title: Can cocaine use be evaluated through analysis of wastewater? A nation-wide approach conducted in Belgium.
abstract: OBJECTIVE
  Cocaine is the second most-used illicit drug world-wide and its consumption is increasing significantly, especially in western Europe. Until now, the annual prevalence has been estimated indirectly by means of interviews. A recently introduced and direct nation-wide approach based on measurements of the major urinary excreted metabolite of cocaine, benzoylecgonine, in wastewater is proposed.
  
  
  METHODS
  Wastewater samples from 41 wastewater treatment plants (WWTPs) in Belgium, covering approximately 3,700,000 residents, were collected. Each WWTP was sampled on Wednesdays and Sundays during two sampling campaigns in 2007-08. Samples were analysed for cocaine (COC) and its metabolites, benzoylecgonine (BE) and ecgonine methylester (EME) by a validated procedure based on liquid chromatography coupled with tandem mass spectrometry. Concentrations of BE were used to calculate cocaine consumption (g/day per 1000 inhabitants) for each WWTP region and for both sampling campaigns (g/year per 1000 inhabitants).
  
  
  RESULTS
  Weekend days showed significantly higher cocaine consumption compared with weekdays. The highest cocaine consumption was observed for WWTPs receiving wastewater from large cities, such as Antwerp, Brussels and Charleroi. Results were extrapolated for the total Belgian population and an estimation of a yearly prevalence of cocaine use was made based on various assumptions. An amount of 1.88 tonnes (t) per year [standard error (SE) 0.05 t] cocaine is consumed in Belgium, corresponding to a yearly prevalence of 0.80% (SE 0.02%) for the Belgian population aged 15-64 years. This result is in agreement with an earlier reported estimate of the Belgian prevalence of cocaine use conducted through socio-epidemiological studies (0.9% for people aged 15-64 years).
  
  
  CONCLUSIONS
  Wastewater analysis is a promising tool to evaluate cocaine consumption at both local and national scale. This rapid and direct estimation of the prevalence of cocaine use in Belgium corresponds with socio-epidemiological data. However, the strategy needs to be refined further to allow a more exact calculation of cocaine consumption from concentrations of BE in wastewater.
authors.affiliation: Toxicological Centre, Department of Pharmaceutical Sciences, University of Antwerp, Universiteitsplein, Antwerp, Belgium.
authors.forename: Alexander L N
authors.initials: AL
authors.lastname: van Nuijs
authors.forename: Bert
authors.initials: B
authors.lastname: Pecceu
authors.forename: Laetitia
authors.initials: L
authors.lastname: Theunis
authors.forename: Nathalie
authors.initials: N
authors.lastname: Dubois
authors.forename: Corinne
authors.initials: C
authors.lastname: Charlier
authors.forename: Philippe G
authors.initials: PG
authors.lastname: Jorens
authors.forename: Lieven
authors.initials: L
authors.lastname: Bervoets
authors.forename: Ronny
authors.initials: R
authors.lastname: Blust
authors.forename: Herman
authors.initials: H
authors.lastname: Meulemans
authors.forename: Hugo
authors.initials: H
authors.lastname: Neels
authors.forename: Adrian
authors.initials: A
authors.lastname: Covaci