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These datasets underpin the analysis presented in the agency's work. Most data may be viewed interactively on screen and downloaded in Excel format. All countries. Topics A-Z. The content in this section is aimed at anyone involved in planning, implementing or making decisions about health and social responses. Best practice. We have developed a systemic approach that brings together the human networks, processes and scientific tools necessary for collecting, analysing and reporting on the many aspects of the European drugs phenomenon. Explore our wide range of publications, videos and infographics on the drugs problem and how Europe is responding to it. All publications. More events. More news. We are your source of drug-related expertise in Europe. We prepare and share independent, scientifically validated knowledge, alerts and recommendations. About the EUDA. Harm reduction encompasses interventions, programmes and policies that seek to reduce the health, social and economic harms of drug use to individuals, communities and societies. On this page, you can find the latest analysis of harm reduction interventions in Europe, including key data on opioid agonist treatment, naloxone programmes, drug consumption rooms and more. European Drug Report — home. The drug situation in Europe up to Drug supply, production and precursors. Synthetic stimulants. Heroin and other opioids. Other drugs. New psychoactive substances. Injecting drug use in Europe. Drug-related infectious diseases. Drug-induced deaths. Opioid agonist treatment. Harm reduction. The use of illicit drugs is a recognised contributor to the global burden of disease. Interventions designed to reduce this burden include prevention activities, intended to reduce or slow the rate at which drug use may be initiated, and the offer of treatment to those who have developed drug problems. A complementary set of approaches goes under the general heading of harm reduction. Here the emphasis is on working non-judgementally with people who use drugs in order to reduce the risks associated with behaviours that are mostly associated with adverse health outcomes, and more generally to promote health and well-being. Probably the best known of these is the provision of sterile injecting equipment to people who inject drugs, with the aim of reducing the risk of contracting an infectious disease. Over time these sorts of approaches appear to have contributed to the relatively low rate, by international standards, of new HIV infections now associated with injecting drug use in Europe. Over the last decade, as patterns of drug use have changed and the characteristics of those who use drugs have also evolved, to some extent, harm reduction interventions have also needed to adapt to address a broader set of health outcomes and risk behaviours. Prominent among these are reducing the risk of drug overdose and addressing the often-considerable and complex health and social problems faced by people who use drugs in more marginalised and socially excluded populations. Chronic and acute health problems are associated with the use of illicit drugs, and these can be compounded by factors such as the properties of the substances, the route of administration, individual vulnerability and the social context in which drugs are consumed. Chronic problems include dependence and drug-related infectious disease, while there is a range of acute harms, of which drug overdose is perhaps the best documented. Although relatively rare at the population level, the use of opioids still accounts for much of the morbidity and mortality associated with drug use. Injecting drug use also increases risks. Correspondingly, working with opioid users and those who inject drugs has been historically an important target for harm reduction interventions and also the area where service delivery models are most developed and evaluated. Reflecting this, some harm reduction services have become increasingly integrated into the mainstream of healthcare provision for people who use drugs in Europe over the last three decades. Recent joint EMCDDA-ECDC guidance on the prevention and control of infectious diseases among people who inject drugs recommends providing opioid agonist treatment to prevent hepatitis C and HIV, as well as to reduce injecting risk behaviours and injecting frequency, in both the community and prison settings. The guidelines also recommend the provision of sterile injecting equipment alongside opioid agonist treatment to maximise the coverage and effectiveness of the interventions among people who inject opioids. In the last three decades, approaches to harm reduction have been broadened in some EU countries to encompass other responses, including drug consumption rooms and take-home naloxone programmes intended to reduce fatal overdoses Figure Interventions to reduce opioid-related deaths include those aimed at preventing overdoses from occurring and those aimed at preventing death when an overdose does occur Figure Show a text version of the above graphic. Note: Interventions where there is evidence of benefit and where we can have high or reasonable confidence in the available evidence are highlighted in a bolder frame. Much of the current evidence on interventions listed in this figure is either emerging or deemed insufficient, in part because of the practical and methodological difficulties