Improving wastewater-based epidemiology for new psychoactive substance surveillance by combining a high-throughput in vitro metabolism assay and LC-HRMS metabolite identification

One of the primary criteria for a suitable drug biomarker for wastewater-based epidemiology (WBE) is having a unique source representing human metabolism. For WBE studies, this means it is important to identify and monitor metabolites rather than parent drugs, to capture consumption of drugs and not fractions that could be directly disposed. In this study, a high-throughput workflow based on a human liver S9 fraction in vitro metabolism assay was developed to identify human transformation products of new chemicals, using α-pyrrolidino-2-phenylacetophenone (α-D2PV) as a case study. Analysis by liquid chromatography coupled to high resolution mass spectrometry identified four metabolites. Subsequently, a targeted liquid chromatography - tandem mass spectrometry method was developed for their analysis in wastewater samples collected from a music festival in Australia. The successful application of this workflow opens the door for future work to better understand the metabolism of chemicals and their detection and application for wastewater-based epidemiology.

Drug policing down under: An investigation of panic consumption, internal concealment and the use of drug amnesty bins among a sample of Australian festivalgoers

BACKGROUND

The use of drug detection dogs and other punitive policing methods remain common at music festivals in Australia and elsewhere, despite concern about iatrogenic effects and recommendations for their overhaul. While drug amnesty bins are a commonly implemented strategy purported to mitigate risk associated with policing, the efficacy of this intervention is debated. This paper investigates two of the most concerning iatrogenic effects of drug policing practices at Australian festivals - internal concealment and panic consumption - and explores the potential efficacy of drug amnesty bins.

METHODS

A stepped, mixed methods study (qual→QUANT→qual) comprised qualitative interviews with key informants and festivalgoers, and a quantitative online survey completed by almost 2000 Australian festivalgoers (52% male; median age 20 years old). Descriptive statistics were performed alongside bivariable and multivariable logistic regressions predicting internal concealment and panic consumption. Inductive thematic analysis was used to examine the qualitative data.

RESULTS

Among respondents who had ever used illicit drugs at festivals (n=1065), 23% reported hiding drugs internally to evade police detection and 17% reported panic consumption. Female respondents and respondents expecting dogs were at greater odds of reporting internal concealment. The qualitative data provided greater insight into the risky nature of internal concealment practices and panic incited by police at the gates. When asked if they would have considered discarding their drugs into a drug amnesty bin had they been concerned about detection, less than a quarter (24%) said they definitely or probably would have.

CONCLUSION

This paper adds to the evidence regarding iatrogenic effects of punitive drug policing practices at festivals. The findings have implications for shifting away from punitive policies to ones focused on public health. Additionally, the findings suggest drug amnesty bins should not be viewed as an adequate response for averting harms from drug policing.

The environmental release and ecosystem risks of illicit drugs during Glastonbury Festival

Reported high drug use at music festivals coupled with factors such as public urination can lead to the direct release of illicit drugs into the environment. Glastonbury Festival 2019 had 203,000 attendees, its site is intercepted by the Whitelake River providing a direct route for illicit drug pollution into the local environment. We tested for popular illicit drugs such as cocaine and MDMA in the river upstream and downstream of the festival site as well as in the neighbouring Redlake River. Both rivers were sampled the weeks before, during and after the festival. Cocaine, benzoylecgonine and MDMA were found at all sample sites; concentrations, and mass loads (mass carried by the river per unit of time) were significantly higher in the Whitelake site, downstream of the festival. MDMA mass loads were 104 times greater downstream in comparison to upstream sites (1.1-61.0 mg/h vs 114.7 mg/h; p < .01). Cocaine and benzoylecgonine mass loads were also 40 times higher downstream of the festival (1.3-4.2 mg/h vs 50.4 mg/h; p < .01) (22.7-81.4 mg/h vs 854.6 mg/h; p < .01). MDMA reached its highest level during the weekend after the festival with a concentration of 322 ng/L. This concentration is deemed harmful to aquatic life using Risk Quotient assessment (RQ) and provides evidence of continuous release after the festival due to leaching of MDMA from the site. Cocaine and benzoylecgonine concentrations were not at levels deemed harmful to aquatic life according to RQ assessment yet were three times higher than MDMA concentrations. Redlake River experienced no significant changes (p > .05) in any illicit drug levels, further confirming that drug release was likely dependent on the festival site. The release of environmentally damaging levels of illicit drugs into Whitelake River during the period of Glastonbury Festival suggests an underreported potential source of environmental contamination from greenfield festival sites.

