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Tay Wee Teck J, Oteo A, Baldacchino A. Rapid opioid overdose response system technologies. Curr Opin Psychiatry 2023:00001504-990000000-00063. [PMID: 37185583 DOI: 10.1097/yco.0000000000000870] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
PURPOSE OF REVIEW Opioid overdose events are a time sensitive medical emergency, which is often reversible with naloxone administration if detected in time. Many countries are facing rising opioid overdose deaths and have been implementing rapid opioid overdose response Systems (ROORS). We describe how technology is increasingly being used in ROORS design, implementation and delivery. RECENT FINDINGS Technology can contribute in significant ways to ROORS design, implementation, and delivery. Artificial intelligence-based modelling and simulations alongside wastewater-based epidemiology can be used to inform policy decisions around naloxone access laws and effective naloxone distribution strategies. Data linkage and machine learning projects can support service delivery organizations to mobilize and distribute community resources in support of ROORS. Digital phenotyping is an advancement in data linkage and machine learning projects, potentially leading to precision overdose responses. At the coalface, opioid overdose detection devices through fixed location or wearable sensors, improved connectivity, smartphone applications and drone-based emergency naloxone delivery all have a role in improving outcomes from opioid overdose. Data driven technologies also have an important role in empowering community responses to opioid overdose. SUMMARY This review highlights the importance of technology applied to every aspect of ROORS. Key areas of development include the need to protect marginalized groups from algorithmic bias, a better understanding of individual overdose trajectories and new reversal agents and improved drug delivery methods.
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Affiliation(s)
- Joseph Tay Wee Teck
- DigitAS Project, Population and Behavioural Science Division, School of Medicine, University of St Andrews, St Andrews
- Forward Leeds and Humankind Charity, Durham, UK
| | - Alberto Oteo
- DigitAS Project, Population and Behavioural Science Division, School of Medicine, University of St Andrews, St Andrews
| | - Alexander Baldacchino
- DigitAS Project, Population and Behavioural Science Division, School of Medicine, University of St Andrews, St Andrews
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2
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Wright T, Adhikari A. Utilizing a National Wastewater Monitoring Program to Address the U.S. Opioid Epidemic: A Focus on Metro Atlanta, Georgia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5282. [PMID: 37047898 PMCID: PMC10093898 DOI: 10.3390/ijerph20075282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/23/2023] [Accepted: 03/27/2023] [Indexed: 06/19/2023]
Abstract
The opioid epidemic has continued to be an ongoing public health crisis within Metro Atlanta for the last three decades. However, estimating opioid use and exposure in a large population is almost impossible, and alternative methods are being explored, including wastewater-based epidemiology. Wastewater contains various contaminants that can be monitored to track pathogens, infectious diseases, viruses, opioids, and more. This commentary is focusing on two issues: use of opioid residue data in wastewater as an alternative method for opioid exposure assessment in the community, and the adoption of a streamlined approach that can be utilized by public health officials. Opioid metabolites travel through the sanitary sewer through urine, fecal matter, and improper disposal of opioids to local wastewater treatment plants. Public health officials and researchers within various entities have utilized numerous approaches to reduce the impacts associated with opioid use. National wastewater monitoring programs and wastewater-based epidemiology are approaches that have been utilized globally by researchers and public health officials to combat the opioid epidemic. Currently, public health officials and policy makers within Metro Atlanta are exploring different solutions to reduce opioid use and opioid-related deaths throughout the community. In this commentary, we are proposing a new innovative approach for monitoring opioid use and analyzing trends by utilizing wastewater-based epidemiologic methods, which may help public health officials worldwide manage the opioid epidemic in a large metro area in the future.
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Affiliation(s)
- Tamara Wright
- University College, University of Denver, 2211 South Josephine Street, Denver, CO 80208, USA
| | - Atin Adhikari
- Jiann-Ping Hsu College of Public Health, Georgia Southern University, 501 Forest Drive, Statesboro, GA 30460, USA;
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Vliet SMF, Hazemi M, Blatz D, Jensen M, Mayasich S, Transue TR, Simmons C, Wilkinson A, LaLone CA. Demonstration of the Sequence Alignment to Predict Across Species Susceptibility Tool for Rapid Assessment of Protein Conservation. J Vis Exp 2023:10.3791/63970. [PMID: 36847398 PMCID: PMC10758989 DOI: 10.3791/63970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
The US Environmental Protection Agency Sequence Alignment to Predict Across Species Susceptibility (SeqAPASS) tool is a fast, freely available, online screening application that allows researchers and regulators to extrapolate toxicity information across species. For biological targets in model systems such as human cells, mice, rats, and zebrafish, toxicity data are available for a variety of chemicals. Through the evaluation of protein target conservation, this tool can be used to extrapolate data generated from such model systems to thousands of other species lacking toxicity data, yielding predictions of relative intrinsic chemical susceptibility. The latest releases of the tool (versions 2.0-6.1) have incorporated new features that allow for the rapid synthesis, interpretation, and use of the data for publication plus presentation-quality graphics. Among these features are customizable data visualizations and a comprehensive summary report designed to summarize SeqAPASS data for ease of interpretation. This paper describes the protocol to guide users through submitting jobs, navigating the various levels of protein sequence comparisons, and interpreting and displaying the resulting data. New features of SeqAPASS v2.0-6.0 are highlighted. Furthermore, two use-cases focused on transthyretin and opioid receptor protein conservation using this tool are described. Finally, SeqAPASS' strengths and limitations are discussed to define the domain of applicability for the tool and highlight different applications for cross-species extrapolation.
