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Cocaine use in Cyprus low compared to European average, KNEWS

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Federal government websites often end in. The site is secure. Preview improvements coming to the PMC website in October Learn More or Try it out now. Box , Nicosia, Cyprus. Box , , Nicosia, Cyprus. The outbreak and spread of COVID impacted through various ways the lives of millions of humans globally. In this work, wastewater-based epidemiology WBE was applied to investigate the effect of the actions taken by the Republic of Cyprus to confine COVID on the use of illicit stimulant drugs. Daily influent samples were collected from the six main wastewater treatment plants WWTPs of the country i before lockdown 3—9 April , ii during lockdown 21—27 April , iii during the post-lockdown period 14—20 July , and, iv during each season of the following year 20—26 April , 19—25 July , 11—17 October , 25 December —2 January , and analyzed for amphetamine, methamphetamine, MDMA and cocaine. In most areas, amphetamine and methamphetamine use was not affected during the confinement period, but as availability of the substances decreased with time, a drop in their use was observed when most restriction measures were eased up to 9- and fold decrease, respectively. The limitations on social interactions and events during the quarantine period seem to have led to the reduction of MDMA and cocaine and driven a sharp decrease of their use in most areas studied up to 11 and 6 times lower, respectively. In , drug use was re-established to lower levels. The examination of weekly patterns during this year revealed higher weekend use of methamphetamine, MDMA and cocaine. Our results suggest that both the implementation and the easing of COVID related measures affected the availability and the use of drugs. This study also provides the first insight on the consumption of illicit drugs in the Republic of Cyprus during pre-, post- and pandemic times and demonstrates the importance of WBE. These measures impacted societies in various ways and affected both social and economic aspects of life Alygizakis et al. The already well-established wastewater-based epidemiology WBE approach has been widely applied after the COVID outbreak, both for the detection of the SARS-CoV-2 viral RNA, which can provide information on the prevalence of the virus in a community, as well as for the detection and measurement of a series of chemical tracers, to investigate changes on consumption habits among the citizens Alygizakis et al. The EC Recommendation suggested that the outcomes of WBE should be exploited for prevention, early warning purposes and monitoring trends and would allow for a better evaluation of the efficiency of the measures taken from authorities to restrain the spread of the pandemic. WBE represents an analytical approach that can provide qualitative and quantitative information regarding, among others, eating, drinking, smoking and drug consuming habits of a population. This tool is based on the fact that chemical compounds consumed by a population, are excreted from the human body and end up, usually in trace levels, in the sewage system, and consequently they can be detected in the wastewater influents, either unchanged, or as their metabolites Been et al. Thus, WBE enables near real-time monitoring of the consumption habits of a population by the investigation of the composition of the influent wastewater that arrives at the wastewater treatment plant WWTP of an area. Therefore, the monitoring of the composition of sewage influents can reveal the presence of various indicators, as well as their consumption profiles, supporting the development of regional or national policies particularly, in relation to health issues. Illicit drug use is an activity that cannot be easily unveiled to its actual extent through the usual questionnaires and other similar methods used in epidemiology studies, owing to the fact that drug use is mostly illegal, and because of this, biased answers could be obtained. Additionally, in many cases drug users are often unaware of the actual drug or a mixture of substances they are consuming, making questionnaire-based studies less reliable Ort et al. On the other hand, WBE can provide a more realistic approach and reveal the drug use problem in a community to its real extent, enabling the estimation of the consumption of illicit drugs by measuring the drugs or their metabolites in the influent wastewater that arrives at the WWTP which serves the community. To the authors knowledge, up to now, there is no scientific literature on the actual drug use in the Republic of Cyprus. In this work, we investigate whether the implementation and easing of restriction measures in the Republic of Cyprus, due to COVID, impacted the illicit stimulant drugs use in the country, applying the WBE approach. The presence, the changes in their concentrations and the consumption of four illicit stimulant drugs, i. Sampling campaigns took place before, during the lockdown period, during the period that followed the lockdown, when most restriction measures were eased and finally during four different periods of the following year. These campaigns allow the examination of the extent of the influence of the pandemic and the implemented measures on the stimulant drugs use in this long-term monitoring programme. Seasonal and weekly variations of these drugs are also discussed. Working solutions were prepared in methanol. Nitrogen From March 15th