of conducting research, especially in developing randomised controlled trials see Spotlight on Understanding and using evidence and also because service delivery models often differ considerably. In some countries, there are drug checking facilities, which have been established with the aim of enabling people to understand better what substances the illicit drugs they have bought contain. Tablets, for example, purchased as MDMA, may also contain adulterants and other drugs, such as synthetic cathinones. With many synthetic stimulants and new psychoactive substances now available on the illicit market in similar looking powders or pills, consumers may be increasingly at risk of being unaware of what particular stimulant or mixture of substances they may be consuming. The increasing integration of the markets for new psychoactive substances and illicit drugs is creating new public health challenges, such as herbal cannabis mixed with synthetic cannabinoids, stimulants mixed with cathinones and ketamine or new synthetic opioids mixed with or mis-sold as heroin. As poisoning events can evolve rapidly, understanding what constitutes the delivery of effective of risk communication has become more important. Although the range of services provided may differ, all drug checking services undertake some form of health risk communication activity, often by issuing alerts on analysed drug products and sharing data with other stakeholders. The aim is to prevent or reduce harm at the level of the individual the person submitting the substance for checking and of the population others who may be exposed to the same substance. Future steps in this field may include moves towards harmonisation and the building of consensus among European drug checking services on the determination of criteria and thresholds for when and how to issue alerts, as well as the adoption of evidence-based standard operating procedures for health risk communication. Some of these interventions remain controversial for reasons that include their legal status and the evolving nature of their evidence base. Coverage of these newer interventions therefore remains uneven within and between countries, and where they do exist, they are often most commonly found only in large cities. Overall, coverage and access to harm reduction services more generally, including those service models that are long-established and relatively well evidenced, varies considerably between EU countries, and in some countries remains inadequate in comparison to estimated needs. Potent synthetic substances have a growing potential to cause drug-related harms in Europe, as inadvertent consumption of these substances in powders or mixtures sold as other drugs can lead to poisonings and deaths. This, together with more complex patterns of polydrug consumption, adds to the already considerable challenges of developing effective responses to reduce drug overdose deaths and drug-related poisonings. An example of this growing complexity, albeit currently on a relatively small scale, was seen in Estonia in , where mixtures were identified containing new synthetic opioids and new benzodiazepines and also the tranquilliser xylazine. More recently, the highly potent benzimidazole opioids nitazenes , which are more potent than fentanyl, have also been involved in localised poisoning outbreaks in parts of Europe see also New psychoactive substances — the current situation in Europe. During a recent outbreak in Ireland, a rapid risk communication exercise was undertaken, with the support of low-threshold services, which included leaflet drops to open drug scenes and distribution of information on social media and news platforms. This is an example of how services may need to respond both more rapidly and more intensively to outbreaks of drug poisoning than in the past Figure The presence of such mixtures and mis-sold substances on the market highlights the need to review current approaches to the delivery of some harm reduction interventions. For example, the distribution and administration of the opioid antagonist naloxone may need to be reviewed in the context of these mixtures and mis-sold substances. More generally, given possible developments in the synthetic opioid market, it would be prudent to review current plans to prepare for and respond to any possible increase in the availability and use of synthetic opioids or in the harm associated with these substances. This could include enhancing toxicological analysis capabilities, alert messaging and frontline responder preparedness. Where drug consumption rooms are operational, the possible benefits and risks from also providing drug checking services may be an issue for consideration. Most drug consumption rooms in Canada, for example, offer drug checking for fentanyl. This is currently uncommon in the European Union, but a consumption room in Copenhagen has recently started providing this service, and other pilot projects are reported to be in development elsewhere in Europe. Reducing the risks associated with injecting drug use has always been an important target for harm reduction interventions, and the service models are relatively well developed and evidenced. However, even in this area, changes in drug consumption are creating new challenges for effective service delivery. In the last decade, there have been HIV outbreaks associated with the injection of illicit synthetic stimulants in 