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Official websites use. Share sensitive information only on official, secure websites. Reviewed by: Jolanta B. This article was submitted to Addictive Disorders, a section of the journal Frontiers in Psychiatry. The use, distribution or reproduction in other forums is permitted, provided the original author s and the copyright owner s are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. There is limited data on the awareness and use of synthetic cannabinoids SCs in high-risk population in Serbia, despite SCs becoming more and more common at illicit drug market. This pilot study aimed to examine the awareness and prevalence of use of SCs in patients with an opioid-use disorder and to identify patient characteristics and other factors associated with SCs use. This cross-sectional study was conducted at the Clinic for Psychiatry, Clinical Center Vojvodina, Serbia, the largest tertiary health care institution in this region of the country. Out of 64 patients median age Socio-demographic characteristics of the subjects were not associated with SCs use. There were differences in the most common sources of information reported between the SCs users and non-users. Majority of SCs users Nearly all study participants The share of respondents reporting alcohol and marihuana use was significantly higher among the SCs users Higher share of SCs users used multiple psychoactive substances The most commonly reported adverse effect of SCs among users included dry mouth Understanding the awareness and use of SCs among high-risk drug users, as well as associated factors can help improve substance-use disorder treatment in our setting. Educational activities targeting public are urgently needed to raise awareness on SCs, considering that social contacts are the main sources of information on SC for this vulnerable population. Users of SCs have also reported using other psychoactive substances more often, and this calls for a holistic approach addressing multiple factors to improve substance-use treatment in our setting. Keywords: synthetic cannabinoids, opioid use disorder, use, awareness, predictive factors. According to the distinguished experts in the field, NPS are also defined as narcotic drugs or psychotropic substances made available or used from the early to mids for their psychoactive properties 3. The appearance of NPS has raised considerable concern at international level. In addition, a growing number of NPS consumers have been assessed by health care professionals HCPs with very severe clinical manifestations and unpredictable NPS associated untoward effects 4 , 5. The prevalence of NPS use is very difficult to estimate, especially for the countries not included in the standard world warning and monitoring systems. Scarce data available originates from analysis of calls to national poison control centers, emergency department admissions and drug use surveys 7. Moreover, prevalence rate also varied across countries included in the study 9. Additionally, to investigate the use of selected NPS in general population, wastewater-based epidemiology has been applied in 14 European countries including Serbia during and Also, this study confirms that NPS use in Europe is much lower than the use of classical psychoactive drugs The Early Warning System in Serbia has been active since Even though the inhalation of SCs is intended to mimic the psychotropic effects of cannabis mostly euphoric effects and relaxation , SCs undesirable effects are unpredictable and more severe e. Finally, SCs use could lead to dependence, tolerance and withdrawal phenomena To the best of our knowledge, there is no available data on the awareness and use of SCs in patients admitted to drug detoxification treatment in Serbia. This survey based cross-sectional pilot study aimed to examine the awareness and use of SCs in patients with an opioid-use disorder and to identify patient characteristics and other factors associated with SCs use. This cross-sectional, observational study was conducted at the Department for substance-related and addictive disorders of the Clinic for Psychiatry Clinical Center Vojvodina. All patients hospitalized for the treatment of opioid dependence F After obtaining consent for participation, the survey was started. Based on the literature, recommended minimum sample size for pilot and feasibility studies is between 24 and 50 participants 18 — Items of the study included questions about demographics and past and current past day substance consumption tobacco, alcohol, marijuana, and other drugs. The survey also inquired about 1 source of information regarding SCs, 2 SCs product use and its frequency pattern of use , 3 undesirable subjective effects of SCs products risk and consequences of SCs use , and 4 types of SCs used and common slang names. Questionnaire used is available in the Supplementary material. Descriptive statistics, Chi-square test for categorical variables and t-test for continuous variables were used for the analysis. Out of 64 patients included in the study, one-third 21, One third of the SCs Majority of the respondents 53, The median age of respondents was Almost all Most Most of the survey subjects Regarding relationship status, one half of the participants were single There were no differences in demographic characteristics between those reporting having ever used SCs and non-users Table 1. Over one-third of the participants Higher share of non-users reported social media and internet as sources of information in comparison with SCs users Also, a third of non-users reported never having heard about SCs. Overall, approximately one third reported alcohol and marijuana use, However, the share of respondents reporting alcohol and marijuana use was significantly higher among the SCs users Ninety The most reported adverse effects associated with SCs use were dry mouth Survey subjects reported 29 different names of new psychoactive drugs available on the Serbian market, but just 3 The present study identified