Wastewater monitoring program reveals spike in illicit drug use

Australia’s National Wastewater Drug Monitoring program is set to continue for at least another four years, highlighting the important role wastewater monitoring plays in helping to keep communities healthy and safe, particularly in light of a recent spike in some illicit drug use. 

A new contract has been signed between The University of Queensland (UQ), The University of South Australia and the Australian Criminal Intelligence Commission (ACIC) to continue data collection and analysis for the program for a further four years.
 
In place since 2016, recent results from the program reveal a significant spike in the use of some illicit drugs, particularly since a recorded dip in use during COVID-19 lockdowns.
 
Professor Kevin Thomas from UQ’s Queensland Alliance for Environmental Health Sciences said wastewater monitoring is a vital tool to provide understanding of distribution, trends and fluctuations of drug use in Australia.
 
“We look forward to continuing our partnership with The University of South Australia and the ACIC to enable new research avenues and advance the capability of wastewater analysis in Australia,” he said.
 
“Our program is one of the longest running and most comprehensive wastewater-drug monitoring programs in the world and has influenced other nations to start up their own programs.”
 
UQ’s Dr Ben Tscharke said, while both universities have been collecting wastewater data since 2009, the program officially began in 2016 partly due to the drastic prevalence of methamphetamine use at the time.
 
“In the data from 2009-2016, there was about a five times increase in methamphetamine in the wastewater. Over the same period, median purity of methamphetamine seizures increased by about four times and surveys suggested people were using more of the pure form of the drug. Together, it indicated a big increase in use of stronger forms of methamphetamine – including ‘crystal meth’,” he said.
 
“The Government wanted more monitoring around illicit drug use. A specific recommendation of the National Ice Taskforce was to enhance the capability of wastewater analysis. And so the research at UQ and UniSA became a national program with 20 sites across state capitals, and another 30 sites in regional towns.”

Recent results

Samples from 62 wastewater sites nationwide were analysed in August 2023, representing 57% of Australia’s population, Tscharke said.
 
“Samples were analysed for key illicit drugs including methylamphetamine, cannabis, MDMA, cocaine and heroin, as well as some substances with abuse potential such as alcohol, nicotine, strong opioids, oxycodone and fentanyl,” he said.
 
“There was a dramatic increase in cocaine use in Brisbane and regional Queensland and in August 2023 levels were at their highest levels since wastewater was first monitored in 2016. Levels were more than three times higher in August 2023 than the data recorded in August 2022.
 
“This spike comes after a drop in substance use during the COVID-19 pandemic from late 2020 to mid-2022. While MDMA saw a similar drop during the pandemic, use of the substance has not returned to the same levels of cocaine, however the use of methylamphetamine has gradually increased.”
 
Tscharke said one of the most noticeable results is the recent data around cocaine use.
 
“We have been monitoring for seven years now and in August 2023 we saw a three-fold increase in use from the year before, and the highest result in seven years,” he said.
 
“The speed of the increase is striking. During COVID-19 cocaine decreased from the end of 2020 to mid-2022, almost to the lowest we have seen. And then within one year it has increased three-fold, higher than before COVID-19.”

Benefits of monitoring

Tscharke said monitoring wastewater for the presence of illicit substances adds a robust method for learning more about drug use within communities.
 
“It is really hard to estimate how much use is occurring in communities. Surveys are great for informing us about the demographics of who is using what substances, but they might not be capturing the heaviest users,” he said.
 
“For a lot of substances, the heaviest users make up a large percentage of the total use and other types of data are not as suitable for telling us how much is being used by people in the community.
 
“Wastewater monitoring doesn’t replace other data sets, but it’s another indicator of the scale of drug use occurring. It can look at illicit drug trends over time, which can be difficult for other methods to achieve.”
 
For example, researchers can look at data from wastewater before and after certain interventions, Tscharke said – either external unplanned interventions, like the COVID pandemic, or purposeful interventions introduced to curb drug use.
 
“It can be difficult to get high frequency data and monitor how things change. Wastewater gives us a lot of complementary information, and when combined with other data sets it can help us fill in a bigger picture,” he said.
 
“But wastewater data can’t do a lot of the things surveys and other data sets can do. Some of the risks involved in illicit drug use come down to how the drug is ingested, as well as age demographics, or if people are using multiple drugs at a time. 

“We can’t get those answers with wastewater, which is why we consider it a complimentary data source to the other important sources of information.
 
“Perhaps most importantly, the wastewater data can be used to help decision making. It can help to determine where to focus attention in terms of interventions.”

Power of wastewater analysis

Tscharke said the use of wastewater monitoring for measuring COVID fragments was a great development of the method, showcasing just how effective interventions can be when wastewater data is utilised.
 
“Wastewater research discovered that COVID fragments could be found in feces and wastewater earlier than could be discovered using a nasal swab. In Brisbane, they were able to detect a COVID cluster several days before it was discovered through clinical testing,” he said.
 
“When there was not much COVID-19 around it worked as a forewarning, as COVID virus is shed and detectable before people may start to have symptoms, some people did not have symptoms at all and others were not getting tested when sick. 

“Wastewater monitoring really helped in that regard, in terms of informing of COVID presence and absence, to take early action to reduce the spread of the virus as much as possible. It helped governments raise alerts within certain communities, or set up extra clinic testing support in areas where more cases could be showing up.
 
“There’s further work now considering how to potentially implement wastewater testing at airports and from long-haul flights. If you monitor wastewater at the world’s biggest airports, you could look at global transmission trends, for COVID, or potentially any other virus that is excreted into urine or feces.”
 
Tscharke said the team at UQ is also collating an archive of all samples collected from all research ventures so they can be re-visited to explore community exposure or use of substances retrospectively.
 
“Every year since 2016 through a project we call SewAus (sewer Australia) we have surveyed about 100 treatment plants across the country, and we keep all the samples. It acts as a bit of a time machine,” he said. 

“If we develop a new analysis, we can then go back to the sample archive and analyse the trends from the last decade to assess how drugs or chemicals have emerged or changed in use over time. 
 
“Planned and unplanned interventions are happening all the time. We can go back and measure before and after and see what the impact of the intervention was. It helps us to test how interventions have worked, not only for illegal drugs, but also legal substances that have potential for abuse.
 
“We as researchers don’t know about every intervention planned for every single drug. But if there is a good reason to do some testing, we can turn to our samples and see what shows up to try and help figure out what was happening in the community.”