Opioid-related deaths have reached epidemic proportions in parts of the globe, particularly Northern America. Concerns about a similar crisis in Australia have also been voiced. Although deaths associated with prescription opioids have increased in Australia in recent years, actual prescriptions of various drugs have either been steady, or declining.  We have been measuring biomarkers of five pharmaceutical opioids, oxycodone, fentanyl, methadone, codeine and morphine, as well as heroin, in wastewater over an eight year period in Adelaide, South Australia. The study was expanded nationally three years ago. For this purpose, SPE/LC/MS methods have been developed, with LLOD in water ranging from 0.3 ng/L for norfentanyl to 30 ng/L for morphine. The LLOQ in wastewater ranged from 1 ng/L for norfentanyl and noroxycodone to 100 ng/l for morphine. The method was demonstrated to be sufficiently sensitive to detect the target drugs in actual samples with a detection frequency of codeine, methadone, morphine and noroxycodone of 100%, while fentanyl was 99% and heroin 74%.  In South Australia, pharmaceutical opioid use reached a peak in 2015. Various interventions led to a substantial decrease over the course of 2016, with levels of fentanyl declining by 50% and oxycodone by almost 70%. Heroin use did not change significantly over the same period. The reductions in prescribed use have been maintained up to the present time. Elsewhere in Australia, levels of prescription opioids have been relatively steady since the start of the nationwide study in 2016. On average, pharmaceutical opioid consumption was substantially higher in regional areas compared to metropolitan catchments.  This work represents a longitudinal wastewater study to determine the scale and temporal changes in opioid use on a population scale. The results indicate that the prevalence of prescription and illicit opioid use in Australia is not indicative of a rising trend.

Measuring the scale of opioid consumption in Australia by wastewater analysis

2019 Fall National Meeting

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