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Official websites use. Share sensitive information only on official, secure websites. Ave Talu: Investigation. Sigrid Vorbjov: Investigation. Liis Lemsalu: Investigation. Don Des Jarlais: Conceptualization. The spread of illicitly manufactured fentanyl has the potential to greatly increase the fatal overdoses in many places in the world. The purpose of this paper is to analyse the evolution of fentanyl use epidemic in Estonia. For an over a decade up to , Estonia has had the highest overdose death mortality in Europe. The use of injected fentanyl is a major contributor to the Estonian overdose death epidemic. Shutting down a major producer and distributor of illicit fentanyl has been extremely effective in curbing the number of overdose deaths. Unfortunately, this supply-side intervention came ten years into the epidemic, and might be difficult to replicate in settings with decentralized production. Further, the means of responding to emerging substances should match the world in which different substances can be rapidly introduced, and where people who use drugs can change preferences based on market availability. Addressing illicitly manufactured fentanyl may serve as a public health learning experience for developing early detection and rapid response programs in rapidly changing drug use environments. Opioid-related deaths are the biggest contributor to drug-related deaths and drive the recent increase in such deaths also elsewhere in Europe National Operations Department National Operations Department, Sweden, ; National Records of Scotland, ; National Crime Agency, UK, In North America, fentanyl derivatives make a major contribution to the current opioid crisis, and over a short period, they have become the substances most associated with overdose mortality Hedegaard et al. While diversion of controlled substances including fentanyl from health care system can occur, there is compelling evidence that recent multinational outbreaks of drug-related deaths are attributable to illicitly manufactured fentanyl Pihl, ; Office of National Drug Control Policy Office of National Drug Control Policy, USA, Further spread of fentanyl has the great potential to increase fatal overdoses in many places in the world. The purpose of this paper is to analyse the evolution of the fentanyl use epidemic in Estonia and implications for countries currently facing fentanyl es epidemics and the usage of other synthetic opioids. Estonia is a small country in the north-eastern part of Europe with a population of about 1,, For an over a decade up to , Estonia has had the highest overdose death mortality rate in Europe European Monitoring Centre for Drugs and Drug Addiction, The country has excellent health records Metsallik et al. In terms of the different types of scientific reviews meta-analysis, qualitative, etc. As with scoping reviews, we conducted an extensive search to integrate evidence from research literature, regulatory documents, public health institutions and government administrative data publications, reports , and national surveillance. Also similar to a scoping review, we did not attempt to derive a single summary finding that synthesized all of the information. Thus, we did not utilize information that could not be placed within a historical timeline for the epidemic. Our research question was: What are the drivers, course and consequences of the two-decade illicit fentanyl use epidemic in Estonia? The title and abstract of each citation were screened by the lead author, where any doubt remained in terms of inclusion another author also reviewed the article Levac et al. The initial search identified articles after excluding 2 duplicates , of which 9 that we believed contributed empirical data to our historical reconstruction of the fentanyl use epidemic in Estonia. Three other research publications were identified from the reference lists of included papers. The next stage of the work involved synthesizing and interpreting qualitative data by sifting, charting and sorting material on key items of information obtained from the primary reports being reviewed. Our scoping study also included a consultation element. This involved three groups of stakeholders: system level representatives public health system, criminal justice, drug treatment system , prevention and care service harm reduction service providers and PWID. We present our understanding of selected important features of fentanyl use, and suggest public policy recommendations. Namely: 1 incubation period — use of specific drug among highly limited subpopulation is a specific social context; 2 expansion phase — specific drug use introduced to wider subgroups; 3 plateau phase — everyone most at risk of the new practice has either initiated use or at least had the opportunity to do so; and 4 decline phase during which, an illicit drug tends to go out of favour. In Estonia, fentanyl use emerged in and, within a year, had replaced heroin in the illicit drug market Wilson et al. It has been hypothesized that market change from heroin to fentanyles was in reaction to the drop in poppy production in Afghanistan in the early s Rowlatt, Mars et al. Mars and Rosenblum, have reported that in both North America and parts of Europe illicit fentanyl is often mixed into heroin to be sold as heroin or is made to mimic the appearance of other opioids. This might be a supply side strategy to be responsive and increase profit to the preferences of established heroin users. In Estonia, in early s, after a short period of use, homemade poppy liquid MAK and heroin were rapidly replaced with fentanyl, and it has been marketed as a fentanyl and not as heroin , under the street names such as China White, Afghan