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Affiliation(s)
- Sara M F Vliet
- Office of Research and Development, Center for Computational Toxicology and Exposure, Scientific Computing and Data Curation Division, U.S. Environmental Protection Agency;
| | | | | | - Marissa Jensen
- Swenson College of Science and Engineering, Department of Biology, University of Minnesota Duluth
| | | | | | - Cody Simmons
- General Dynamics Information Technology, Research Triangle Park
| | | | - Carlie A LaLone
- Office of Research and Development, Center for Computational Toxicology and Exposure, Great Lakes Toxicology and Ecology Division, U.S. Environmental Protection Agency
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4
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Standards to support an enduring capability in wastewater surveillance for public health: Where are we? CASE STUDIES IN CHEMICAL AND ENVIRONMENTAL ENGINEERING 2022; 6:100247. [PMID: 37520917 PMCID: PMC9376981 DOI: 10.1016/j.cscee.2022.100247] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 06/02/2023]
Abstract
The COVID-19 pandemic highlighted a wide range of public health system challenges for infectious disease surveillance. The discovery that the SARS-CoV-2 virus was shed in feces and can be characterized using PCR-based testing of sewage samples offers new possibilities and challenges for wastewater surveillance (WWS). However, WWS standardization of practices is needed to provide actionable data for a public health response. A workshop was convened consisting of academic, federal government, and industry stakeholders. The objective was to review WWS sampling protocols, testing methods, analyses, and data interpretation approaches for WWS employed nationally and identify opportunities for standardizing practices, including the development of documentary standards or reference materials in the case of SARS-CoV-2 surveillance. Other WWS potential future threats to public health were also discussed. Several aspects of WWS were considered and each offers the opportunity for standards development. These areas included sampling strategies, analytical methods, and data reporting practices. Each of these areas converged on a common theme, the challenge of results comparability across facilities and jurisdictions. For sampling, the consensus solution was the development of documentary standards to guide appropriate sampling practices. In contrast, the predominant opportunity for analytical methods was reference material development, such as PCR-based standards and surrogate recovery controls. For data reporting practices, the need for establishing the minimal required metadata, a metadata vocabulary, and standardizing data units of measure including measurement threshold definitions was discussed. Beyond SARS-CoV-2 testing, there was general agreement that the WWS platform will continue to be a valuable tool for a wide range of public health threats and that future cross-sector engagements are needed to guide an enduring WWS capability.
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Hoar C, Li Y, Silverman AI. Assessment of Commonly Measured Wastewater Parameters to Estimate Sewershed Populations for Use in Wastewater-Based Epidemiology: Insights into Population Dynamics in New York City during the COVID-19 Pandemic. ACS ES&T WATER 2022; 2:2014-2024. [PMID: 37552716 PMCID: PMC9063991 DOI: 10.1021/acsestwater.2c00052] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 06/18/2023]
Abstract
Understanding per capita rates of disease incidence or prevalence from wastewater surveillance data requires an estimate of the population contributing to wastewater samples, given that populations in large urban areas are dynamic, especially if major events, such as the onset of the COVID-19 pandemic, cause large population shifts. To assess whether commonly measured wastewater parameters can be used to estimate sewershed populations, we used wastewater data collected from New York City's (NYC) 14 wastewater treatment facilities to evaluate the relationship between influent loads of four wastewater parameters-ammonia, total Kjeldahl nitrogen, total suspended solids, and five-day carbonaceous biochemical oxygen demand-and census-based population estimates of the corresponding sewersheds during 2019, when populations were assumed to be relatively stable. Ammonia mass load had the most consistent relationship with sewershed population, regardless of wet weather contributions to NYC's predominantly combined sewer system. Changes in ammonia loads due to COVID-19 restrictions enacted in March 2020 generally reflected population shifts in sewersheds serving areas of Manhattan and Brooklyn, for which previous studies report decreased commuter mobility and residential populations. Our findings highlight the utility of ammonia mass load in influent wastewater as a population indicator to normalize wastewater-based epidemiology data and track sewershed population dynamics.