the borders were closed and after the 31st of March only in special circumstances, e. The mobility of the citizens was also restricted and limited to accessing food and other essential supplies, while moving from one district to another was only allowed for very specific reasons. The strict lockdown ended on April 30th, but significant restrictions remained thereafter, including night curfew and limitations on the number of people present in various settings. The first flights started arriving to the Republic of Cyprus after the 1st of June Quattrocchi et al. Shaded bars indicate the number of cases during the strict lockdown period. The lockdown and post-lockdown sampling campaigns are also shown. Sampling campaigns took place one year before the lockdown 3—9 April , sampling period marked as SP1 , during the lockdown 21—27 April , marked as SP2 , after the lockdown, post-lockdown period, 14—20 July , marked as SP3 and the following spring 20—26 April , marked as SP4 , summer 19—25 July , marked as SP5 , autumn 11—17 October , marked as SP6 and winter 25 December —2 January , marked as SP7. Each sampling campaign lasted seven days, except the last one which lasted nine days, to include both Christmas and New Year's weekends. The exact location of the WWTPs and the average population served during all sampling campaigns are shown in Fig. The exact location of the six WWTPs sampling sites during the seven sampling campaigns. The collection of the influent hour composite samples was starting at am and ending at am of the following day. Amber glass bottles of 1 L were used for the sample collection. The bottles were pre-rinsed with de-ionized and ultra-pure water consecutively and dried. The time between sampling and analysis was always less than a week. Each sample was analyzed in triplicate. All samples were successively filtered through 2. Next, mL of each sample was percolated through the cartridges by gravity. A volume of 10 mL of ultrapure water was used to rinse the sample containers and was also percolated through the cartridges, to improve the recovery of analytes. The analytical procedure is described in detail elsewhere Gros et al. A triple quadrupole mass spectrometer coupled with an electrospray ionization ESI source was used. Eluent A was 0. The quantification of each compound was achieved based on the most abundant daughter ion Q transition while the second transition and their ion ratios were used for confirmation of the identification. For all drugs, optimization of collision energies and cone voltages was performed. Instrument and method repeatability were controlled by analyzing each sample three times. Details on the validation procedure can be found elsewhere Boleda et al. The validity of the results is also monitored by the successful participation in the yearly SCORE interlaboratory study. As mentioned above, for the estimation of amphetamine, methamphetamine and MDMA the measured concentrations of the parent drug residues were used for the estimation of the consumption, due to their high stability in wastewater and the fact that the parent compounds are excreted from the human body unaltered, to a significant extent. Cocaine consumption was calculated based on the concentration of benzoylecgonine, its main human metabolite that is produced in the liver and excreted in urine Devault et al. Thus, the consumption is expressed in terms of mg per day per inhabitants from Eq. For amphetamine, methamphetamine and MDMA, the Mw ratio is 1, as the calculation of their consumption is based on the measurement of the same compounds, whereas for cocaine is 1. Thus, the CFs for amphetamine, methamphetamine, MDMA and benzoylecgonine used for the back-calculation of the drugs consumption were 2. Statistical analysis was performed with Wavemetrics Igor Pro, version 6. One-way ANOVA with Bonferroni post hoc analyses was used to investigate statistically significant differences between different sites or different sampling periods. A p -value lower than 0. According to most recent EMCDDA annual reports, it is estimated that almost one third of adults aged 15—64 in the European Union have used illicit drugs at least once in their lifetime. Studies between and in 25 countries suggest that 1. Based on relevant literature and in particular the study by Deng et al. According to this study, when the ratio is above 0. Amphetamine consumption variation at the six sampling sites during all sampling periods. The implementation of the lockdown did not show a significant effect on the use of amphetamine, as in most areas it was at a comparable level to that before lockdown and to that of the following year's measurements, except in Larnaca, where a sharp decrease in the consumption of amphetamine was observed during the lockdown, compared to the consumption one year before April However, for the other areas, no significant change on the consumption was observed with the easing of the restriction measures. This mixed picture could indicate a limited availability of the drug during the post-lockdown period at parts of the country, affecting specific areas and leading to the observed decrease of the drug's use. In the same period, illegal stockpiling probably had covered the needs of the users in Nicosia I, Nicosia II and Agia Napa, where availability of the drug was observed. Additionally, according to the EMCDDA report, local drug markets have been significantly affected by the implemented restrictions on citizens movement and assembly, with users reporting higher prices of illicit drugs