : 06 June 2018

Date: 20 August 2018

Page count

Figures: 4, Tables: 2, Equations: 0, References: 27, Pages: 1

Funding

Funded by: Agencia Estatal de Investigación (AEI)

Award ID: CTM2016-81935-REDT/AEI

Agencia Estatal de Investigación (AEI), ref. CTM2016-81935-REDT/AEI

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Use of illicit drugs, alcohol and tobacco in Spain and Portugal during the COVID-19 crisis in 2020 as measured by wastewater-based epidemiology
Authors: Andrea Estévez-Danta, Lubertus Bijlsma, Ricardo Capela …

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Most cited references 28

Cocaine in surface waters: a new evidence-based tool to monitor community drug abuse

Evaluation of uncertainties associated with the determination of community drug use through the measurement of sewage drug biomarkers.

Spatial differences and temporal changes in illicit drug use in Europe quantified by wastewater analysis

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