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Case Study. Wastewater to Monitor New Psychoactive Substances

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Case Study. Wastewater to Monitor New Psychoactive Substances Wastewater to monitor new psychoactive substances Dr David M Wood Consultant Physician and Clinical Toxicologist Guy’s and St Thomas’ NHS Foundation Trust and King’s College London, London, UK COST is supported by the ESF provides the EU Framework COST Office through Programme Horizon 2020 an EC contract Epidemiology of drug use Population Sub-population Self-Reported Use Variable content of drugs ‘Ecstasy’ Variable content of drugs Novel Drugs Could we samples from portable urinals? . Portable urinals widely used in city centres across Europe . Self-collecting or direct sewer emptying . Self-collecting systems - Urine discarded when urinals picked up - Potential to collect this discarded urine for analysis - Take sampling closer to point of elimination Could we samples from portable urinals? . Participation anonymous and voluntary . Individuals can use study urinals or standard toilets . Not a true (sub) population sample – Males “only” Approvals process . London Metropolitan Police permission . Discussed with Ethics Committee – Formal ethical approval not required . UK Human Tissue Act exempt Archer JR, Wood DM, Hudson S, Dargan PI. Current Drug Abuse Reviews 2013 In Press Studies from our network since 2011 . July 2011: – Urinal in South East London nightclub July 2011 . March 2012 onwards: – 12x urinals in central London . July 2012 onwards: – Urinal in North West England music festival . December 2012: – Urinal at an Oslo, Norway music festival . April 2014: – Pan-London urinal study Archer JR JSU 2012; Archer JR CLin Tox 2012, Archer JR QJM 2013; Dargan PI Clin Tox 2012; Wood DM Clin Tox 2013; Archer JR Clin Tox 2013; Heyerdal F Clin Tox 2013 City Centre Studies Urinal Pilot Study – Summer 2011 Sampling site . Large south London night club in July 2011 Sample collection . Portable study standalone four-person urinal . Separate collections: 2 consecutive nightclub events . Pooled urine samples collected using a manual vacuum pump, urine stored at 4C Sample analysis . LC-MSMS and TOF-MS . 870 drugs and metabolites screened for 38 Drug Findings in Night Club urine samples 37 36 35 34 Mephedrone 33 32 31 30 29 28 27 MDAI 26 25 24 23 22 2:00 AM 21 TFMPP 3:00 AM 20 19 4:00 AM Finding 18 10.00AM 17 16 15 14 13 Nicotine 12 MDMA & metabolites 11 10 9 8 7 6 Ketamine & metabolites 5 4 3 2 1 0 500 1000 1500 2000 2500 3000 Estimated concentration (ng/ml) Linking urine analysis to self-reported use Central London Project – March 2012 . 12 urinals across central London . Urine collected overnight on Saturday . Samples collected at depot using manual vacuum pump . Urine stored at 4C . Analysis undertaken by LC-MSMS – >1700 drugs/metabolites screened for 12 10 8 6 Classical Drugs and NPS Detected 4 Number of urinals of Number 2 0 MDMA Cocaine 4-MMC Cathine Hordenineketamine Amphetamine 2-aminoindane Methoxetamine Nicotine/contine Methiopropamine Methylhexanamine Methamphetamine 4-methylamphetamine detectedCaffeine in all and collections nicotine Detection of metabolites Use rather than discarded drugs . MDMA, cocaine, ketamine and metabolites . Mephedrone and metabolites Adulterants Number of Potential adulterant Alternative Compound Detected urinals of explanation Levamisole / Tetramisole 12 Cocaine N/A Benzocaine / Lidocaine 8 Cocaine N/A Caffeine 11 Cocaine, NPS Caffeinated drinks Quinine 9 Heroin Tonic Water Central London: July 2012 onwards . Same 12 urinal sites . Collection on first weekend each month . Same analytical technique . Caffeine and nicotine in all collections . Consistency in the detection of classical recreational drugs (and metabolites) – Cocaine, MDMA, ketamine . Variation over time in the NPS detected – No methoxetamine Archer JR et al. Clin Tox 2013; Archer JR et al. Clin Tox [submitted] 14 July – December 2012 12 July August 10 September October 8 November December 6 4 2 0 5-APB TFMPP Pipradrol Mephedrone Methiopropamine Ethylmethcathinone Methylhexaneamine 4-methylbuphedrone 4-methylethcathinone 1,4-methoxyphenylpiperazine Pan-UK Study: April 2014 Classical NPS 9 8 7 6 5 4 3 2 1 0 MDMA Cathine TFMPP Cocaine* 3,4-MDAMorphine Glaucine Ketamine* TotalMethylone substances Classical recreational NPS Methadone* Pentedrone Number Number of cities indetected which substance Amphetamine Methoxetamine* Methiopropamine 18 Benzylpiperazine Methamphetamine 4-methylmethcathinone 16 14 12 10 8 6 4 2 Number of substances detected in city in detected substances of Number 0 Leeds B'ham Bristol London Liverpool Brighton Edinburgh Newcastle M'chesterUrinal location UK and European Music Festivals NW England: Music Festival July 2012 NW England: Music Festival July 2012 Oslo, Norway: Music Festival Dec 2012 . Four portable urinals at different locations at a winter “house music” festival (22,000 attendees) . Same methodology . Collection only possible from two urinals – Urine frozen in the other two!! . Caffeine and nicotine in all collections . Significant difference in both the classical drugs and NPS detected compared to UK Heyerdal F et al. Clin Tox [submitted] Oslo, Norway: Music Festival Dec 2012 Compound detected Urinal 1 Urinal 2 Amphetamine and metabolites Y Y Classical Cannabis and metabolites Y Y Recreational Cocaine and metabolites Y Y Drugs MDMA Y Y Methamphetamine Y Y Cathine Y Y Novel Psychoactive Hordenine Y Y Substances Methylhexaneamine Y Y Heyerdal F et al. Clin Tox [submitted] Conclusions . Analysis of anonymous pooled urine samples from street urinals can detect a range of NPS – Collection is easy with minimal costs . Enables monitoring of detection trends – over time – across different geographical regions . Easy to expand collections across different cities / geographical regions across Europe . Possible to link to sub-population surveys to confirm data from both sources .
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