7 European cities, across 6 EU countries. A potentially increased frequency of injection is associated with stimulant use compared with heroin use, while crushing and dissolving crack cocaine and other tablets for injection also brings with it additional health risks. These consumption patterns raise questions regarding, for example, the type and adequacy of needles and syringes provided to people in street-based open drug scenes, which now are typically characterised by polydrug use. An additional concern exists that service restrictions during COVID lockdowns adversely impacted on testing for drug-related infections, such as HIV and HCV, and on conduits to care among more vulnerable and marginalised populations of people who use drugs, including those experiencing homelessness. While this definition is imprecise, it is usually used to refer to settings or events where both high-risk drug taking and high-risk sexual behaviour may occur. While it is difficult to estimate the prevalence of chemsex, information from research studies suggests it is an issue that is present, albeit at a small scale and among specific subgroups of people who use drugs, across Europe. Engaging with and providing effective harm reduction responses for people engaged in these forms of high-risk behaviours remains a challenge, and the development of tailored harm-reduction interventions is likely to be needed. Also likely to be needed in this area are strong multi-agency partnerships between those providing sexual health services and those services providing drug-related harm reduction. Cannabis users in Europe commonly smoke the drug with tobacco, and an undeveloped area for the development of harm reduction approaches is the consideration of what might constitute effective inventions to reduce smoking-related harm in this group. More generally, as the types and forms of cannabis products available in Europe continue to change, so too have considerations about the implications this has for harm reduction responses. Overall, cannabis products, both resin and herbal, are now of a higher potency — they contain more THC — than they were historically, and high-potency cannabis products are associated with more acute and chronic harms. In addition, the diversity of product types has expanded, with edibles, e-liquids and extracts all now available. These changes create new potential challenges to identify what constitutes effective harm reduction interventions and opportunities to implement them to reduce harm. Cannabis is not the only area in which harm reduction approaches have the potential to play a greater role. These substances do have the potential to cause possible harm, and some patterns of use are likely to increase the risk of adverse consequences occurring, creating potential opportunities for harm reduction approaches. While some harm reduction responses remain controversial in some countries in Europe, the overall concept that evidence-based measures to reduce harm are an important component of balanced drug policies is largely accepted. The contexts within which harm reduction services operate, the evidence base that supports them, and what constitutes standards for quality of care in this area therefore remain key areas for further development and policy consideration. Needle and syringe programmes are also a widely available and standard component of harm reduction services. Needle and syringe coverage and access remain a challenge, with only 5 of the 17 EU countries with available data reaching the WHO service provision targets in Figure The coverage is based on the latest national estimates of injecting drug use and high-risk opioid use matched by harm reduction activity data within a maximum of 2 years. The estimate of coverage of opioid agonist treatment for Belgium is derived from a subnational study conducted in Opioid agonist treatment can be considered as an effective form of drug treatment and also as a service delivery model that addresses some harm reduction objectives. Opioid agonist treatment is a well-established intervention that is implemented in all European countries and is acknowledged as a protective factor against overdose deaths. Up to , 16 European countries have reported the implementation of take-home naloxone programmes, which includes pilot projects, to prevent overdose deaths and 10 countries report having opened at least one drug consumption room, intended to facilitate safer use and prevent various health problems Figure Twelve European countries report the existence of some type of drug checking service. These services aim to prevent harms by allowing people to find out what chemicals are in the illicit substances they have bought, and, in some cases, provide access to counselling or brief interventions. The analytical techniques used by services range from sophisticated technology that can provide information on strength and content of a wide variety of substances, to methods that simply show the presence or absence of a particular drug Figure While drug consumption rooms have become a more accepted harm reduction response, establishing them remains problematic in some countries. In , 10 EU countries and Norway had operational facilities Figure Where multicultural and new immigrant populations are present, increased own-language harm reduction messaging is desirable for people engaged in high-risk drug use. Initiation of opioid agonist treatment