title: 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.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Single-day samples were obtained from a convenience sample of 96 municipalities representing 65% of the population of the State of Oregon.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
authors.affiliation: Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA 98105, USA. calebbg@u.washington.edu
authors.forename: Caleb J
authors.initials: CJ
authors.lastname: Banta-Green
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Field
authors.forename: Aurea C
authors.initials: AC
authors.lastname: Chiaia
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Sudakin
authors.forename: Laura
authors.initials: L
authors.lastname: Power
authors.forename: Luc
authors.initials: L
authors.lastname: de Montigny
mesh_terms: D003042:Cocaine / Q000031:analogs & derivatives* / Q000032:analysis; D004784:Environmental Monitoring / Q000379:methods; D062665:Epidemiological Monitoring; D006801:Humans; D008694:Methamphetamine / Q000032:analysis*; D018817:N-Methyl-3,4-methylenedioxyamphetamine / Q000032:analysis*; D009294:Narcotics / Q000032:analysis*; D009922:Oregon / Q000453:epidemiology; D012424:Rural Population; D015813:Substance Abuse Detection / Q000379:methods; D019966:Substance-Related Disorders / Q000453:epidemiology*; D014505:Urban Population; D014865:Waste Disposal, Fluid; D014874:Water Pollutants, Chemical / Q000032:analysis*
chemical_list: D009294:Narcotics; D014874:Water Pollutants, Chemical; D008694:Methamphetamine; C005618:benzoylecgonine; D003042:Cocaine; D018817:N-Methyl-3,4-methylenedioxyamphetamine