Wastewater Analysis for Substance Abuse Monitoring and Policy Development

Jeremy Prichard, Wayne Hall, Paul Kirkbride, Jake O'Brien

• Publisher: CRC Press
• Year: 2020
• ISBN:
  9780429655241
• Edition: 1
• Topic: Derecho
• Subtopic: Ciencias forenses

This book addresses how to estimate substance use and thereby evaluate policies intended to reduce the harms caused by drugs and other substances. Wastewater analysis (WWA) can provide efficient, affordable, fine-grained and objective data on population substance use trends on a very large scale.

The authors discuss the potential implications of WWA as a new method for understanding substance use in a variety of settings and ignite a discourse with policy makers, criminologists, epidemiologists and other disciplines about the need for collaboration with WWA scientists. The book also features an explanation of the costs and harms of substance use with academic literature from criminological and epidemiological sources and reports from lead agencies.

Additional features include:

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• Details on the origin of wastewater analysis in environmental science

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• Description of analytical chemistry methods for tracing a wide variety of substances, including illicit drugs, alcohol, tobacco and other chemicals

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• Exploration of the major empirical problems in estimating population consumption of alcohol, tobacco and drugs at the international and national level

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• Examination of the principles of human research ethics and their application to wastewater analysis

Wastewater Analysis for Substance Abuse Monitoring and Policy Development is a valuable tool for analytical chemists, wastewater scientists and criminologists, as well as researchers and policy makers across disciplines who work in drug sectors.

chapter one

Measuring Strategies to Counter the Harms of Substance Use

A Global Overview

Introduction

If progress is to be made on the prevention and treatment of drug problems, new quantitative and qualitative research methods need to be applied in large population areas, methodologies that do not conform readily to traditional experimental and evaluation designs.

(Babor et al. 2010b, 97)

This book is about how to measure substance use and thereby evaluate policies intended to reduce drug-related harm. The book can be précised in four main points.

First, the misuse of psychoactive substances, including illicit drugs, alcohol and tobacco, constitutes a very significant and complex health and social burden in all parts of the globe.

Second, at international, national and local levels, there are combinations of strategies used with the aim of reducing this burden. These aim to reduce the supply and the demand for psychoactive substances. Harm reduction strategies attempt to reduce the harms associated with the use of psychoactive substances without necessarily reducing demand or supply.

Third, it is often difficult to assess to what extent these strategies achieve their desired effects, or produce unintended consequences. Assessments of policy efficacy draw upon a wide variety of information, including intelligence and quantitative and qualitative data on drug use.

Fourth, a new method has emerged to measure the whole population consumption of psychoactive substances. Called wastewater analysis, the method relies upon separation science to detect traces of specific substances in sewage water and uses these traces to estimate per capita consumption of the substance.

This book is responding to the call made by Babor and colleagues (2010a) quoted above. We ask whether wastewater analysis can be incorporated into research designs to meaningfully assess the impact of policies that aim to reduce the harms of psychoactive substance use. This is the book’s central question. We answer it by examining the capabilities of wastewater analysis and critically discussing whether the method may be put to good use in evaluating policies at international, national and local levels.

The book’s focus is weighted towards illicit drug use because of the special impediments that researchers face in measuring the use of drugs provided by an underground (black) market. However, we also discuss the potential use of wastewater analysis in assessing alcohol and tobacco use from criminological and epidemiological perspectives.

The authors’ backgrounds are in chemistry, epidemiology, criminology, law and policy analysis. We have attempted to avoid biases towards particular fields as best we can to produce a book that is ‘transdisciplinary’ in the sense Henry (2012) used this term, collaborative research relationships between biological and social scientists and experts in water management, health and law enforcement. Commentators from completely different viewpoints are increasingly recommending diverse collaborations to address the world’s most complex problems, including substance misuse. These sentiments have been voiced by scientists (Ledford 2015), epidemiologists (Babor et al. 2010b), criminologists (Henry 2012) and wastewater researchers (e.g. Castiglioni, Vandam and Griffiths 2016; Prichard et al. 2017).

Terminology

Consistent with the social science literature on the topic, we have adopted the term ‘psychoactive substances’ to collectively refer to illicit drugs, alcohol and tobacco. We refer to their use as ‘substance use’. In some sections we use the term ‘drugs’ interchangeably with illicit drugs. However, ‘drug’ should be taken to include alcohol and tobacco. In the case of the non-therapeutic use of pharmaceuticals, our key term is ‘pharmaceutical misuse’.

‘New psychoactive substances’ is a phrase that refers to a rapidly expanding list of synthetic compounds that mimic the effects of widely used illicit drugs but which fall outside of current definitions in criminal law. The book does not discuss this class of substances extensively for reasons provided in Chapter 2 (2.2.4). ‘Psychoactive inhalants’, such as glue, petrol, paints and so on are also not considered.

Normally, the literature refers to alcohol ‘use’, the ‘use’ of illicit drugs and so forth. We employ the same terminology except where wastewater data are concerned. Following a convention that acknowledges the inability of wastewater data to directly infer anything about the number of users and their patterns or frequency of use, we refer to wastewater data in terms of what they tell us about the total ‘consumption’ of substances in a given population.