in prison was not allowed in 2 countries Bulgaria, Slovakia. Needle and syringe programmes were available in prisons in 3 countries: in all prisons in Spain and Luxembourg 2 prisons , and in one female prison in Germany. Show source tables. The complete set of source data for the European Drug Report including metadata and methodological notes is available in our data catalogue. A subset of this data, used to generate infographics, charts and similar elements on this page, may be found below. Homepage Quick links Quick links. GO Results hosted on duckduckgo. Main navigation Data Open related submenu Data. Latest data Prevalence of drug use Drug-induced deaths Infectious diseases Problem drug use Treatment demand Seizures of drugs Price, purity and potency. Drug use and prison Drug law offences Health and social responses Drug checking Hospital emergencies data Syringe residues data Wastewater analysis Data catalogue. Selected topics Alternatives to coercive sanctions Cannabis Cannabis policy Cocaine Darknet markets Drug checking Drug consumption facilities Drug markets Drug-related deaths Drug-related infectious diseases. Recently published Findings from a scoping literature…. Penalties at a glance. Frequently asked questions FAQ : drug…. FAQ: therapeutic use of psychedelic…. Viral hepatitis elimination barometer…. EU Drug Market: New psychoactive…. EU Drug Market: Drivers and facilitators. Statistical Bulletin home. Recent events EUDA webinar: Preventing substance-related crime in the community — how can we provide safer and healthier environments? Recent news How do economic recessions influence illicit drug use? Quick links Search news Subscribe newsletter for recent news Subscribe to news releases. This make take up to a minute. Once the PDF is ready it will appear in this tab. Sorry, the download of the PDF failed. Table of contents Search within the book. Search within the book Operator Any match. Exact term match only. Download all files zip. Hidden tables for page Term Colour Available 92c Not available da Unknown a3a3a3 ID Term 10 WHO target for opioid agonist treatment coverage 20 Proportion of high-risk opioid users receiving opioid agonist treatment 30 WHO target for needle and syringe distribution 40 Number of sterile syringes per person who injects drugs per year 45 Number people who inject drugs 50 Click to zoom in. Number of sites: 90 Number of countries 60 sites 70 Availability of interventions in prison settings 80 Select an intervention from the dropdown list below. Main subject. Target audience. Publication type. European Drug Report main page. On this page.

Down the Drain: Wastewater with the Most Cocaine

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These datasets underpin the analysis presented in the agency's work. Most data may be viewed interactively on screen and downloaded in Excel format. All countries. Topics A-Z. The content in this section is aimed at anyone involved in planning, implementing or making decisions about health and social responses. Best practice. We have developed a systemic approach that brings together the human networks, processes and scientific tools necessary for collecting, analysing and reporting on the many aspects of the European drugs phenomenon. Explore our wide range of publications, videos and infographics on the drugs problem and how Europe is responding to it. All publications. More events. More news. We are your source of drug-related expertise in Europe. We prepare and share independent, scientifically validated knowledge, alerts and recommendations. About the EUDA. The analysis of municipal wastewaters for drugs and their metabolic products to estimate community consumption is a developing field, involving scientists working in different research areas, including analytical chemistry, physiology, biochemistry, sewage engineering, spatial epidemiology and statistics, and conventional drug epidemiology. This page presents the findings from studies conducted since Data from all studies can be explored through an interactive tool, and a detailed analysis of the findings of the most recent study, in , is presented. See our wastewater analysis hub page for more resources on this topic. Please note that due to the large amount of data involved processed on this page, it may take some moments before all content appears. In this section you can explore the data from the most recent study in , as well as from previous studies. Each study reveals a picture of distinct geographical and temporal patterns of drug use across European cities. Clicking on a symbol in the graph or the map will show more detailed information for a given wastewater treatment plant. You can also select a site from the drop-down menu. Preparing the data The data explorer is designed to work with most modern browsers but if this message is still visible after 1 minute, we recommend trying again with another browser. The findings of the largest European project to date in the emerging science of wastewater analysis are presented in this section. The results provide a valuable snapshot of the drug flow through the cities involved, revealing marked geographical variations. Wastewater analysis is a rapidly developing scientific discipline with the potential for monitoring real-time data on geographical and temporal trends in illicit drug use. Originally used in the s to monitor the environmental impact of liquid household waste, the