during this period EMCDDA, Such an implication could have impacted the access and the use of specific drugs among different cities with different social or demographic characteristics, in various ways. According to the same report, these alterations appeared to have a short-term impact on the drug markets, as relaxation of measures allowed the markets to return to a pre-COVID situation. In general, the findings on the consumption levels of amphetamine determined at all areas of the Republic of Cyprus are consistent with other WBE-based estimations Been et al. The data collected during the sampling campaigns allowed for the examination of possible seasonal changes of amphetamine use in the country, as one campaign took place during each season of the year. During this year, no impact of the pandemic on drug use was expected, as no restriction measures were applied. One Way ANOVA was used to reveal statistically significant differences between the estimated consumption during each season. No statistical differences were found among the amphetamine consumption levels during the sampling periods of at half the areas studied Limassol, Larnaca and Paphos. On the other hand, the consumption during the summer campaign was found to be higher compared to that in the autumn and winter in both Agia Napa and Nicosia II, which could have been a result of the higher touristic activity during this period. In Nicosia I, amphetamine consumption was found to be significantly higher during spring, compared to that in autumn and winter. The fact that the winter measurements were conducted during the Christmas and New Year's period did not show any significant impact on the amphetamine's seasonal consumption variation. The results may suggest that the availability of the drug at the local drug market, together with other factors e. Comparing methamphetamine consumption during the spring of and the spring of , it is shown that the implementation of the restriction measures did not have any significant impact on its use, at the majority of the areas studied Nicosia II, Larnaca, Paphos, Agia Napa. Regardless of this difference among the areas, the use of methamphetamine dropped sharply during the post-lockdown period at all the areas studied. The most pronounced decrease was observed in Paphos and Limassol, where consumption dropped fold and almost fold, respectively. Possible lack of availability of methamphetamine's precursors could also have led to the decrease or ceasing of local production of this stimulant, affecting its purity and the extent of its use. Methamphetamine consumption variation at the six sampling sites during all sampling periods. The measurements of the following year revealed a small increasing trend of methamphetamine's use during the last months of the year at most of the areas studied. Higher consumption during autumn and winter was observed at the majority of the areas under study. Apart from Nicosia II and Agia Napa, where a stable profile of the consumption of the drug was observed throughout the year, at all the other areas the highest methamphetamine use was found during the winter period. MDMA is one of the stimulant drugs that is mainly used in nightlife settings, such as clubs and bars and is regarded as a party drug. In the European territory it is produced both for local and global markets. On the other hand, at Nicosia II and Paphos areas, the MDMA use was not significantly affected by the lockdown, and the consumption at these areas during both periods of spring of and lockdown were rather low, compared with the other sites. MDMA consumption variation at the six sampling sites during all sampling periods. As shown in Fig. A notable increase of the consumption was observed at four out of six areas Nicosia I, Nicosia II, Limassol and Agia Napa, statistically significant at the last three during this period, compared with that of the lockdown campaign. It should be noted that at four sites Agia Napa, Nicosia I, Nicosia II and Paphos the consumption levels observed during the post-lockdown period were the highest of the whole monitoring period of this study. The observed decrease of MDMA use during the lockdown is attributed to the shutdown of entertainment industry, the cancelation of various events and social gatherings and to difficulties related with the distribution of drugs during this period. The easing of transportation limitations and the reopening of entertainment activities during the summer of facilitated both the distribution and the use of the drug and hence the observed increase of its consumption during the post-lockdown sampling. Based on the determined concentrations, the following year MDMA use seems to have been stabilized in the whole country and no seasonal differences were detected at all the areas under study. In general, the consumption levels during this year were lower, compared to those during the post-lockdown period. Due to the relatively low stability of cocaine in sewage samples, its consumption was estimated based on the concentrations of its major metabolite, benzoylecgonine, from Eq. Benzoylecgonine was detected in all daily samples collected from all the six WWTPs. Cocaine is the second most commonly used illicit drug in Europe; in this work, it was found to be the most commonly used illicit stimulant drug in the Republic of Cyprus, as well. The implementation of the lockdown severely impacted the cocaine consumption in the country. Variations of cocaine consumption among all studied areas during all sampling campaigns are presented