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Affiliation(s)
| | | | - Andrea I. Silverman
- Department of Civil and Urban Engineering, Tandon School of Engineering,
New York University, Brooklyn, New York 11201,
United States
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6
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Lee WL, Gu X, Armas F, Leifels M, Wu F, Chandra F, Chua FJD, Syenina A, Chen H, Cheng D, Ooi EE, Wuertz S, Alm EJ, Thompson J. Monitoring human arboviral diseases through wastewater surveillance: Challenges, progress and future opportunities. WATER RESEARCH 2022; 223:118904. [PMID: 36007397 DOI: 10.1016/j.watres.2022.118904] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 07/19/2022] [Accepted: 07/23/2022] [Indexed: 05/21/2023]
Abstract
Arboviral diseases are caused by a group of viruses spread by the bite of infected arthropods. Amongst these, dengue, Zika, west nile fever and yellow fever cause the greatest economic and social impact. Arboviral epidemics have increased in frequency, magnitude and geographical extent over the past decades and are expected to continue increasing with climate change and expanding urbanisation. Arboviral prevalence is largely underestimated, as most infections are asymptomatic, nevertheless existing surveillance systems are based on passive reporting of loosely defined clinical syndromes with infrequent laboratory confirmation. Wastewater-based surveillance (WBS), which has been demonstrated to be useful for monitoring diseases with significant asymptomatic populations including COVID19 and polio, could be a useful complement to arboviral surveillance. We review the current state of knowledge and identify key factors that affect the feasibility of monitoring arboviral diseases by WBS to include viral shedding loads by infected persons, the persistence of shed arboviruses and the efficiency of their recovery from sewage. We provide a simple model on the volume of wastewater that needs to be processed for detection of arboviruses, in face of lower arboviral shedding rates. In all, this review serves to reflect on the key challenges that need to be addressed and overcome for successful implementation of arboviral WBS.
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Affiliation(s)
- Wei Lin Lee
- Antimicrobial Resistance Interdisciplinary Research Group, Singapore-MIT Alliance for Research and Technology, Singapore 138602, Singapore; Campus for Research Excellence and Technological Enterprise (CREATE), Singapore 138602, Singapore
| | - Xiaoqiong Gu
- Antimicrobial Resistance Interdisciplinary Research Group, Singapore-MIT Alliance for Research and Technology, Singapore 138602, Singapore; Campus for Research Excellence and Technological Enterprise (CREATE), Singapore 138602, Singapore
| | - Federica Armas
- Antimicrobial Resistance Interdisciplinary Research Group, Singapore-MIT Alliance for Research and Technology, Singapore 138602, Singapore; Campus for Research Excellence and Technological Enterprise (CREATE), Singapore 138602, Singapore
| | - Mats Leifels
- Singapore Centre for Environmental Life Sciences Engineering, Nanyang Technological University, Singapore 637551, Singapore
| | - Fuqing Wu
- Department of Epidemiology, Human Genetics, and Environmental Sciences, Center for Infectious Disease, University of Texas School of Public Health, Houston, TX, USA
| | - Franciscus Chandra
- Antimicrobial Resistance Interdisciplinary Research Group, Singapore-MIT Alliance for Research and Technology, Singapore 138602, Singapore; Campus for Research Excellence and Technological Enterprise (CREATE), Singapore 138602, Singapore
| | - Feng Jun Desmond Chua
- Singapore Centre for Environmental Life Sciences Engineering, Nanyang Technological University, Singapore 637551, Singapore
| | - Ayesa Syenina
- Program in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore 169857, Singapore; Viral Research and Experimental Medicine Centre (ViREMiCS), SingHealth Duke-NUS Academic Medical Centre, Singapore 169856, Singapore
| | - Hongjie Chen
- Antimicrobial Resistance Interdisciplinary Research Group, Singapore-MIT Alliance for Research and Technology, Singapore 138602, Singapore; Campus for Research Excellence and Technological Enterprise (CREATE), Singapore 138602, Singapore
| | - Dan Cheng
- Singapore Centre for Environmental Life Sciences Engineering, Nanyang Technological University, Singapore 637551, Singapore
| | - Eng Eong Ooi
- Antimicrobial Resistance Interdisciplinary Research Group, Singapore-MIT Alliance for Research and Technology, Singapore 138602, Singapore; Campus for Research Excellence and Technological Enterprise (CREATE), Singapore 138602, Singapore; Program in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore 169857, Singapore; Viral Research and Experimental Medicine Centre (ViREMiCS), SingHealth Duke-NUS Academic Medical Centre, Singapore 169856, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore
| | - Stefan Wuertz
- Singapore Centre for Environmental Life Sciences Engineering, Nanyang Technological University, Singapore 637551, Singapore; School of Civil and Environmental Engineering, Nanyang Technological University, Singapore 639798, Singapore
| | - Eric J Alm
- Antimicrobial Resistance Interdisciplinary Research Group, Singapore-MIT Alliance for Research and Technology, Singapore 138602, Singapore; Campus for Research Excellence and Technological Enterprise (CREATE), Singapore 138602, Singapore; Center for Microbiome Informatics and Therapeutics, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Department of Biological Engineering, Massachusetts Institute of Technology, MA 02139, USA; Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA.
| | - Janelle Thompson
- Campus for Research Excellence and Technological Enterprise (CREATE), Singapore 138602, Singapore; Singapore Centre for Environmental Life Sciences Engineering, Nanyang Technological University, Singapore 637551, Singapore; Asian School of the Environment, Nanyang Technological University, Singapore 637459, Singapore.