or Persian Talu, ; Talu et al. Estonia has a longer history of fentanyl and its analogues 3-methylfentanyl, carfentanyl use than any other country Platt et al. For an over a decade up to , Estonia has had the highest overdose death rate in Europe European Monitoring Centre for Drugs and Drug Addiction, Evidence from various resources Estonian Causes of Deaths Registry, ; The Estonian Forensic Science Institute, has documented the use of injected fentanyles as a major contributor to the Estonian overdose death epidemic Figure 1. The fentanyl epidemic in Estonia: the amount of seized illicitly manufactured fentanyles in grams , the number n of overdose deaths and overdose mortality per , the number of naloxone doses distributed to drug users and their family members, and the prevalence of injection drug use among population aged 15—44 years in to data on from the first 8 months also presented. Fentanyl use has been deeply harmful: it is highly addictive, requiring multiple injections per day, leading to considerably increased risks of trauma and injury Talu et al. These are the noises and rumble of the denied mass-grave in our own backyard. The cohort of men in Estonia born — M. Those would have been the men in their teenage years in mid s and early s - the period coincides with the economical and societal unrest in Estonia after regaining independence from Soviet Union in Estonian Human Development Report, Until , only fentanyl and 3-methylfentanyl had been detected by the Estonian Forensic Science Institute, since then a myriad of analogues carfentanyl, acryl fentanyl, cyclopropylfentanyl, furanylfentanyl and U a novel synthetic opioid have been seized The Estonian Forensic Science Institute, and identified at overdose death forensic analysis Tuusov et al. Whether the expanding list of fentanyl analogues is a marker of an increase in the number of individual clandestine producers or distribution networks is, currently, unknown, but is of importance. The origin of fentanyl in Estonia has been a topic of much speculation. Some authors claim that the fentanyl available in Estonia since the early s was smuggled in from Russia Tuusov et al. However, it is intriguing to note that data on fentanyl use in Russia is difficult to pinpoint. The production or trafficking of fentanyl for over a decade for just the Estonian market needs to be validated, but based on the available evidence, this appears unlikely. Anecdotal reports from drug users in Tallinn, the capital of Estonia, have indicated the domestic production of fentanyl in Estonia. These claims, however, were not supported by the Estonian Police until It was in that Estonian law enforcement disabled a domestic fentanyl production site, shut down its laboratory, and seized a record amount of fentanyl Pihl, ; Reiljan, , The Prosecutor Office Yearbook , Estonia, see Figures 2 , 3 photos, from Margo Kivila, Estonian Police and Border Guard Board. The way of packing and transportation of illicitly manufactured fentanyl, Estonia Illicit fentanyl manufacturing laboratory, fentanyl and inactive ingredients mixing instrument, and product, Estonia Since the beginning of , the availability of fentanyl and its analogues has been limited. Fieldwork notes. Sept 14, ; Margo Kivila, Estonian Police and Border Guard Board, personal communication, Dec 13, , and importantly, opioid users are in need of an alternative, that creates a demand for a potent, more concealable alternative. Given that for majority of the PWID fentanyl has been the main drug to inject, it is hard to disentangle fentanyl use and injection drug use epidemics over the period of observation. The PWID population is getting older with the mean age of study respondents being 25 years in Wilson et al. Free, voluntary and confidential HIV testing is available to the population groups who are at the most risk at several AIDS voluntary counselling and testing clinics and via prevention and harm reduction service providers. NSP were initiated in in Estonia. In , there were nine organizations providing syringe exchange and HIV and drug counselling services. PWID may obtain sterile syringes and needles either directly at an exchange site or from syringe exchange community outreach workers and via Syringe Exchange Mobile van. Fentanyl injection may thus require much greater numbers of syringes per PWID. The volume and quality of OST treatment provided in Estonia is suboptimal to achieve a population level effect Raben et al. Medical HIV care and antiretroviral treatment ART is provided by the government healthcare system through infectious disease departments, and is free for all in need. Opioids overdoses deaths prevention - naloxone take-home - programme in Estonia as a community-based programme was launched in September National Institute for Health development, Since , naloxone is also distributed by prison medical departments. Naloxone can only be prescribed by a physician listed in the register of health care professionals, and though, the program is operated at local level in cooperation between health care providers and organizations providing harm reduction services mostly NSP Abel-Ollo, Increased provision of take-home naloxone e. While the interventions listed above are critical to reducing the burden of HIV faced by active injectors, it has been argued that the most effective method of preventing injection-driven harms epidemics to shift resources upstream, towards the prevention of injection drug use Werb. Injecting an illicit drug is a complicated and often dangerous procedure, and almost everyone who begins injecting requires the assistance of an experienced injector for their first injection. This almost universal requirement for beginning to inject drugs led Hunt et al. Hunt et