Vol 15 Edition 2

The tale told by our wastewater

The poo doesn’t lie.

Australia’s increasingly sophisticated wastewater drug monitoring shows that ice (crystal methamphetamine) remains the most consumed illicit drug in Australia and its usage is increasing.

That’s one of the major findings of the most recent National Wastewater Drug Monitoring Program report, from March 2018. According to the content of our sewers, alcohol and nicotine remain Australia’s drugs of choice while ice, fentanyl and oxycodone are more prevalent than heroin. People who use drugs and live in regional areas are using more of those drugs than city dwellers, proportionally, and New South Wales prefers cocaine while Victorians are more likely to use heroin. Western Australia and South Australia have the strongest ice usage.

Wastewater testing is a relatively recent development but has had a major impact on drug-related health services and policing around the world. It was first used in Italy less than a decade ago and was pioneered in Victoria in 2014 by Penington Institute (publisher of the Anex Bulletin) to prove that ice use was a serious issue in Victoria.

Since then, wastewater testing has expanded across the nation, to the extent that at least 45 sites are now monitored across Australia, covering about 12.7 million people, more than half of Australia’s total population. Scientists sample wastewater from the sites about six times a year and test for a range of drugs and substances, including ice (crystal methamphetamine), amphetamine, cocaine, MDMA (3,4-methylenedioxymethylamphetamine), MDA (3,4-methylenedioxyamphetamine), heroin, mephedrone, methylone, oxycodone, fentanyl, nicotine and alcohol.

“It’s like urine testing the whole population,” explains a pioneer of the testing, Adjunct Professor Jason White, Head of the School of Pharmacy and Medical Sciences at the University of South Australia. He says it is a game changer in terms of understanding drug usage.

“Wastewater testing provides an objective indicator of drug use when before we relied on surveys. Surveys are limited and people don’t always give accurate information for a range of reasons. This [wastewater testing] gives a more accurate estimation of total usage and the tests can be far more frequent, so it’s near to real-time data,” he says.

“Health workers can use the data in their planning and evaluate if what they are doing is working. In South Australia, we’ve been doing the program for a number of years and we regularly report back to the health department, and the police also get that information.”

Wastewater testing does not come without its challenges. Jason calls the raw waste a ‘chemical soup’ of all kinds of refuse and says scientists need to take into account how the drugs being monitored react with other chemicals, bacteria or waste products. “Cocaine, for example, in itself rapidly disintegrates but a metabolite, benzoylecgonine that it causes in urine is quite stable, so we can search for that.”

Another issue is that the remnants of drugs are only a fraction of the sample. “It’s a dilution of 400 to one, so we use a lot of water,” Jason says. “You have to have pretty sophisticated equipment.”

Water treatment plant (photo courtesy of Melbourne Water)

The data sourced has a number of uses. Jason says it provided a genuine snapshot of drug use across Australia, as well as specific local variations. For example, in the last six months, the data found that MDMA use in Adelaide was about 90 per cent higher in December than in other months, while cannabis use dropped by 45 per cent in February. Variations like these sometimes need to be explored with experts while other dips in some drugs are expected, because of recent seizures or the closure of drug labs. While general results are provided to the public, more specific details are only offered to health and law enforcement officials.

“The police love the data because it provides objective information about the impact of their work,” Jason says. “We recently contacted the police because there was an unexplained huge change in a particular drug in a particular location and they were thrilled because they had predicted it was going to occur.”

Regional drug use is a huge concern, going by the data, but Jason says testers were careful not to reveal specific town names when discussing results. “You don’t want a small town or regional centre getting a reputation as a drug capital,” he says. However, such information did mean measures could be put in place to try and address the issue in that locality.

“It’s really about resource allocation for the health workers and police,” he says. “In Adelaide, when we started, people had views on the availability of different drugs in certain suburbs and a lot of those turned out to be true.” Resources could then be allocated on evidence instead of hunches.

Jason says there had been very little opposition to wastewater testing, possibly because it is too anonymous to be threatening individual privacy concerns. He believes the testing will become more sophisticated and ‘smarter’ as other researchers cross reference the data or layer their findings on top of the wastewater information, to create ever more detailed results. He also thinks more drugs will be added to those being tested for, possibly in the near future.

– Nick Place

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