Expanding the Use of Wastewater Epidemiology Tools to Improve Water Quality, Identify Service Populations Under Stress, and Promote One Water Goals for a Thriving City

This project explores the utility of wastewater-based epidemiology (WBE) as a public health tool for characterizing opioid use in the US. WBE offers a way to track chemicals, viruses, and bacteria excreted by humans and collected in sewers. It has been used in the past to study diseases such as poliovirus and more recently to understand community behaviors and consumption, such as illicit drug use. While wastewater testing to estimate drug use is slowly gaining traction across the country, more research is needed to determine how the data can be used to support public health decisions. This report presents results of wastewater-based monitoring for opioids and other drugs from three communities. ERG, Mathematica and its study partners conducted WBE pilot studies focused on monitoring pharmaceutical opioids and other drugs in and around Knox County, Tennessee; Memphis, Tennessee; and Madison, Wisconsin. For this, We developed a sampling and monitoring protocol that was broadly applicable across locations and then pilot tested the approach with wastewater utilities in each of the three communities for a period of up to three months. The goal of this effort was to design and implement a WBE study that successfully generated information on population-level drug use and to identify challenges for future study. The project team evaluated wastewater measurements of opioids and other drugs to identify target biomarkers for monitoring and estimating drug consumption patterns. The team also explored spatial and temporal trends in wastewater measurements and then compared those results to available public health surveillance data from other sources (e.g., opioid-related overdoses, emergency department visits, prescription use). The information gathered from the three pilot studies was used to develop insights, lessons learned, and recommendations for similar WBE monitoring programs.