method has since been used to estimate illicit drug consumption in different cities Daughton, ; van Nuijs et al. It involves sampling a source of wastewater, such as a sewage influent to a wastewater treatment plant. This allows scientists to estimate the quantity of drugs consumed by a community by measuring the levels of illicit drugs and their metabolites excreted in urine Zuccato et al. In , a Europe-wide network Sewage analysis CORe group — Europe SCORE was established with the aim of standardising the approaches used for wastewater analysis and coordinating international studies through the establishment of a common protocol of action. The first activity of the SCORE group was a Europe-wide investigation, performed in in 19 European cities, which allowed the first ever wastewater study of regional differences in illicit drug use in Europe Thomas et al. That study included the first intercalibration exercise for the evaluation of the quality of the analytical data and allowed a comprehensive characterisation of the major uncertainties of the approach Castiglioni et al. A standard protocol and a common quality control exercise were used in all locations, which made it possible to directly compare illicit drug loads in Europe over a one-week period during 10 consecutive years van Nuijs et al. Raw hour composite samples were collected during a single week between March and May in the majority of the cities. These samples were analysed for the urinary biomarkers i. In addition, the samples were analysed for the main urinary metabolites i. The specific metabolite of heroin, 6-monoacetylmorphine, has been found to be unstable in wastewater. Consequently, the only alternative is to use morphine, although it is not a specific biomarker and can also be excreted as a result of therapeutic use. The project findings revealed distinct geographical and temporal patterns of drug use across European cities see the data explorer. The annual SCORE wastewater sampling presented here, from 88 cities, showed that, overall, the loads of the different stimulant drugs detected in wastewater in varied considerably across study locations, although all illicit drugs investigated were found in almost every city that participated. For the first time, data from outside Europe is also shown and compared against European cities. The BE loads observed in wastewater indicate that cocaine use remains highest in western and southern European cities, in particular in cities in Belgium, the Netherlands and Spain. Low levels were found in the majority of the eastern European cities, although the most recent data continues to show signs of increase. The loads of amphetamine detected in wastewater varied considerably across study locations, with the highest levels being reported in cities in the north and east of Europe, as in previous years. Amphetamine was found at much lower levels in cities in the south of Europe, although with the most recent data showing some signs of increase. The observed methamphetamine loads in the other locations were very low, although most recent data show signals of increases in central European cities. For the second time, ketamine loads are being published. The highest mass loads were found in the wastewater in cities in Belgium, France, the Netherlands, and Spain. The study highlighted differences between these cities within the same country, which may be explained in part by the different social and demographic characteristics of the cities universities, nightlife areas and age distribution of the population. Interestingly, in the majority of countries with multiple study locations, no marked differences were found when comparing large cities to smaller locations for all substances. In addition to geographical patterns, wastewater analysis can detect fluctuations in weekly patterns of illicit drug use. More than three quarters of cities show higher loads of amphetamine, BE, ketamine and MDMA in wastewater during the weekend Friday to Monday than during weekdays. Seventy-three cities have participated in at least five of the annual wastewater monitoring campaigns since This allows for time trend analysis of drug consumption based on wastewater testing. Cannabis is Europe's most commonly used illicit drug, with an estimated However, both the level of use and trends in use reported in recent national data appear heterogeneous. In wastewater, cannabis use is estimated by measuring its main metabolite, THC-COOH, which is the only suitable biomarker found so far. Although it is excreted in a low percentage and more research is still needed Causanilles et al. In , there were diverging trends with 20 cities out of 51 reporting an increase in THC-COOH loads in wastewater samples, and 15 a decrease. Low levels were found in the majority of the eastern European cities, but the most recent data continues to show signs of increases. When comparing to study locations outside the European Union, cities in Brazil, Switzerland and in the United States show similar levels of use as the cities in Europe with the highest loads. A relatively stable picture of cocaine use was observed between and in most cities. The data revealed further increases in cocaine residues in most cities when compared to data, with 49 out of 72 cities reporting an increase, while 13 cities reported no change and 10 cities reported a decrease. An overall increase is seen for all 10 cities with data for