Water treatment and re-use at temporary events using a mobile constructed wetland and drinking water production system

Temporary events such as music festivals are often organized in places that are not connected to a sewage network. As such, the waste (water) generated and discharged can place a heavy burden on the environment. A mobile vertical flow constructed wetland (MCW) with an area of 15 m² was constructed, optimized and operated for three years treating grey water (GW) as well as grey and black water (GW + BW) at different festival locations to tackle this problem. During the initial development phase, the appropriate influent type (GW and/or GW + BW) was determined and challenge tests with pre-settled diluted domestic waste water (mimicking GW) were carried out to determine the maximal allowable loading rate. The MCW was able to treat both types of water. However, for further experiments GW was selected as the discharge limits could not be met when treating GW + BW. The challenge tests demonstrated that the MCW could be operated at a maximal allowable hydraulic loading rate of 1.1 m³·m^-2·d^-1, corresponding to mass loading rates of 68 gTSS·m^-2·d^-1, 160 gCOD·m^-2·d^-1 and 137 gBOD·m^-2·d^-1. During treatment of GW, the MCW achieved effluent concentrations for respectively chemical oxygen demand (COD), biological oxygen demand (BOD), total suspended solids (TSS) and total phosphorus (TP) of 43 mg·L^-1, 16 mg·L^-1, 2.7 mg·L^-1 and 1.7 mgP·L^-1. This corresponds to a removal of 90% (COD), 95% (BOD), 97% (TSS) and 76% (TP) respectively. Total nitrogen removal was 25% (from 45 mgN·L^-1 to 34 mgN·L^-1) as particularly denitrification was not complete. As a further development, the MCW was coupled to a drinking water treatment system using ultrafiltration and reverse osmosis (UF-RO) membranes to produce potable water on site. The drinking water system produced potable water that met the legislative criteria. As such, a sustainable and mobile water treatment system aiming at producing potable water at temporary events was demonstrated.

Monitoring psychoactive substance use at six European festivals through wastewater and pooled urine analysis

The consumption of psychoactive substances is considered a growing problem in many communities. Moreover, new psychoactive substances (NPS) designed as (legal) substitutes to traditional illicit drugs are relatively easily available to the public through e-commerce and retail shops, but there is little knowledge regarding the extent and actual use of these substances. This study aims to gain new and complementary information on NPS and traditional illicit drug use at six music festivals across Europe by investigating wastewater and pooled urine. Samples were collected, between 2015 and 2018, at six music festivals across Europe with approximately 465.000 attendees. Wastewater samples were also collected during a period not coinciding with festivals. A wide-scope screening for 197 NPS, six illicit drugs and known metabolites was applied using different chromatography-mass spectrometric strategies. Several illicit drugs and in total 21 different NPS, mainly synthetic cathinones, phenethylamines and tryptamines, were identified in the samples. Ketamine and the traditional illicit drugs, such as amphetamine-type stimulants, cannabis and cocaine were most abundant and/or frequently detected in the samples collected, suggesting a higher use compared to NPS. The analyses of urine and wastewater is quick and a high number of attendees may be monitored anonymously by analysing only a few samples which allows identifying the local profiles of use of different drugs within a wide panel of psychoactive substances. This approach contributes to the development of an efficient surveillance system which can provide timely insight in the trends of NPS and illicit drugs use.