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7
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Aramjoo H, Yousefizadeh S, Aschner M, Roshanravan B, Farkhondeh T, Samarghandian S. Oxidative Stress Indices Changes in the Hearts of Rat Pups in Response to Maternal Buprenorphine Treatment during Gestation and Lactation. Cardiovasc Toxicol 2022; 22:29-34. [PMID: 34599474 DOI: 10.1007/s12012-021-09686-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/28/2021] [Indexed: 11/28/2022]
Abstract
This study aimed to assess the effects of Buprenorphine (BUP) on oxidative parameters in pups born to mothers exposed to the drug during gestation and lactation. Pregnant and lactating rats received BUP, 0.5 or 0.1 mg/kg subcutaneously for 21 and 28 days, respectively. At the end of the study, the pups were anesthetized, and the hearts were dissected out to measure oxidative stress indices, including the levels of Malondialdehyde (MDA), Nitric oxide (NO), Glutathione (GSH), and the activity of Superoxide dismutase (SOD). Our findings indicated that BUP did not alter MDA, NO, GSH levels, nor SOD activity in the cardiac tissue of pups exposed to this drug during the fetal period and through breast milk. We suggest performing additional studies to determine the association between BUP and oxidative modifications in cardiac tissues of pups born to mothers under BUP therapy during gestation and lactation.
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Affiliation(s)
- Hamed Aramjoo
- Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran
| | - Shahnaz Yousefizadeh
- Department of Laboratory and Clinical Sciences, Faculty of Para-Veterinary, Ilam University, Ilam, Iran
| | - Michael Aschner
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Forchheimer 209, 1300 Morris Park Avenue, Bronx, NY, USA
| | - Babak Roshanravan
- Student Research Committee, Birjand University of Medical Sciences (BUMS), Birjand, Iran
| | - Tahereh Farkhondeh
- Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran.
- Faculty of Pharmacy, Birjand University of Medical Sciences, Birjand, Iran.
| | - Saeed Samarghandian
- Noncommunicable Diseases Research Center, Neyshabur University of Medical Sciences, Neyshabur, Iran.
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8
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Picó Y, Barceló D. Identification of biomarkers in wastewater-based epidemiology: Main approaches and analytical methods. Trends Analyt Chem 2021; 145:116465. [PMID: 34803197 PMCID: PMC8591405 DOI: 10.1016/j.trac.2021.116465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Wastewater-based epidemiology (WBE) has become popular to estimate the use of drugs of abuse and recently to establish the incidence of CoVID 19 in large cities. However, its possibilities have been expanded recently as a technique that allows to establish a fingerprint of the characteristics of a city, such as state of health/disease, healthy/unhealthy living habits, exposure to different types of contaminants, etc. with respect to other cities. This has been thanks to the identification of human biomarkers as well as to the fingerprinting and profiling of the characteristics of the wastewater catchment that determine these circumstances. The purpose of this review is to analyze the different methodological schemes that have been developed to perform this biomarker identification as well as the most characteristic analytical techniques in each scheme, their advantages and disadvantages and the knowledge gaps identified. We also discussed the future scope for development.
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Affiliation(s)
- Yolanda Picó
- Environmental and Food Safety Research Group of the University of Valencia (SAMA-UV), Desertification Research Centre (CIDE), CSIC-GV-UV, Moncada Naquera Road Km 4.3, 46113 Moncada, Valencia, Spain,Corresponding author
| | - Damià Barceló
- Department of Environmental Chemistry, IDAEA-CSIC, Jordi Girona 18-26, 08034 Barcelona, Spain,Catalan Institute for Water Research, ICRA – CERCA, Technological Park of the University of Girona, Emili Grahit 101, 17003 Girona, Spain
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9
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Boogaerts T, Ahmed F, Choi PM, Tscharke B, O'Brien J, De Loof H, Gao J, Thai P, Thomas K, Mueller JF, Hall W, Covaci A, van Nuijs ALN. Current and future perspectives for wastewater-based epidemiology as a monitoring tool for pharmaceutical use. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 789:148047. [PMID: 34323839 DOI: 10.1016/j.scitotenv.2021.148047] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/21/2021] [Accepted: 05/21/2021] [Indexed: 06/13/2023]
Abstract
The medical and societal consequences of the misuse of pharmaceuticals clearly justify the need for comprehensive drug utilization research (DUR). Wastewater-based epidemiology (WBE) employs the analysis of human metabolic excretion products in wastewater to monitor consumption patterns of xenobiotics at the population level. Recently, WBE has demonstrated its potential to evaluate lifestyle factors such as illicit drug, alcohol and tobacco consumption at the population level, in near real-time and with high spatial and temporal resolution. Up until now there have been fewer WBE studies investigating health biomarkers such as pharmaceuticals. WBE publications monitoring the consumption of pharmaceuticals were systematically reviewed from three databases (PubMed, Web of Science and Google Scholar). 64 publications that reported population-normalised mass loads or defined daily doses of pharmaceuticals were selected. We document that WBE could be employed as a complementary information source for DUR. Interest in using WBE approaches for monitoring pharmaceutical use is growing but more foundation research (e.g. compound-specific uncertainties) is required to link WBE data to routine pharmacoepidemiologic information sources and workflows. WBE offers the possibility of i) estimating consumption of pharmaceuticals through the analysis of human metabolic excretion products in wastewater; ii) monitoring spatial and temporal consumption patterns of pharmaceuticals continuously and in near real-time; and iii) triangulating data with other DUR information sources to assess the impacts of strategies or interventions to reduce inappropriate use of pharmaceuticals.