both and These 7 cities were selected owing to the availability of annual data from to Contrary to previous years, in most countries with multiple study locations, no marked differences were found when comparing large cities to smaller locations. More than three quarters of cities show higher loads of BE in wastewater during the weekend Friday to Monday than during weekdays, which may reflect a pattern of more recreational use. A recent European project on wastewater found crack cocaine residues in all 13 participating cities and for all sampling days, with the highest loads reported in Amsterdam and Antwerp. Where data is available, when comparing to study locations outside the European Union, only cities in Switzerland show similar levels of use as the cities in Europe with the highest loads, while all the other location show low levels of MDMA use. General population surveys in many countries showed that MDMA prevalence was declining from peak levels attained in the early to mids. In recent years, however, the picture has remained mixed with no clear trends. Where prevalence is high, this may reflect MDMA no longer being a niche or subcultural drug limited to dance clubs and parties, but now being used by a broader range of young people in mainstream nightlife settings, including bars and house parties. Looking at longer-term trends in wastewater analysis, in most cases the loads increased between , and have fluctuated after this. In , possibly due to the fact that in the majority of countries nightlife was largely closed for long periods, almost half of the cities 24 of 49 reported a decrease with 18 reporting an increase. In , 38 out of 58 cities, reported a decrease. In , 28 out of 62 cities reported an increase and 27 a decrease. Of the 69 cities that have data on MDMA residues in municipal wastewater for and , 42 reported an increase mostly in northern Europe , 11 a stable situation and 16 a decrease mostly in cities in southern and central Europe. Of the 9 cities with data for both and , 9 had higher MDMA loads in than in As for cocaine, and contrary to previous years, in most countries with multiple study locations, no marked differences were found when comparing large cities to smaller locations. More than three quarters of cities showed higher loads of MDMA in wastewater during the weekend Friday to Monday than during weekdays, reflecting the predominant use of ecstasy in recreational settings. Amphetamine and methamphetamine, two closely related stimulants, are both consumed in Europe, although amphetamine is much more commonly used. Methamphetamine consumption has historically been restricted to Czechia and, more recently, Slovakia, although recent years have seen increases in use in other countries. The loads of amphetamine detected in wastewater varied considerably across study locations, with the highest levels reported in cities in the north and east of Europe. Amphetamine was found at much lower levels in cities in the south of Europe, although the most recent data shows some signs of increase. To examine the data, use the data explorer , also available on this page. Underlying data is available in source data. The observed methamphetamine loads in the other locations were very low to negligible, although most recent data show signals of increases in central European cities. Overall, the data related to amphetamine and methamphetamine from the 11 monitoring campaigns showed no major changes in the general patterns of use observed, although since increases were observed in several cities for both substances in regions where use has traditionally been low to negligible. Of the 65 cities with data on amphetamine residues in municipal wastewater for and , 26 reported an increase, 13 a stable situation and 26 a decrease. Of the 67 cities that have data on methamphetamine residues in municipal wastewater for and , 15 reported an increase, 13 a stable situation and 39 a decrease. In , methamphetamine use was found to be distributed more evenly over the whole week than in previous years, possibly reflecting the use of these drugs being associated with more regular consumption by a cohort of high-risk users. For amphetamine, more than three quarters of cities show higher loads during the weekend Friday to Monday than during weekdays. In , low levels of ketamine residues in municipal wastewater were reported by 49 cities, although with signals of increases. Of the 22 cities that have data on ketamine residues for and , 12 reported an increase, 8 a stable situation and 2 a decrease. The highest mass loads were detected in cities in Belgium, France, the Netherlands, and Spain. More than three quarters of cities showed higher loads of ketamine in wastewater during the weekend Friday to Monday than during weekdays, reflecting the predominant use of ketamine in recreational settings. Wastewater analysis offers an interesting complementary data source for monitoring the quantities of illicit drugs used at the population level, but it cannot provide information on prevalence and frequency of use, main classes of users and purity of the drugs. Additional challenges arise from uncertainties associated with the behaviour of the selected biomarkers in the sewer, different back-calculation methods and different approaches to estimate the size of the population being tested Castiglioni et al. The caveats in selecting the analytical targets for heroin, for example, make