A Metropolitan Monitoring Framework Proposed to Track Opioids in Wastewater

A new innovative approach for monitoring opioid use and analyzing trends by utilizing wastewater-based epidemiologic methods may help public health officials worldwide manage the opioid epidemic in large metro areas, according to a study published in the International Journal of Environmental Research and Public Health.

“Considering the enormous impact of opioid overdose deaths, it is imperative that large metro areas, such as the one comprising Atlanta, establish a drug surveillance system that monitors the use and deaths related to opioids and other harmful substances,” wrote Tamara Wright, University College, University of Denver in Denver, CO and Atin Adhikari, Jiann-Ping Hsu College of Public Health, Georgia Southern University, in Statesboro, GA.

Wastewater-Based Epidemiology (WBE) is a more accurate and timely method for monitoring community health than traditional methods. WBE provides real-time data on the population's health, is less invasive, and does not rely on self-reported data or a database of prescribed opioids. WBE is a necessary complementary tool for traditional surveillance methods.

A framework has been proposed to monitor the opioid epidemic in the metropolitan area by using the National Pollutant Discharge Elimination System (NPDES) permit program. This program was established by the Environmental Protection Agency (EPA) under the Clean Water Act (CWA) to regulate point sources that discharge pollutants into the waters of the US and address water pollution. However, currently, the wastewater treatment plants in Metro Atlanta are not required to report opioid metabolites to the Georgia Department of Natural Resources as part of the requirements for the Georgia NPDES permit. To tackle this issue, the proposed solution is to increase the monitoring of opioid usage through wastewater surveillance under the NPDES permits.

This process requires wastewater treatment plants in Metro Atlanta to report various opioid contaminants to the Georgia Environmental Protection Division in compliance with NPDES regulations. The process involves collecting samples from the wastewater treatment plant, analyzing them via onsite or private contract environmental laboratories, reporting the results to the GA Department of Natural Resources through the Network Discharge Monitoring Report, recording them in public databases, and distributing them to local public health officials. The information received by public health officials can then be used to allocate more resources toward preventing opioid use, requesting additional funding, and increasing community awareness.

“The process of analysis discussed within this paper outlines the potential to broaden the policy and resources provided to communities throughout the US that are battling opioid use, abuse, and overdoses,” wrote the study authors. “In addition, the mentioned approach within this paper to address the opioid epidemic in the US would require a collaborative effort among the EPA and local public health officials to monitor opioid metabolites through the utilization of wastewater-based epidemiology on NPDES permits.”

Reference

Wright T, Adhikari A. Utilizing a national wastewater monitoring program to address the U.S. opioid epidemic: A focus on metro Atlanta, Georgia. Int J Environ Res Public Health. 2023;20(7):5282. doi:10.3390/ijerph20075282