Spatial variations in the consumption of illicit stimulant drugs across Australia: A nationwide application of wastewater-based epidemiology.
Obtaining representative information on illicit drug use and patterns across a country remains difficult using surveys because of low response rates and response biases. A range of studies have used wastewater-based epidemiology (WBE) as a complementary approach to monitor community-wide illicit drug use. In Australia, no large-scale WBE studies have been conducted to date to reveal illicit drug use profiles in a national context. In this study, we performed the first Australia-wide WBE monitoring to examine spatial patterns in the use of three illicit stimulants (cocaine, as its human metabolite benzoylecgonine; methamphetamine; and 3,4-methylendioxymethamphetamine (MDMA)). A total of 112 daily composite wastewater samples were collected from 14 wastewater treatment plants across four states and two territories. These covered approximately 40% of the Australian population. We identified and quantified illicit drug residues using liquid chromatography coupled with tandem mass spectrometry. There were distinctive spatial patterns of illicit stimulant use in Australia. Multivariate analyses showed that consumption of cocaine and MDMA was higher in the large cities than in rural areas. Also, cocaine consumption differed significantly between different jurisdictions. Methamphetamine consumption was more similar between urban and rural locations. Only a few cities had elevated levels of use. Extrapolation of the WBE estimates suggested that the annual consumption was 3tonnes for cocaine and 9tonnes combined for methamphetamine and MDMA, which outweighed the annual seizure amount by 25 times and 45 times, respectively. These ratios imply the difficulty of detecting the trafficking of these stimulants in Australia, possibly more so for methamphetamine than cocaine. The obtained spatial pattern of use was compared with that in the most recent national household survey. Together both WBE and survey methods provide a more comprehensive evaluation of drug use that can assist governments in developing policies to reduce drug use and harm in the communities.
The University of Queensland, The National Research Centre for Environmental Toxicology (Entox), 39 Kessels Road, Coopers Plains, QLD 4108, Australia. Electronic address: foon.lai@uqconnect.edu.au.
Foon Yin
FY
Lai
The University of Queensland, The National Research Centre for Environmental Toxicology (Entox), 39 Kessels Road, Coopers Plains, QLD 4108, Australia.
Jake
J
O'Brien
School of Psychology, University of Tasmania, Private Bag 30, Hobart, TAS 7001, Australia.
Raimondo
R
Bruno
The University of Queensland, Centre for Clinical Research, Brisbane, QLD 4000, Australia.
Wayne
W
Hall
Faculty of Law, University of Tasmania, Australia.
Jeremy
J
Prichard
School of Chemical and Physical Sciences, Flinders University, Adelaide, SA 5001, Australia.
Paul
P
Kirkbride
The University of Queensland, Centre for Clinical Research, Brisbane, QLD 4000, Australia.
Coral
C
Gartner
International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, QLD 4000, Australia.
Phong
P
Thai
Queensland Health Forensic Scientific Services, Queensland Government, 39 Kessels Road, Coopers Plains, QLD 4108, Australia.
Steve
S
Carter
Eastern Health Clinical School, Monash University, Melbourne, VIC 3000, Australia; Turning Point, Eastern Health, Melbourne, VIC 3000, Australia.
Belinda
B
Lloyd
National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2031, Australia.
Lucy
L
Burns
The University of Queensland, The National Research Centre for Environmental Toxicology (Entox), 39 Kessels Road, Coopers Plains, QLD 4108, Australia.
Jochen
J
Mueller
D001315:Australia / Q000453:epidemiology; D006801:Humans; D013287:Illicit Drugs / Q000032:analysis*; D062211:Spatio-Temporal Analysis; D015813:Substance Abuse Detection / Q000379:methods* / Q000639:trends*; D019966:Substance-Related Disorders / Q000453:epidemiology*; D062065:Wastewater / Q000737:chemistry*; D014874:Water Pollutants, Chemical / Q000032:analysis*
D013287:Illicit Drugs; D062065:Wastewater; D014874:Water Pollutants, Chemical
Cocaine; Drug residues; LC–MS/MS; MDMA; Methamphetamine; Wastewater analysis