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Affiliation(s)
- Tim Boogaerts
- Toxicological Centre, University of Antwerp, Belgium, Universiteitsplein 1, 2610 Antwerp, Belgium.
| | - Fahad Ahmed
- Queensland Alliance for Environmental Health Sciences (QAEHS), University of Queensland, 20 Cornwall St, Woolloongabba, QLD 4102, Australia
| | - Phil M Choi
- Queensland Alliance for Environmental Health Sciences (QAEHS), University of Queensland, 20 Cornwall St, Woolloongabba, QLD 4102, Australia; Water Unit, Health Protection Branch, Prevention Division, Queensland Health, GPO Box 48, Brisbane, QLD 4001, Australia
| | - Benjamin Tscharke
- Queensland Alliance for Environmental Health Sciences (QAEHS), University of Queensland, 20 Cornwall St, Woolloongabba, QLD 4102, Australia
| | - Jake O'Brien
- Queensland Alliance for Environmental Health Sciences (QAEHS), University of Queensland, 20 Cornwall St, Woolloongabba, QLD 4102, Australia
| | - Hans De Loof
- Laboratory of Physiopharmacology, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Jianfa Gao
- College of Chemistry and Environmental Engineering, Shenzhen University, 1066 Xueyuan Avenue, Shenzhen 518060, China
| | - Phong Thai
- Queensland Alliance for Environmental Health Sciences (QAEHS), University of Queensland, 20 Cornwall St, Woolloongabba, QLD 4102, Australia
| | - Kevin Thomas
- Queensland Alliance for Environmental Health Sciences (QAEHS), University of Queensland, 20 Cornwall St, Woolloongabba, QLD 4102, Australia
| | - Jochen F Mueller
- Queensland Alliance for Environmental Health Sciences (QAEHS), University of Queensland, 20 Cornwall St, Woolloongabba, QLD 4102, Australia
| | - Wayne Hall
- Queensland Alliance for Environmental Health Sciences (QAEHS), University of Queensland, 20 Cornwall St, Woolloongabba, QLD 4102, Australia; Centre for Youth Substance Abuse, University of Queensland, 17 Upland Road, Woolloongabba, QLD 4102, Australia
| | - Adrian Covaci
- Toxicological Centre, University of Antwerp, Belgium, Universiteitsplein 1, 2610 Antwerp, Belgium
| | - Alexander L N van Nuijs
- Toxicological Centre, University of Antwerp, Belgium, Universiteitsplein 1, 2610 Antwerp, Belgium.
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Erickson TB, Endo N, Duvallet C, Ghaeli N, Hess K, Alm EJ, Matus M, Chai PR. "Waste Not, Want Not" - Leveraging Sewer Systems and Wastewater-Based Epidemiology for Drug Use Trends and Pharmaceutical Monitoring. J Med Toxicol 2021; 17:397-410. [PMID: 34402038 PMCID: PMC8366482 DOI: 10.1007/s13181-021-00853-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/28/2021] [Accepted: 07/09/2021] [Indexed: 12/26/2022] Open
Abstract
During the current global COVID-19 pandemic and opioid epidemic, wastewater-based epidemiology (WBE) has emerged as a powerful tool for monitoring public health trends by analysis of biomarkers including drugs, chemicals, and pathogens. Wastewater surveillance downstream at wastewater treatment plants provides large-scale population and regional-scale aggregation while upstream surveillance monitors locations at the neighborhood level with more precise geographic analysis. WBE can provide insights into dynamic drug consumption trends as well as environmental and toxicological contaminants. Applications of WBE include monitoring policy changes with cannabinoid legalization, tracking emerging illicit drugs, and early warning systems for potent fentanyl analogues along with the resurging wave of stimulants (e.g., methamphetamine, cocaine). Beyond drug consumption, WBE can also be used to monitor pharmaceuticals and their metabolites, including antidepressants and antipsychotics. In this manuscript, we describe the basic tenets and techniques of WBE, review its current application among drugs of abuse, and propose methods to scale and develop both monitoring and early warning systems with respect to measurement of illicit drugs and pharmaceuticals. We propose new frontiers in toxicological research with wastewater surveillance including assessment of medication assisted treatment of opioid use disorder (e.g., buprenorphine, methadone) in the context of other social burdens like COVID-19 disease.
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Affiliation(s)
- Timothy B Erickson
- Department of Emergency Medicine / Division of Toxicology, Brigham & Women's Hospital / Harvard Medical School, 10 Vining St, Boston, MA, 02155, USA.
- Division of Medical Toxicology, Department of Emergency Medicine, Mass General Brigham, Boston, USA.
