The opioid epidemic is considered the worst drug crisis in American history. On average, 130 Americans die every day from opioid overdoses. The cost of the country’s opioid crisis is estimated to have exceeded $1 trillion from 2001 to 2017, and is projected to cost an additional $500 billion by 2020. In an effort to curb the opioid crisis, the U.S. Department of Health and Human Services (HHS) has called for data that is more timely than overdose death data.  Wastewater-based epidemiology (WWBE) has been proposed as an alternative method to assess the scope of the opioid crisis near-real time. The analysis of opioid metabolites in wastewater can be used to estimate consumption trends in cities. This data can be used to identify areas of high consumption, tailor programming, and evaluate the effectiveness of interventions.  However, opioid metabolites have remained an open challenge in the field due to rapid degradation in the wastewater system. Biobot is a novel wastewater-based epidemiology platform that measures the concentration of various prescription and illicit opioid metabolites in wastewater collected within the city rather than treatment plants. This novel approach captures many urinary metabolites that were previously inaccessible, it is not biased by flushing substances in the toilet, and provides geographic resolution useful to public health practice.  From May to December 2018, we implemented our platform in a suburban community in North Carolina. We estimated the consumption of naloxone, heroin, fentanyl, five prescription opioids (other than fentanyl), and methadone by measuring urinary metabolites of those drugs in wastewater samples taken from residential communities. Opioid consumption was found to be prevalent across all communities. The frequency of detection of the overdose reversal drug, naloxone, was correlated with reported overdoses. The amount of naloxone in wastewater indicated 10 to 30-times more overdose rescues than expected.  Our findings validate that WWBE implemented in upstream locations within a city can be used to estimate consumption of various prescription and illicit opioids. Future development will include expanding our analysis capabilities to cannabis, cocaine, meth and other drugs of emerging concern in our country; as well as continuing to integrate our data within public health practice to help design and evaluate programs.

Biobot analytics: Novel platform to estimate opioid consumption in cities by analyzing opioid urinary metabolites in wastewater

2019 Fall National Meeting

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