Individuals with opioid use disorder (OUD) continue to experience disproportionate morbidity and mortality due to COVID-19. The pandemic has reduced the ability of individuals with OUD to access pharmacotherapy, and social isolation and increased stress has magnified the risk of overdose and death. While deployment of telehealth has maintained some linkages to care around OUD, the prevalence of illicit opioid use and medications for OUD (MOUD) adherence have been challenging to measure. Decreased in-person visits for OUD treatment have limited traditional routes of assessing the burden of OUD through individual testing. Additionally, the complex interaction of societal measures related to COVID-19 restrictions and their impact on MOUD is unknown. Wastewater based epidemiology (WBE) leveraged during the COVID-19 pandemic has provided insights into dynamics of COVID-19 disease burden in communities. In parallel, WBE simultaneously provides unique insights into MOUD consumption in relation to COVID-19 trends. By measuring concentrations of opioids in wastewater networks, focused on upstream locations like manholes we can infer the prevalence of opioid use and adherence to MOUD in areas of interest. To demonstrate the ability of WBE to simultaneously measure incidence of COVID-19, OUD, and MOUD adherence, we developed and deployed an approach for measuring SARS-CoV-2 in wastewater using quantitative polymerase chain reaction and a suite of opioids and MOUD using liquid chromatography tandem mass spectrometry. We evaluated method performance through a pilot study conducted in two communities from July to September 2021. Weekly, time-proportional 24-hour composite samples were collected from six manhole locations serving approx. 3,000-58,000 people. Samples were processed and analyzed for SARS-CoV-2, buprenorphine and its main metabolite norbuprenorphine-3-glucuronide, methadone and its metabolite 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP), 6-monoacetylmorphine–the main specific metabolite of heroin–and fentanyl. In this presentation, we evaluate trends in the prevalence of COVID-19 disease burden and OUD/MOUD consumption in order to understand the ability of WBE to inform public health response to OUD during the COVID-19 pandemic. Other events which may interrupt access to in-person care will also be discussed as well as the potential for leveraging nationwide COVID-19 surveillance monitoring to understand geographic trends in OUD and MOUD.

Understanding the relationship between community COVID-19 disease burden and Opioid Use Disorder treatment through wastewater based epidemiology

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ACS Fall 2022

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