in Fig. For five out of six areas, i. Interestingly, at the city of Larnaca, cocaine use increased significantly, by more than double, compared with the consumption in Similar decreasing trends were also observed in other countries during COVID restrictions, however, such findings were not consistent everywhere, as cocaine use during lockdowns presented a mixed behaviour, highly dependent on the location of the study Alygizakis et al. This heterogeneity in drug use trends suggest a complexity of the society responses to the various stressors related to COVID implications. Cocaine consumption variation at the six sampling sites during all sampling periods. During the post-lockdown period of , cocaine consumption showed a remarkable increase at most areas of the Republic of Cyprus Nicosia I, Nicosia II, Limassol, Paphos and Agia Napa , compared with the lockdown period. An almost fold increase of the consumption was observed at Agia Napa, 9-fold at Nicosia I, 4-fold at Nicosia II, while the consumption at Limassol and Paphos was around 2. At most areas, cocaine use was highest during the post-lockdown campaign, compared to all the other monitoring periods. Only Larnaca city again presented a different behaviour, where cocaine, but also MDMA consumption levels remained similar during the lockdown and the post-lockdown periods. The observed trend of high cocaine use after the relaxation of COVID related restriction measures in the Republic of Cyprus is supported by other WBE-based studies, depicting an increase of cocaine and other stimulants during post-lockdown periods Bade et al. The results also show a stabilization of cocaine during the following year, with no significant seasonal variations. Only in Paphos, statistically significant higher cocaine use was observed during the winter, which is mainly attributed to the high consumption during New Year's Eve and New Year's Day Fig. The daily consumption data from all six areas under study from spring, summer, autumn and winter of campaigns was grouped, in order to investigate the weekly patterns of the drugs use. For each drug, data points from all sampling sites were combined, to reflect the weekly patterns of stimulants use in the Republic of Cyprus. Daily consumption of amphetamine, methamphetamine, MDMA and cocaine, estimated from all areas studied, during the campaigns grouped data. All drugs, except amphetamine, showed weekly consumption cycles, with higher drug use during weekends, however Monday samples also showed higher consumption compared to the other weekdays. Regarding the use of amphetamine, no daily differences of its use could be detected, with the drug presenting a very stable weekly profile. Similar profiles for cocaine and MDMA consumption during weekdays and weekends have been previously reported in other works, revealing weekly patterns of the use of these drugs Irvine et al. The weekly patterns of MDMA and cocaine confirm the recreational character of the use of these drugs, which has often been stressed in previous studies. However, in this work, methamphetamine was also found to be used more during the weekends, indicating its consumption for similar reasons. These weekly trends were absent for cocaine and methamphetamine during the lockdown period and only MDMA was found to be used more during the weekends Fig. Less pronounced or lack of weekend consumption peaks during the lockdown were also reported in other WBE-based studies during similar lockdown periods. This observation is attributed to the absence of events and the impediments in socialization Been et al. This work investigated the illicit stimulant drugs use in the Republic of Cyprus during a pre-COVID period, during the quarantine period, right after it, and during the four seasons of the following year, by applying the WBE approach. The results point towards a heterogeneous effect of the pandemic on the use of stimulants and an overall short-term impact of the COVID related restrictions. The little to no effect on the use of amphetamine and methamphetamine by the implementation of the lockdown is mainly attributed to stockpiling, which led to the observed decreasing trend during the post-lockdown period, probably due to a delayed shortage. On the other hand, the closure of entertainment industry and the cancelation of all events led to a significant drop of the use of other substances, typically related to recreational occasions i. The occurring differences support the high complexity of the impact of the pandemic on drug use, which is dependent on the substance and the location and cannot be attributed to a single factor. Our results also indicate that not only the confinement, but also the relaxation measures can drive alterations on drug use patterns. The study also revealed that methamphetamine use is evolving in the Republic of Cyprus, as the estimated consumption of this drug was significant at all areas, during most of the monitoring periods of this work. For cocaine, MDMA and methamphetamine, a recreational pattern of their use was also observed, confirming previous studies. The application of WBE demonstrates that this technique can provide real-time information on the illicit drugs use at local level, revealing their actual temporal and spatial trends, and stress the importance of the establishment of wastewater surveillance networks, which can address current threats and provide support to law enforcement and prevention interventions. Mina: Investigation, Methodology. Savvidou: Conceptualization, Funding acquisition. Mina: Conceptualization, Funding acquisition. The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. This study was funded by the Cyprus National Addictions Authority. All authors would like to thank the management and administration of Sewage Boards of Nicosia, Limassol-Amathus, Larnaca, Paphos and Agia Napa for their valuable collaboration. The authors would like to express their gratitude to the persons who performed the samplings, namely C. Sofocleous, C. Theodorou, D. Tzelios, A. Pittali, E. Nikolaou, C. Papanicolaou and G. Their continuous support and assistance are greatly appreciated. Hapeshi, Dr. Karaolia and Dr. Minas Iakovides are acknowledged for their contribution in samplings, elaboration and visualization of data. As a library, NLM provides access to scientific literature. Sci Total Environ. Published online Sep Psichoudaki , a T. Savvidou , c C. Mina , c C. Michael , a and D. Box , Nicosia, Cyprus Find articles by M. Box , , Nicosia, Cyprus Find articles by T. Box , Nicosia, Cyprus Find articles by C. Box , , Nicosia, Cyprus Find articles by D. All rights reserved. Elsevier hereby grants permission to make all its COVIDrelated research that is available on the COVID resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. Graphical abstract. Open in a separate window. Materials and methods 2. Analytical method 2. Sample pre-treatment and solid phase extraction All samples were successively filtered through 2. Back-calculation of population drug use As mentioned above, for the estimation of amphetamine, methamphetamine and MDMA the measured concentrations of the parent drug residues were used for the estimation of the consumption, due to their high stability in wastewater and the fact that the parent compounds are excreted from the human body unaltered, to a significant extent. Statistics Statistical analysis was performed with Wavemetrics Igor Pro, version 6. Results and discussion 3. Amphetamine According to most recent EMCDDA annual reports, it is estimated that almost one third of adults aged 15—64 in the European Union have used illicit drugs at least once in their lifetime. MDMA consumption MDMA is one of the stimulant drugs that is mainly used in nightlife settings, such as clubs and bars and is regarded as a party drug. Cocaine consumption Due to the relatively low stability of cocaine in sewage samples, its consumption was estimated based on the concentrations of its major metabolite, benzoylecgonine, from Eq. Weekly patterns of stimulants use The daily consumption data from all six areas under study from spring, summer, autumn and winter of campaigns was grouped, in order to investigate the weekly patterns of the drugs use. Conclusions This work investigated the illicit stimulant drugs use in the Republic of Cyprus during a pre-COVID period, during the quarantine period, right after it, and during the four seasons of the following year, by applying the WBE approach. CRediT authorship contribution statement M. Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Notes Editor: Damia Barcelo. Appendix A. Supplementary data Supplementary Information Click here to view. Data availability Data will be made available on request. References Ahmed W. Total Environ. TrAC - Trends Anal. Bacteria and fungi in aerosols generated by two different types of wastewater treatment plants. Water Res. Analysis of illicit drugs in wastewater - is there an added value for law enforcement? Forensic Sci. No party, no drugs? Drug Policy. Trace determination of cannabinoids and opiates in wastewater and surface waters by ultra-performance liquid chromatography-tandem mass spectrometry. Evaluation of uncertainties associated with the determination of community drug use through the measurement of sewage drug biomarkers. Testing wastewater to detect illicit drugs: state of the art, potential and research needs. Acta Biomed. Assessment of illicit drugs in wastewater and estimation of drugs of abuse in Adana Province, Turkey. Illicit Drugs in Municipal Sewage. Occurrence and removal of illicit drugs in different wastewater treatment plants with different treatment techniques. Applying sewage epidemiology approach to estimate illicit drug consumption in a tropical context: bias related to sewage temperature and pH. European drug report trends and developments. Perspectives on drugs. Wastewater analysis and drugs: a European multi-city study. Use of illicit drugs, alcohol and tobacco in Spain and Portugal during the COVID crisis in as measured by wastewater-based epidemiology. Spatio-temporal assessment of illicit drug use at large scale: evidence from 7 years of international wastewater monitoring. Refining correction factors for back-calculation of illicit drug use. Licit and illicit drugs in urban wastewater in Cyprus. Clean - Soil, Air, Water. Population drug use in Australia: a wastewater analysis. Long-term monitoring of drug consumption patterns in a large-sized European city using wastewater-based epidemiology: comparison of two sampling schemes for the assessment of multiannual trends. Critical review on the stability of illicit drugs in sewers and wastewater samples. ChemRxiv; Spatial differences and temporal changes in illicit drug use in Europe quantified by wastewater analysis. Reflection of socioeconomic changes in wastewater: licit and illicit drug use patterns. Sewage epidemiology - a real-time approach to estimate the consumption of illicit drugs in Brussels, Belgium. Illicit drugs in the environment. A Math. Copy Download.

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