al. Injection drug use is an inherently social and cultural process and almost all individuals who start to inject drugs require the assistance and knowledge of an experienced injector s. Therefore, both — the skills and harms are transferred. The illicit fentanyl used in Estonia originates from clandestine production; it is not a drug diverted from the medical or veterinary systems. There are many implications of clandestine production of synthetic opioids. The quality and — importantly — as the product itself fentanyl or analogues changes, the potency, purity and quantities of the product produced are inconsistent. Oct 14, Given that Estonia has not witnessed a well-established heroin use epidemic other than heroin use around the turn of the Millennium , a direct comparison of heroin and fentanyl harms is not possible. However, it is indisputable that fentanyl use is deadly. Zinberg described how three exhaustive classes of factors influence a drug use experience: drug, set personal disposition as well as genetic factors and setting context and culture Zinberg, We have seen introduction of fentanyles following heroin shortage in Estonia in —, and recent influx of new synthetic drugs in response to the current fentanyl shortage. Set may have to be reconceptualized when the user does not know what the drugs are, as in the case of where fentanyl has been added to other drugs or substituted for other drugs. The introduction of new drugs into market is orchestrated by the supply side. The illicit drug trade is dynamic, and profit oriented. Cheaper synthetic production, innovations simplifications in the production process, access to precursors, and an ability to circumvent legal enforcement have provided incentives for the production of fentanyls Pardo et al. Vigorous surveillance including monitoring for new drugs based on the samples from drugs users Peiper et al. Based on the sequence of events, shutting down a major producer and distributor of fentanyl and the increased distribution of naloxone were followed by dramatic decline in the number of overdose deaths from in to 39 in but it is not possible to determine the relative importance of these as factors in the dramatic decline of overdose deaths. Unfortunately, in Estonia, this supply-side intervention came ten years into the epidemic, and might be difficult to replicate in settings with decentralized production. Based on the long-term Estonian experience, we would recommend large-scale implementation of the following evidence-based programs in areas faced by fentanyl use. These recommendations apply both to non-injecting use of fentanyl but particularly to injecting use, as that is a much more dangerous route of administration:. Fentanyl can quickly replace other opioids, leading to rapid increases in drug overdoses. Naloxone distribution National Institute for Health Development, and education about fentanyl should be in place prior to any fentanyl entering a local drug scene. Figure 1 ;. The high frequencies of fentanyl injection Talu et al. Eliminating a fentanyl supply does not cure opioid use disorder. If fentanyl supply is substantially disrupted, users will change to other drugs which may pose different risks to the lives and health of users. There should be continuous monitoring the different types of drugs used in the local community and contingency plans for implementing new public health measures to reduce harms associated with new patterns of drug use. This includes providing timely warnings and information directly to drug users via appropriate information channels. We would also highlight the importance of opiate substitution treatment Stone et al. Additionally, because the time period after leaving OST is a high risk period for overdose which would be increased if fentanyl is a commonly used drug. Finally, we would recommend developing programs to reduce stigmatization of opioid use, as stigma often prevents drug users from utilizing health services, and compounds the psychological damage caused by drug use. However, we believe it significantly contributes to the generation and synthesis of knowledge on illicit fentanyl use. Illicitly manufactured fentanyls are, however, only one of the many potential novel psychoactive substances that may threaten the health of people who use drugs and the communities where they live. The means of responding to emerging substances should match the world in which different substances can be rapidly introduced, and where people who use drugs change preferences based on market availability Peacock, Addressing fentanyl may serve as a public health learning experience for developing early detection and rapid response programs in rapidly changing drug use environments. We call for continuous monitoring of local drug use situations and to adapt to new developments with rapid implementation of appropriate evidence-based interventions. Petersburg, Russia for sharing the data and information. We also thank also thank persons using drugs who have shared their experiences and life stories with us. As a library, NLM provides access to scientific literature. Int J Drug Policy. Published in final edited form as: Int J Drug Policy. Find articles by Ave Talu. Find articles by Sigrid Vorbjov. Find articles by Liis Lemsalu. Find articles by Don Des Jarlais. Issue date Jul. PMC Copyright notice. The publisher's version of this article is available at Int J Drug Policy. Open in a new tab. Declaration of Competing Interest None. 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. Treatment slots for opioid substitution treatment.

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How can I buy cocaine online in Tartu

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.

How can I buy cocaine online in Tartu