monitoring this drug in wastewater more complicated compared to other substances Been et al. Also, the purity of street products fluctuates unpredictably over time and in different locations. Furthermore, translating the total consumed amounts into the corresponding number of average doses is complicated, as drugs can be taken by different routes and in amounts that vary widely, and purity levels fluctuate Zuccato et al. Efforts are being made to enhance wastewater monitoring approaches. For example, work has been undertaken on overcoming a major source of uncertainty related to estimating the number of people present in a sewer catchment at the time of sample collection. This involved using data from mobile devices to better estimate the dynamic population size for wastewater-based epidemiology Thomas et al. Wastewater-based epidemiology has established itself as an important tool for monitoring illicit drug use and future directions for wastewater research have been explored EMCDDA, First, wastewater analysis has been proposed as a tool to address some of the challenges related to the dynamic new psychoactive substances NPS market. This includes the large number of individual NPS, the relatively low prevalence of use and the fact that many of the users are actually unaware of exactly which substances they are using. A technique has been established to identify NPS that involves the collection and analysis of pooled urine from stand-alone portable urinals from nightclubs, city centres and music festivals, thereby providing timely data on exactly which NPS are currently in use at a particular location Archer et al. The project applied innovative analytical chemical and epidemiological methods and a robust risk-assessment procedure to improve the identification of NPS, to assess risks, and to estimate the extent and patterns of use in specific groups e. Second, in addition to estimating illicit drug use, wastewater-based epidemiology has been successfully applied in recent years to providing detailed information on the use and misuse of alcohol Boogaerts et al. Furthermore, wastewater analysis can potentially provide information on health and illness indicators within a community Kasprzyk-Hordern et al. Third, the potential for wastewater-based epidemiology to be used as an outcome measurement tool, in particular in the evaluation of the effectiveness of interventions that target drug supply e. Close collaboration between the different stakeholders involved, including epidemiologists, wastewater experts and legal authorities, is highly recommended in order to start examining these potential wastewater-based epidemiology applications EMCDDA, High levels of MDMA were recorded during the whole monitoring period in one city in the Netherlands, suggesting continuous discharges of unconsumed MDMA from sources within the wastewater catchment area, indicating drug production was taking place in this region. Fourth, by back-calculating the daily sewer loads of target residues, wastewater analysis can provide total consumption estimates, and specific efforts are now being directed towards finding the best procedures for estimating annual averages. It is envisaged that findings from wastewater analysis can help to further develop work in this area. Finally, new methods such as enantiomeric profiling have been developed to determine if mass loads of drugs in wastewater originated from consumption or from the disposal of unused drugs or production waste. It is now important to assess the possible utility of wastewater analysis to report on drug supply dynamics, including synthetic drug production Emke et al. For example, recent malfunctioning of a small wastewater treatment plant in the Netherlands was caused by direct discharges in the sewage system of chemical waste from a drug production site. Further analysis revealed the actual synthesis process used to manufacture the corresponding drugs. The study confirmed that the chemical waste from the illegal manufacturing of stimulants will result in a specific chemical fingerprint that can be tracked in wastewater and used for forensic purposes. Such profiles can be used to identify drug production or synthesis waste disposal in the wastewater catchment area Emke et al. Wastewater analysis has demonstrated its potential as a useful complement to established monitoring tools in the drugs area. It has some clear advantages over other approaches as it is not subject to response and non-response bias and can better identify the true spectrum of drugs being consumed, as users are often unaware of the actual mix of substances they take. This tool also has the potential to provide timely information in short timeframes on geographical and temporal trends. In order to check the quality and accuracy of data, further comparisons between wastewater analysis and data obtained through other indicators are needed. As a method, wastewater analysis has moved from being an experimental technique to being a new method in the epidemiological toolkit. Its rapid ability to detect new trends can help target public health programmes and policy initiatives at specific groups of people and the different drugs they are using. In addition to the glossary below, see also Frequently-asked questions on wastewater-based epidemiology and drugs. Traces of drugs consumed will end up in the sewer network either unchanged or as a mixture of metabolites. Metabolites, the