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Background and aims: Illicit drug consumption is associated with public health effects and criminal activities. This study aimed to estimate Illicit drug consumption and annual market in the Netherlands from wastewater analysis of drug residues. Methods: Residues of cocaine, amphetamine and 3,4-methylene dioxymethamphetamine MDMA were measured between and in 30 Dutch wastewater treatment plants serving both rural and urban populations. The Dutch annual retail market was estimated by extrapolating consumption to the total Dutch population, back-calculating consumption volume, correcting for drug purity and street price collected in voluntary checking services, and accounting for the correlation of consumption and urbanity. Amphetamine did not show a significant correlation with urbanity. Market estimations from prevalence figures and interceptions of international trade were similar. Conclusions: Illicit drug consumption in the Netherlands appears to correlate positively with urban in contrast to rural areas. Wastewater analysis can be used to estimate the volume and monetary value of illicit drug markets as a proof of concept. Keywords: Dutch drug consumption estimate; Dutch drug market estimate; MDMA; amphetamine; cocaine; environmental forensics; illicit drugs; illicit stimulants; rural vs. Abstract Background and aims: Illicit drug consumption is associated with public health effects and criminal activities.

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