Toxicological analysis of serious drug-related harm among electronic dance music festival attendees in New South Wales, Australia: A consecutive case series

BACKGROUND

A substantial increase in drug-related harm was observed during the 2018-2019 music festival season in New South Wales, Australia, including the deaths of five young people. As part of a rapid public health response, the New South Wales Ministry of Health referred samples from patients with suspected severe drug-related illness for forensic toxicological testing to identify the type and concentration of substances associated with the presentations.

METHODS

Cases were identified through a variety of active and passive surveillance systems, and selected consecutively based on indicators of clinical severity. Comprehensive toxicology testing of blood and urine samples was expedited for all cases. Demographic and clinical characteristics were collated, together with quantitative toxicology results. Results were analysed using descriptive statistics.

RESULTS

Forty cases from eleven different music festivals were included. The majority of cases (80.0%) were aged 25 years and under. There were five fatalities, and 62.5% of cases were admitted to intensive care units. MDMA was the most frequent substance, detected in 87.5% of cases. In 82.9% of cases with MDMA, blood concentrations were above thresholds that have been associated with toxicity. Multiple substances were detected in 60.0% of cases. Novel psychoactive substances were not detected.

CONCLUSIONS

Our findings strongly suggest that MDMA-related toxicity was a major factor in the severity of the clinical presentations among these cases. Other substances may have enhanced MDMA toxicity but appear unlikely to have caused severe toxicity in isolation. These findings have important implications for harm reduction strategies targeted to music festival settings.

Music festivals and drugs: Wastewater analysis

Drug consumption in individual cities, regions, and at various music events and festivals across the EU has generally been monitored via questionnaires, patients' medical data, and police reports. However, an overview of drug consumption obtained from these methods can be negatively affected by various subjective factors. We aimed to investigate an association between levels of target drugs in wastewater, music genres, and festival courses. The occurrence of illicit drugs, their metabolites, and psychoactive compounds was investigated in the influent of six wastewater treatment plants in the Czech and Slovak Republic during seven large-scale music festivals from different music genres: metal, rock, pop, country and folk, ethnic, multi-genre, dance, and trance. The total number of participants included >130,000 active festival attendees. The association between music genre and illicit drug and/or psychoactive pharmaceutical consumptions is discussed on the basis of the results obtained through wastewater analyses. The observed trend was similar to worldwide published data with a specific local phenomenon of methamphetamine prevalence that did not significantly change between music events. Increased specific loads of cocaine (measured as its metabolite benzoylecgonine) and Ecstasy, along with some cannabis, were mainly observed during pop/rock and dance music festivals. However, there was no significant increase observed in the specific loads of all monitored psychoactive pharmaceuticals. This study demonstrates that the abuse of some illicit drugs is closely associated with specific music preferences.

Evaluation of different smoking habits during music festivals through wastewater analysis

Wastewater analysis is a powerful method that can provide useful information about the abuse of legal and illicit drugs. The aim of our study was to determine nicotine consumption during four different music festivals and to find a connection between smoking and preferences for specific music styles using wastewater analysis. The amount of the nicotine metabolite cotinine was monitored in wastewater at the influent of three waste water treatment plants WWTPs in the Czech Republic and Slovakia, where the festivals took place. Urinary bio-markers of nicotine utilization were analyzed by LC-HRMS. More than 80,000 festival participants were monitored during our study from June to September 2014. A significant increase of nicotine consumption was observed in wastewaters during music festivals. The nicotine ingestion level was back-calculated and expressed as mass of pure drug consumed per day and per 1000 inhabitants for selected cities of both countries. The highest differences between typical levels of cotinine in wastewaters and the levels during music festivals were detected in Piešťany: 4 g/L/1000 inhabitants during non-festival days compared to 8 g/L/1000 inhabitants during the Topfest pop-rock festival and 6g/L/1000 inhabitants during the Grape dance festival. No significant increase of the amounts of cotinine in wastewater was recorded for the Country and Folk festivals.