end products of metabolism, are the substances produced when the body breaks drugs down. Wastewater analysis is based on the fact that we excrete traces in our urine of almost everything we consume, including illicit drugs. The target drug residue is what remains in the wastewater after excretion and is used to quantify the consumption of illicit drugs in the population. Analytical chemists look for urinary biomarkers measurable characteristics to calculate population drug use in wastewater samples, which can be the parent drug i. Enantiomeric profiling is an analytical chemistry technique used to determine if studied drugs in wastewater originate from consumption or direct disposal eq. It is based on the fact that chiral molecules if only one chiral centre is present exist as two enantiomers opposite forms which are non-superimposable mirror images of each other. As the enantiomeric ratio will change after human metabolism, the enantiomeric fraction can be used to determine whether the studied drugs in wastewater originate from consumption. In order to estimate levels of drug use from wastewater, researchers attempt first to identify and quantify drug residues, and then to back-calculate the amount of the illicit drugs used by the population served by the sewage treatment plants Castiglioni et al. This approach involves several steps see figure. Initially, composite samples of untreated wastewater are collected from the sewers in a defined geographical area. The samples are then analysed to determine the concentrations of the target drug residues. A correction factor for each drug is taken into account as part of the calculation. In a last step, the result is divided by the population served by the wastewater treatment plant, which shows the amount of a substance consumed per day per 1 inhabitants. Population estimates can be calculated using different biological parameters, census data, number of house connections, or the design capacity, but the overall variability of different estimates is generally very high. Although primarily used to study trends in illicit drug consumption in the general population, wastewater analysis has also been applied to small communities, including workplaces, schools Zuccato et al. Using this method in small communities can involve ethical risks Prichard et al. In the SCORE group published ethical guidelines for wastewater-based epidemiology and related fields Prichard et al. The objective of these guidelines is to outline the main potential ethical risks for wastewater research and to propose strategies to mitigate those risks. Archer, J. Bade, R. Baz-Lomba, J. Been, F. Bijlsma, L. Boogaerts, T. Castiglioni, S. Causanilles, A. Daughton, C. Emke, E. Hall, W. Kasprzyk-Hordern, B. Kinyua, J. Krizman-Matasic, I. Lai, F. Mardal, M. Mastroianni, N. Prichard, J. Reid, M. Senta, I. Thomaidis, N. Thomas, K. Yang, Z. Zuccato, E. Show source tables. You can download the source data for drugs in wastewater in cities from our our data catalogue or use the links below to directly download the CSV files. Homepage Quick links Quick links. GO Results hosted on duckduckgo. Main navigation Data Open related submenu Data. Latest data Prevalence of drug use Drug-induced deaths Infectious diseases Problem drug use Treatment demand Seizures of drugs Price, purity and potency. Drug use and prison Drug law offences Health and social responses Drug checking Hospital emergencies data Syringe residues data Wastewater analysis Data catalogue. Selected topics Alternatives to coercive sanctions Cannabis Cannabis policy Cocaine Darknet markets Drug checking Drug consumption facilities Drug markets Drug-related deaths Drug-related infectious diseases. Recently published Findings from a scoping literature…. Penalties at a glance. Frequently asked questions FAQ : drug…. FAQ: therapeutic use of psychedelic…. Viral hepatitis elimination barometer…. EU Drug Market: New psychoactive…. EU Drug Market: Drivers and facilitators. Statistical Bulletin home. Recent events EUDA webinar: Preventing substance-related crime in the community — how can we provide safer and healthier environments? Recent news How do economic recessions influence illicit drug use? Quick links Search news Subscribe newsletter for recent news Subscribe to news releases. Breadcrumb Home Publications Wastewater analysis and drugs — a European multi-city study. On this page. Wastewater analysis and drugs — a European multi-city study. PDF is being prepared. This make take up to a minute. Once the PDF is ready it will appear in this tab. Sorry, the download of the PDF failed. Introduction The analysis of municipal wastewaters for drugs and their metabolic products to estimate community consumption is a developing field, involving scientists working in different research areas, including analytical chemistry, physiology, biochemistry, sewage engineering, spatial epidemiology and statistics, and conventional drug epidemiology. Page last updated: 20 March World view Europe South America Oceania. Complete source data for all wastewater measurments, all cities, all years CSV format Wastewater treatment centres information table CSV format Changes in the mean weekly measurements by targeted substance, from wastewater analyses in selected European cities between and CSV format Aggregated trends in cocaine residues in 7 EU cities, to CSV format.

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