‘Wastewater analysis’ has at times been called ‘sewage-based epidemiology’ and more recently ‘wastewater-based epidemiology’ (WBE) (e.g. Castiglioni and Vandam 2016). As implied above, we prefer wastewater analysis (WWA). We think this is a simpler term. We also think that terms like WBE denote how wastewater data might be used – to epidemiological ends – rather than what wastewater analysis is (mainly chemical analyses of drug residues and metabolites in wastewater samples). Additionally, since language expresses meaning, we are concerned that terms like WBE may discourage non-epidemiologists from engaging with this new field, thereby undermining efforts to incorporate expertise from broader social science and other research domains.

Structure of This Book

Chapter 1 sets the framework for the book by introducing three interlocking themes: the problems raised by substance misuse; the strategies available to address these problems; and the methods available to assess whether these strategies are working.

Cutting across those themes are three tiers – macro (international), meso (national) and micro (local). Section 1.1 accordingly explains the costs and harms of substance at the individual, national and global level. The main stratagems to counter the harms associated with substance use are overviewed in Section 1.2, including international, national and local efforts. The focus of Section 1.3 is on assessing the efficacy of these different tiers of strategies.

Chapter 2 explains WWA from a social scientist’s perspective. The aim is to equip the reader with a clear sense of the strengths and weaknesses of WWA compared to other sources of information on substance use. It answers common questions about WWA, such as how it copes with the dumping of illicit drugs down sewers. The chapter gives the reader a sense of the WWA field that is transparent about the capabilities of WWA, the ethical issues it may raise and potential interactions with experts from other areas. Because the chapter describes the key stages in WWA studies, it is also a useful resource for readers who may be considering participating in or managing a WWA project.

Chapters 3, 4 and 5 are investigative. They deal with the macro, meso and micro tiers referred to above. The chapters have the same format. They start with the limitations of the current sources of information and methods for assessing the efficacy of strategies. Then they dispassionately examine whether WWA might compensate for some of those limitations. These chapters consider a spectrum of research designs that range from: the simple use of WWA data to estimate population drug consumption, time series analyses of trends in drug consumption, and incorporating WWA data into evaluations of natural policy experiments, intervention studies and quasi-experimental designs (see Babor et al. 2010b, 8, 99).

Global issues are at the centre of Chapter 3, which surveys key international agreements and agencies. The principal topics examined are the value of WWA in developing countries and the potential for WWA to provide comparable global metrics on consumption of alcohol and tobacco.

Chapter 4 deals with national applications of WWA. It devotes particular attention to the estimation of the extent of rural substance use, especially in large countries like Canada, the USA and Australia. It uses recent case-studies to consider the broader implications of WWA for small communities, which often lie in a ‘data shadow’ because of the difficulties in using traditional social science survey research methods to estimate their drug use. Paradoxically, there may be empirical advantages to conducting WWA in towns and small communities that are isolated. The ethical issues raised by this type of research are also discussed.

In Chapter 5 the utility of WWA in micro contexts is deliberated. We discuss technical challenges relating to sampling from small sewers with highly variable water flow. The chapter devotes particular attention to the problem of substance use by prisoners and corrective services staff. Using WWA prison studies previously undertaken (e.g. Brewer et al. 2016), the chapter explores how WWA intervention studies could evaluate the effectiveness of supply or demand reduction strategies. Schools and workplaces are the other micro settings that raise the highest level of ethical complexity for WWA research.

The concluding sixth chapter is speculative because it considers what future scientific applications of WWA might mean for the work of criminologists and epidemiologists and for evaluations of drug policy. Future risks for WWA are examined, including technical changes in sewage treatment and the mismanagement of ethically sensitive WWA studies.

1.1 The Problem of Substance Misuse

We start with an overview of the problem of substance use to explain why the measurement of drug use is so important. We also explain why measurement is often difficult. The full implications of substance misuse for the global community are impossible to gauge. Even at the individual level, causation can be complex and ripple effects hard to disentangle from the effects of other factors in the life-course. For instance, how can the long-term psychological implications of parental drug dependence on children be delineated? Or the premature death of a spouse from a tobacco-related disease?

As we widen our scope from the individual to the community, the nation, the region and the globe, the complexity of harm increases by orders of magnitude. Substance use causes significant harm to public health and wellbeing and places a large burden upon criminal justice agencies (WHO 2017b; UNODC 2016b). Illicit drugs produce different problems to alcohol and tobacco because illicit drug markets are a major source of income for global organised crime groups.¹ As such, they have a distinct geo-political relevance.

Organized crime feeds on instability and the weak rule of law, shows violence, and grows strong with help from corruption and money-laundering. It threatens the safety and security of communities, violates human rights and undermines economic, social, cultural, political and civil development of societies around the world.

(UNODC 2016b, 32)

1.1.1 Harms for the Individual and Community

Drug use can adversely affect people’s physical health, personal safety, mental health and social wellbeing (Loxley et al. 2004). Three variables that affect harms are dose, patterns of substance use and the route of administration (see Babor et al. 2010b, 19). Regarding dose, psychoactive substances differ in terms of their toxicity and their potential for harm. Substance use behaviours encompass a cluster of related but discrete issues: regularity of use (including substance dependence); quantity consumed at any one time (even if only occasional); and poly-substance use....

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Contents
• Preface
• Acknowledgements
• About the Authors
• chapter one Measuring Strategies to Counter the Harms of Substance Use: A Global Overview
• chapter two Understanding Wastewater Analysis: How It Works; Its Strengths and Limitations
• chapter three Macro Applications of Wastewater Analysis: International Comparisons
• chapter four Meso Applications of Wastewater Analysis: National Research
• chapter five Micro Applications of Wastewater Analysis: Prisons, Educational Institutions and Workplaces
• chapter six Future Directions
• Index