- Harvard Humanitarian Institute, Cambridge, MA, USA.
| | | | | | | | | | - Eric J Alm
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
- Center for Microbiome Informatics and Therapeutics, Massachusetts Institute of Technology, Cambridge, MA, USA
- Antimicrobial Resistance Interdisciplinary Research Group, Singapore-MIT Alliance for Research and Technology, Singapore, Singapore
- Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | | | - Peter R Chai
- Department of Emergency Medicine / Division of Toxicology, Brigham & Women's Hospital / Harvard Medical School, 10 Vining St, Boston, MA, 02155, USA
- Division of Medical Toxicology, Department of Emergency Medicine, Mass General Brigham, Boston, USA
- The Fenway Institute, Boston, MA, USA
- The Koch Institute for Integrated Cancer Research, Massachusetts Institute of Technology (MIT), Cambridge, MA, USA
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11
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Boogaerts T, Quireyns M, Covaci A, De Loof H, van Nuijs AL. Analytical method for the simultaneous determination of a broad range of opioids in influent wastewater: Optimization, validation and applicability to monitor consumption patterns. Talanta 2021; 232:122443. [DOI: 10.1016/j.talanta.2021.122443] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/13/2021] [Accepted: 04/18/2021] [Indexed: 10/21/2022]
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12
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Gibas C, Lambirth K, Mittal N, Juel MAI, Barua VB, Roppolo Brazell L, Hinton K, Lontai J, Stark N, Young I, Quach C, Russ M, Kauer J, Nicolosi B, Chen D, Akella S, Tang W, Schlueter J, Munir M. Implementing building-level SARS-CoV-2 wastewater surveillance on a university campus. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 782:146749. [PMID: 33838367 PMCID: PMC8007530 DOI: 10.1016/j.scitotenv.2021.146749] [Citation(s) in RCA: 166] [Impact Index Per Article: 55.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/20/2021] [Accepted: 03/21/2021] [Indexed: 05/17/2023]
Abstract
The COVID-19 pandemic has been a source of ongoing challenges and presents an increased risk of illness in group environments, including jails, long-term care facilities, schools, and residential college campuses. Early reports that the SARS-CoV-2 virus was detectable in wastewater in advance of confirmed cases sparked widespread interest in wastewater-based epidemiology (WBE) as a tool for mitigation of COVID-19 outbreaks. One hypothesis was that wastewater surveillance might provide a cost-effective alternative to other more expensive approaches such as pooled and random testing of groups. In this paper, we report the outcomes of a wastewater surveillance pilot program at the University of North Carolina at Charlotte, a large urban university with a substantial population of students living in on-campus dormitories. Surveillance was conducted at the building level on a thrice-weekly schedule throughout the university's fall residential semester. In multiple cases, wastewater surveillance enabled the identification of asymptomatic COVID-19 cases that were not detected by other components of the campus monitoring program, which also included in-house contact tracing, symptomatic testing, scheduled testing of student athletes, and daily symptom reporting. In the context of all cluster events reported to the University community during the fall semester, wastewater-based testing events resulted in the identification of smaller clusters than were reported in other types of cluster events. Wastewater surveillance was able to detect single asymptomatic individuals in dorms with resident populations of 150-200. While the strategy described was developed for COVID-19, it is likely to be applicable to mitigation of future pandemics in universities and other group-living environments.
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Affiliation(s)
- Cynthia Gibas
- Department of Bioinformatics and Genomics, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, United States of America; Bioinformatics Research Center, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, United States of America.
| | - Kevin Lambirth
- Department of Bioinformatics and Genomics, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, United States of America.
| | - Neha Mittal
- Department of Bioinformatics and Genomics, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, United States of America
| | - Md Ariful Islam Juel
- Department of Civil and Environmental Engineering, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, United States of America
| | - Visva Bharati Barua
- Department of Civil and Environmental Engineering, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, United States of America
| | - Lauren Roppolo Brazell
- Department of Bioinformatics and Genomics, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, United States of America
| | - Keshawn Hinton
- Department of Bioinformatics and Genomics, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, United States of America
| | - Jordan Lontai
- Department of Geography and Earth Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, United States of America
| | - Nicholas Stark
- Department of Bioinformatics and Genomics, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, United States of America
| | - Isaiah Young
- Department of Civil and Environmental Engineering, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, United States of America
| | - Cristine Quach
- Department of Civil and Environmental Engineering, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, United States of America
| | - Morgan Russ
- Department of Bioinformatics and Genomics, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, United States of America
| | - Jacob Kauer
- Department of Bioinformatics and Genomics, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, United States of America
| | - Bridgette Nicolosi
- Department of Bioinformatics and Genomics, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, United States of America
| | - Don Chen
- Department of Engineering Technology and Construction Management, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, United States of America
| | - Srinivas Akella
- Department of Computer Science, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, United States of America
| | - Wenwu Tang
- Department of Geography and Earth Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, United States of America; Center for Applied Geographic Information Systems, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, United States of America
| | - Jessica Schlueter
- Department of Bioinformatics and Genomics, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, United States of America; Bioinformatics Research Center, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, United States of America
| | - Mariya Munir
- Department of Civil and Environmental Engineering, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, United States of America
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13
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Gibas C, Lambirth K, Mittal N, Juel MAI, Barua VB, Roppolo Brazell L, Hinton K, Lontai J, Stark N, Young I, Quach C, Russ M, Kauer J, Nicolosi B, Chen D, Akella S, Tang W, Schlueter J, Munir M. Implementing building-level SARS-CoV-2 wastewater surveillance on a university campus. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 782:146749. [PMID: 33838367 DOI: 10.1101/2020.12.31.20248843] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/20/2021] [Accepted: 03/21/2021] [Indexed: 05/18/2023]
Abstract
The COVID-19 pandemic has been a source of ongoing challenges and presents an increased risk of illness in group environments, including jails, long-term care facilities, schools, and residential college campuses. Early reports that the SARS-CoV-2 virus was detectable in wastewater in advance of confirmed cases sparked widespread interest in wastewater-based epidemiology (WBE) as a tool for mitigation of COVID-19 outbreaks. One hypothesis was that wastewater surveillance might provide a cost-effective alternative to other more expensive approaches such as pooled and random testing of groups. In this paper, we report the outcomes of a wastewater surveillance pilot program at the University of North Carolina at Charlotte, a large urban university with a substantial population of students living in on-campus dormitories. Surveillance was conducted at the building level on a thrice-weekly schedule throughout the university's fall residential semester. In multiple cases, wastewater surveillance enabled the identification of asymptomatic COVID-19 cases that were not detected by other components of the campus monitoring program, which also included in-house contact tracing, symptomatic testing, scheduled testing of student athletes, and daily symptom reporting. In the context of all cluster events reported to the University community during the fall semester, wastewater-based testing events resulted in the identification of smaller clusters than were reported in other types of cluster events. Wastewater surveillance was able to detect single asymptomatic individuals in dorms with resident populations of 150-200. While the strategy described was developed for COVID-19, it is likely to be applicable to mitigation of future pandemics in universities and other group-living environments.
