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Eur Addict Res 13 December ; 28 6 : — Introduction: Wastewater-based epidemiology WBE has emerged as a timely, non-invasive, and cost-effective indicator of illicit drug consumption. It is increasingly used by international organizations as a proxy measure for estimates of drug prevalence and related trends. Nevertheless, the literature exploring the limitations of WBE remains limited. This paper aims to shed further light on important shortcomings of WBE with recommendations on moving forward. Method: Utilizing case study and statistical analysis, the paper critically reviews methodological challenges associated with WBE results related to i levels, ii trends, and iii between-city comparisons of drug use. Normalized population loads were calculated and variation in daily loads analysed with plots and estimation of means, confidence intervals, and coefficient of variation. Linear regression models examined trends and between-city differences. Substantial differences in load levels and patterns across time and plants were also observed. A carefully designed sampling procedure and a relatively large number of daily samples are required to obtain estimates of sufficient precision for determining trends in space or time. Cross-referencing with alternative trend variables can improve the interpretation of WBE trend indicators. Finally, when using mean load levels for different wastewater-treatment plants to assess spatial variation in drug use, the representativeness of the catchment area should be evaluated before interpreting observed changes as city differences. Conclusion: Although WBE is a useful supplementary indicator of illicit drug consumption, important methodological issues and potential shortcomings should be taken into account when designing sampling procedures and interpreting the analytical results. Sign In or Create an Account. Search Dropdown Menu. Advanced Search. Skip Nav Destination Close navigation menu Article navigation. Volume 28, Issue 6. Article Navigation. Research Articles September 22 This Site. Google Scholar. Ellen J. Amundsen Jane Mounteney Jane Mounteney. Eur Addict Res 28 6 : — Article history Received:. Cite Icon Cite. Abstract Introduction: Wastewater-based epidemiology WBE has emerged as a timely, non-invasive, and cost-effective indicator of illicit drug consumption. You do not currently have access to this content. View full article. Sign in Don't already have an account? Buy Token. This article is also available for rental through DeepDyve. View Metrics. Email alerts Online First Alert. Latest Issue Alert. Citing articles via Google Scholar. Karger International S. Karger AG P. Karger AG, Basel. Close Modal.

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