New Uses of Wastewater Data on High-Risk Substances: Emerging Drug Detection, Overdose Prediction, and Drug Policy Evaluation

New Uses of Wastewater Data on High-Risk Substances: Emerging Drug Detection, Overdose Prediction, and Drug Policy Evaluation

Published: Apr 30, 2024
Publisher: Mathematica
Mathematica | Progress Together.

Alex Buben

Jana Epstein

Allison Burrell

Key Findings
  • Xylazine concentrations were detectable in wastewater at least one month before two suspected overdoses involving xylazine were reported, confirming that wastewater data can proactively inform harm reduction strategies for emerging drug threats.
  • A new Drug-SURGE wastewater alert algorithm correctly flagged 71 to 100% of drug overdoses based on unprecedented patterns in wastewater data, providing early warnings of eight to 11 days that enable officials to act in real time to prevent drug overdoses.
  • In the six months following the decriminalization of fentanyl test strips, wastewater concentrations of fentanyl gradually decreased in two Kentucky counties, providing early evidence of the promise of wastewater data to evaluate the effectiveness of new drug policies and programs.
  • Wastewater data helped fill gaps in drug overdose data—particularly in rural communities, where data and resources can be sparse—and could shed light on patterns of polysubstance use.

Wastewater monitoring can address critical gaps by helping officials track changes in substance use in real time and adapt resources accordingly. By integrating wastewater data with other community data, and applying advanced analytics, we show how policymakers can further the use of wastewater data.

Building on our prior research, Mathematica and Biobot Analytics sought to further characterize how wastewater monitoring could help communities adapt to the changing landscape of substance use and prevent overdoses.

To do so, Mathematica integrated wastewater data from Biobot on four high-risk substances—fentanyl, methamphetamine, cocaine, and xylazine—with Overdose Detection Mapping Application Program (ODMAP) data from the Washington/Baltimore High Intensity Drug Trafficking Area (W/B HIDTA) program on suspected drug overdoses.

We analyzed up to 39 weeks of data from rural, suburban, and urban counties in California, Kentucky, New Jersey, and West Virginia. We selected five counties in these states based on their high prevalence of substance use, availability of longitudinal wastewater data that covered a sizable share of the county’s population, and high-quality reporting of drug overdoses through a statewide ODMAP application programming interface.

We summarize findings from our analysis of wastewater and drug overdose data to assess the ability of wastewater data to detect an emerging drug threat (xylazine), predict suspected drug overdoses, and evaluate the effectiveness of a new drug policy (fentanyl test strip decriminalization).

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