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Affiliation(s)
- Cynthia Gibas
- Department of Bioinformatics and Genomics, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, United States of America; Bioinformatics Research Center, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, United States of America.
| | - Kevin Lambirth
- Department of Bioinformatics and Genomics, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, United States of America.
| | - Neha Mittal
- Department of Bioinformatics and Genomics, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, United States of America
| | - Md Ariful Islam Juel
- Department of Civil and Environmental Engineering, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, United States of America
| | - Visva Bharati Barua
- Department of Civil and Environmental Engineering, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, United States of America
| | - Lauren Roppolo Brazell
- Department of Bioinformatics and Genomics, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, United States of America
| | - Keshawn Hinton
- Department of Bioinformatics and Genomics, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, United States of America
| | - Jordan Lontai
- Department of Geography and Earth Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, United States of America
| | - Nicholas Stark
- Department of Bioinformatics and Genomics, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, United States of America
| | - Isaiah Young
- Department of Civil and Environmental Engineering, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, United States of America
| | - Cristine Quach
- Department of Civil and Environmental Engineering, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, United States of America
| | - Morgan Russ
- Department of Bioinformatics and Genomics, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, United States of America
| | - Jacob Kauer
- Department of Bioinformatics and Genomics, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, United States of America
| | - Bridgette Nicolosi
- Department of Bioinformatics and Genomics, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, United States of America
| | - Don Chen
- Department of Engineering Technology and Construction Management, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, United States of America
| | - Srinivas Akella
- Department of Computer Science, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, United States of America
| | - Wenwu Tang
- Department of Geography and Earth Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, United States of America; Center for Applied Geographic Information Systems, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, United States of America
| | - Jessica Schlueter
- Department of Bioinformatics and Genomics, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, United States of America; Bioinformatics Research Center, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, United States of America
| | - Mariya Munir
- Department of Civil and Environmental Engineering, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, United States of America
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14
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Marks C, Carrasco-Escobar G, Carrasco-Hernández R, Johnson D, Ciccarone D, Strathdee SA, Smith D, Bórquez A. Methodological approaches for the prediction of opioid use-related epidemics in the United States: a narrative review and cross-disciplinary call to action. Transl Res 2021; 234:88-113. [PMID: 33798764 PMCID: PMC8217194 DOI: 10.1016/j.trsl.2021.03.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/25/2021] [Accepted: 03/25/2021] [Indexed: 01/01/2023]
Abstract
The opioid crisis in the United States has been defined by waves of drug- and locality-specific Opioid use-Related Epidemics (OREs) of overdose and bloodborne infections, among a range of health harms. The ability to identify localities at risk of such OREs, and better yet, to predict which ones will experience them, holds the potential to mitigate further morbidity and mortality. This narrative review was conducted to identify and describe quantitative approaches aimed at the "risk assessment," "detection" or "prediction" of OREs in the United States. We implemented a PubMed search composed of the: (1) objective (eg, prediction), (2) epidemiologic outcome (eg, outbreak), (3) underlying cause (ie, opioid use), (4) health outcome (eg, overdose, HIV), (5) location (ie, US). In total, 46 studies were included, and the following information extracted: discipline, objective, health outcome, drug/substance type, geographic region/unit of analysis, and data sources. Studies identified relied on clinical, epidemiological, behavioral and drug markets surveillance and applied a range of methods including statistical regression, geospatial analyses, dynamic modeling, phylogenetic analyses and machine learning. Studies for the prediction of overdose mortality at national/state/county and zip code level are rapidly emerging. Geospatial methods are increasingly used to identify hotspots of opioid use and overdose. In the context of infectious disease OREs, routine genetic sequencing of patient samples to identify growing transmission clusters via phylogenetic methods could increase early detection capacity. A coordinated implementation of multiple, complementary approaches would increase our ability to successfully anticipate outbreak risk and respond preemptively. We present a multi-disciplinary framework for the prediction of OREs in the US and reflect on challenges research teams will face in implementing such strategies along with good practices.
