Z-drugs are prescribed for treating anxiety and sleep disorders, with known side effects including an elevated risk of addiction and substance misuse. Antidepressants are another class of psychotropic drugs used for treating anxiety as well as seasonal and dysthymic depression. Both groups of these drugs have a strong potential for misuse, which has escalated over the years and was hypothesized here to have been exacerbated during the COVID-19 pandemic. Wastewater-based epidemiology (WBE) constitutes a fast, easy, and inexpensive approach to epidemiological surveys for understanding the incidence and frequency of uses of these drugs. This study analyzed wastewater samples from 50 cities across the United States and Mexico during a severe wave of the COVID-19 pandemic from July to September 2020. The goal was to track medication occurrence and concentrations in wastewater to estimate drug use rates during the pandemic. Time proportional composite samples of untreated municipal wastewater were analyzed using solid-phase extraction followed by liquid chromatography-tandem mass spectrometry to determine levels of zolpidem, zaleplon, alprazolam, diazepam, nordiazepam, temazepam, clonazepam, lorazepam, ketamine, and select metabolites. Medications were detected in cities across both countries, and an initial risk assessment was performed. This study is among the first to investigate Z-drugs to further our understanding of mental health status in North America through the use of WBE.

Occurrence of Z-drugs and antidepressants in wastewater in the United States and Mexico during the COVID-19 pandemic

ACS Fall 2021

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