prevalence of SCs use and associated factors among a vulnerable population of persons being treated for opioid-use disorder in order to bring light to this understudied topic considering their increasing availability and number of SCs on the market. Persons with opioid-use disorder commonly abuse other psychoactive substances, including cannabis, which makes them vulnerable to use SCs as well. This is influenced by a combination of social, psychological and economic factors, in addition to biological features of the opioid and cannabinoid receptor systems. SCs, diverse compounds exhibiting high affinity for the cannabinoid receptors, are known to interact with opioids in many physiological and pathological functions, including addiction A neurobiological convergence of the cannabinoid and opioid systems is apparent at both receptor and behavioral levels. CB2 receptors activation indirectly stimulates opioid receptors located in primary afferent pathways, implying that cannabinoids can enhance opioid effects Pharmacological modulation of the opioid system can modify the effects of THC Cannabis use was also found to be a predictor of the duration of untreated psychosis, and of disease outcome In the present study, more than a third of respondents Several patient characteristics were examined with the respect to SCs use. Our study showed that the use of SCs was not reserved exclusively for adolescent population, as often reported, with the average age of the persons reporting SCs use being In contrast to other studies 35 , 36 , we did not find associations between socio-demographic characteristics such as income, education or social-deprivation and SCs use, but several other factors related to the use of SCs in persons with an opioid-use disorder were confirmed. These results are in line with previous findings, suggesting that SCs and other NPS use is associated with polysubstance abuse in opioid addicts. A recent study based on the urine analysis reported the prevalence of polysubstance use of Differentiating by type of NPS, new synthetic opioids were most commonly determined 8. Findings by Larabi et al. A study by Elliott et al. In Serbia, NPS were commonly consumed in combination with amphetamines, cocaine, ecstasy, alcohol and cannabis Acute side effects reported strongly support those described in the literature and included dry mouth, trouble thinking clearly, panic attack, palpitations and fear 6 , 11 , 13 , SCs users from our study were more aware of dangers associated with the SCs consumption than non-users. On the other hand, being asked to report names of SCs available in Serbia, opioid addicts in our survey reported 29 different names, of which only This pilot study has estimated prevalence of SCs use in this vulnerable population, and identified opportunities for larger scale research. With high willingness of patients to participate in study of this type, hospital setting seems a suitable one for recruitment of this population. Other that opening venue for further research, study identified several opporutnites to improve patient care, including offering a basis for preventative strategies. Firstly, the HCPs involved in the care for the patients with opioid use disorder should also be aware of the possibility of patients using SCs, as these appear to be frequent concomitants to the conventional drugs of abuse This should be included when developing treatment plans tailored to specific challenges of each individual patient to support treatment and recovery. To allow for harm reduction, patients should be informed about the dangers of such practice and the fact that these combinations can produce unwanted and unpredictable effects. It was identified that most of the SCs users in the present study were acquainted with SCs through social-contacts. According to Van Hout et al. In addition, high-risk group was older average age This calls for broader educational health communication campaigns about the risks of polydrug use and dangers of the NPS, targeting population at risk to decrease misconceptions and provide reliable information. Understanding the awareness and use of SCs among high-risk drug users, as well as associated factors, could enable more effective prevention and harm reduction within this vulnerable marginalized population. Educational activities targeting public are urgently needed to raise awareness on SCs, considering that social contacts are the main sources of information for this vulnerable population. This study had several limitations that need to be mentioned. As it was based on a survey of patients currently being treated, this might have resulted in selection bias. As with any self-reported measure, recall and reporting bias cannot be excluded, which might have resulted in under-or over-reporting of SCs use. Study included a low number of participants for a disorder with a difficult to estimate prevalence. However, even despite the limitations of this survey, findings identify several problem areas in a difficult-to-sample population. A follow-up study, including the data from health-care records in addition to self-reported measures, as well as larger sample is warranted, which would make it necessary to include other treatment centers in the country. Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements. All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. This section collects any data citations, data availability statements, or supplementary materials included in this article. As a library, NLM provides access to scientific literature. Front Psychiatry. Find articles by Isidora Dickov. Find articles by Aleksandra Dickov. Find articles by Ana Tomas. Received Jul 6; Accepted Jan 18; Collection date Open in a new tab. Click here for additional data file. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel.

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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. 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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