Evaluation of pre-analysis loss of dependent drugs in wastewater: stability and binding assessments.

Wastewater analysis has the potential to provide objective and timely data on population drug consumption, but some crucial factors such as pre-analysis drug loss during sample storage and filtration could affect the accuracy and reliability of the method, and these uncertainties have yet to be fully assessed. This study was designed to evaluate analyte stability in wastewater stored under different conditions with the aim of optimizing the sample storage procedures for future studies. It also investigated whether there is significant analyte loss during filtration before sample extraction and storage after that. The studied substances and metabolites were: cotinine, cocaine and its metabolite benzoylecgonine, phenethylamines amphetamine, methamphetamine, 3,4-methylenedioxyamphetamine (MDA), 3,4-methylenedioxymethamphetamine (MDMA), opioids including codeine, methadone, 6-monoacetylmorphine (MAM) and morphine. In most situations, storing samples at 4 °C is sufficient to stabilize analytes for at least 2 weeks, and refrigeration is unnecessary during sample transportation within 3 days. However, additional measures need to be taken if unstable analytes such as cocaine and MAM are to be analyzed. No significant analyte loss was observed in the filtration process or in reconstituted extract stored at 4 °C or -20 °C for 2 weeks. By choosing stable analytes and proper storage conditions, wastewater analysis has the potential to provide accurate data for estimation of community drug use.

Marked decline in 3,4-methylenedioxymethamphetamine (MDMA) based on wastewater analysis.

OBJECTIVE: Recent reports in Europe suggest a decline in 3,4-methylenedioxymethamphetamine (MDMA; Ecstasy) use, but quantifiable and objective measurement is unavailable. The global extent of changes in MDMA and related stimulant use is also unclear. This study aims to quantify changes in MDMA use in Australia and determine whether these changes have been accompanied by differing amounts of other stimulant use. METHOD: We acquired information on recent use of MDMA and related illicit stimulants in Australia using the method of wastewater analysis. Untreated wastewater samples collected from three metropolitan treatment plants in Adelaide from May to July 2009 and the same months in 2010 were analyzed. Concentrations of MDMA, methamphetamine, and benzoylecgonine (a metabolite of cocaine) were determined using solid phase extraction-liquid chromatography- tandem mass spectrometry. Weekly consumed doses of MDMA, methamphetamine, and cocaine per 1,000 people were estimated. RESULTS: From 2009 to 2010, weekly consumption of MDMA decreased from mean of 4.52 (SEM = 0.74) doses/week per 1,000 people to 0.08 (0.01) doses/week per 1,000 people (p < .001); weekly consumption of methamphetamine increased from a mean of 48.35 (6.13) doses/week per 1,000 people to 68.13 (5.33) doses/week per 1,000 people (p < .05); and weekly consumed doses of cocaine did not significantly change. Local roadside saliva testing data also showed that the MDMA-positive test rate decreased from 0.30% to 0.05% and the methamphetamine-positive test rate increased from 1.43% to 1.52% during the past 2 years. CONCLUSIONS: This study shows a 50-fold decrease in consumed doses of MDMA with a rise in methamphetamine use in Australia over a 1-year period.

Population drug use in Australia: a wastewater analysis.

Accurate information on drug use in communities is essential if health, social and economic harms associated with illicit drug use are to be addressed efficiently. In most countries population drug use is estimated indirectly via surveys, medical presentations and police and custom seizures. All of these methods have at least some problems due to bias, small samples and/or long time delays between collecting the information and analysing the results. Recently the direct quantification of drug residues in wastewater has shown promise as a means of monitoring drug use in defined geographical areas. In this study we measured 3,4-methylenedioxymethamphetamine (MDMA), methamphetamine and benzoylecgonine in sewage inflows in metropolitan and regional areas of Australia and compared these data with published European data. Cocaine use was small compared to European cities (p<0.001) but was compensated for by much greater consumption of methamphetamine (p<0.001) and MDMA (p<0.05). MDMA was more popular in regional areas (p<0.05) whereas methamphetamine and cocaine were mainly consumed in the city (p<0.05). Greater than 5-fold increases in MDMA use were detected on weekends (p<0.001). This approach has the potential to improve our understanding of drug use in populations and should be further developed to improve prevention and treatment programs.

Fatalities associated with the use of gamma-hydroxybutyrate and its analogues in Australasia.

OBJECTIVE: To identify deaths in Australasia associated with overdose of gamma-hydroxybutyrate (GHB) and its precursors (gamma-butyrolactone and 1,4-butanediol). DESIGN: A retrospective search of medical and scientific information sources, as well as popular newsprint, for the period January 2000-August 2003, with formal clinical, toxicological and forensic evaluation of retrieved data. MAIN OUTCOME MEASURE: Death associated with forensic data implicating GHB or its analogues. RESULTS: Ten confirmed GHB-associated deaths were identified, with eight considered to be directly attributable to GHB. Only two of these eight cases were positive for ethanol toxicology. CONCLUSIONS: Our study supports the existing evidence that GHB overdose is associated with fatalities, and that fatal overdoses occur in the context of isolated use.