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Affiliation(s)
- Charles Marks
- Interdisciplinary Research on Substance Use Joint Doctoral Program at San Diego State University and University of California, San Diego; Division of Infectious Diseases and Global Public Health, University of California, San Diego; School of Social Work, San Diego State University
| | - Gabriel Carrasco-Escobar
- Division of Infectious Diseases and Global Public Health, University of California, San Diego; Health Innovation Laboratory, Institute of Tropical Medicine "Alexander von Humboldt", Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Derek Johnson
- Division of Infectious Diseases and Global Public Health, University of California, San Diego
| | - Dan Ciccarone
- Department of Family and Community Medicine, University of California San Francisco
| | - Steffanie A Strathdee
- Division of Infectious Diseases and Global Public Health, University of California, San Diego
| | - Davey Smith
- Division of Infectious Diseases and Global Public Health, University of California, San Diego
| | - Annick Bórquez
- Division of Infectious Diseases and Global Public Health, University of California, San Diego.
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15
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Foppe KS, Kujawinski EB, Duvallet C, Endo N, Erickson TB, Chai PR, Matus M. Analysis of 39 drugs and metabolites, including 8 glucuronide conjugates, in an upstream wastewater network via HPLC-MS/MS. J Chromatogr B Analyt Technol Biomed Life Sci 2021; 1176:122747. [PMID: 34052556 PMCID: PMC8271266 DOI: 10.1016/j.jchromb.2021.122747] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 04/17/2021] [Accepted: 04/26/2021] [Indexed: 01/03/2023]
Abstract
Pharmaceutical compounds ingested by humans are metabolized and excreted in urine and feces. These metabolites can be quantified in wastewater networks using wastewater-based epidemiology (WBE) methods. Standard WBE methods focus on samples collected at wastewater treatment plants (WWTPs). However, these methods do not capture more labile classes of metabolites such as glucuronide conjugates, products of the major phase II metabolic pathway for drug elimination. By shifting sample collection more upstream, these unambiguous markers of human exposure are captured before hydrolysis in the wastewater network. In this paper, we present an HPLC-MS/MS method that quantifies 8 glucuronide conjugates in addition to 31 parent and other metabolites of prescription and synthetic opioids, overdose treatment drugs, illicit drugs, and population markers. Calibration curves for all analytes are linear (r2 > 0.98), except THC (r2 = 0.97), and in the targeted range (0.1-1,000 ng mL-1) with lower limits of quantification (S/N = 9) ranging from 0.098 to 48.75 ng mL-1. This method is fast with an injection-to-injection time of 7.5 min. We demonstrate the application of the method to five wastewater samples collected from a manhole in a city in eastern Massachusetts. Collected wastewater samples were filtered and extracted via solid-phase extraction (SPE). The SPE cartridges are eluted and concentrated in the laboratory via nitrogen-drying. The method and case study presented here demonstrate the potential and application of expanding WBE to monitoring labile metabolites in upstream wastewater networks.
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Affiliation(s)
- Katelyn S Foppe
- Biobot Analytics, Inc., 501 Massachusetts Avenue, Cambridge, MA 02139, USA
| | - Elizabeth B Kujawinski
- Biobot Analytics, Inc., 501 Massachusetts Avenue, Cambridge, MA 02139, USA; Department of Marine Chemistry and Geochemistry, Woods Hole Oceanographic Institution, Woods Hole, MA 02543, USA
| | - Claire Duvallet
- Biobot Analytics, Inc., 501 Massachusetts Avenue, Cambridge, MA 02139, USA
| | - Noriko Endo
- Biobot Analytics, Inc., 501 Massachusetts Avenue, Cambridge, MA 02139, USA
| | - Timothy B Erickson
- Division of Medical Toxicology, Department of Medical Toxicology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02411, USA; Harvard Humanitarian Institute, Cambridge, MA 02139, USA
| | - Peter R Chai
- Division of Medical Toxicology, Department of Medical Toxicology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02411, USA; The Fenway Institute, 1340 Boylston Street, Boston, MA 02215, USA; The Koch Institute for Integrated Cancer Research, Massachusetts Institute of Technology, 500 Main Street, Cambridge, MA 02142, USA; Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA
| | - Mariana Matus
- Biobot Analytics, Inc., 501 Massachusetts Avenue, Cambridge, MA 02139, USA.
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16
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Strand MA, DiPietro Mager NA, Hall L, Martin SL, Sarpong DF. Pharmacy Contributions to Improved Population Health: Expanding the Public Health Roundtable. Prev Chronic Dis 2020; 17:E113. [PMID: 32975507 PMCID: PMC7553224 DOI: 10.5888/pcd17.200350] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Mark A Strand
- School of Pharmacy, College of Health Professions, North Dakota State University, 118K Sudro Hall, Fargo, ND 58101.
| | | | - Lori Hall
- Division of Strategic National Stockpile, Office of the Assistant Secretary for Preparedness and Response, Atlanta, Georgia
| | - Sarah Levin Martin
- Department of Community Health, University of Maine at Farmington, Farmington, Maine
| | - Daniel F Sarpong
- Center for Minority Health and Health Disparities Research and Education, College of Pharmacy, Xavier University of Louisiana, New Orleans, Louisiana
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