Wastewater monitoring is a cost-effective and reliable tool to help address the toxic drug crisis killing thousands of Canadians each year, giving a window into the prevalence of drug use in certain areas and whether new cocktails are entering the illicit market, Alberta-based researchers say.
Wastewater surveillance has been used for years to monitor a variety of diseases, such as influenza or poliovirus, but gained prominence during the COVID-19 pandemic to detect clusters of the virus. Researchers at the University of Calgary then built on that success to launch a first-of-its-kind study to track 48 substances, including fentanyl, benzodiazepines and xylazine, an animal tranquillizer that is becoming more common in North America.
The group recorded a spike in carfentanil – a drug 10,000 times more potent than morphine – in the drug supply in June, the same month front-line workers warned them of increased overdose deaths.
Addictions physician Monty Ghosh and infectious disease specialist Michael Parkins, two members of the University of Calgary project, said this data can possibly save lives. Drug users could be warned of drugs in circulation, and health care providers could be notified of health risks or presentations associated with certain substances. Policy-makers could also use the data to determine where services such as supervised drug-use sites are needed.
But the pilot study, which is financed by the Mathison Centre for Mental Health Research & Education at the Cumming School of Medicine and Calgary Health Foundation, will end this fall if researchers can’t secure additional funding.
Canada is already far behind other countries that have been running national wastewater surveillance programs to monitor drugs for many years. Statistics Canada, beginning in March, 2019, has been testing wastewater in five cities across the country for 14 drugs of concern.
Paul Westlund, chief executive officer of C.E.C. Analytics, a Calgary company supplying the technology to collect the wastewater samples, said COVID-19 helped people understand the value in collecting this type of data, but that partisan politics and stigma around drug use could now be hindering the expansion of this program.
He said people seem afraid to disclose or learn about the extent of drug use in their communities in that it might “expose that they are not doing as much as they could” to help the most vulnerable.
“You can’t really quantify how big of an issue there actually is without that data,” Mr. Westlund said.
The project team in Calgary wants to see wastewater surveillance expand to Indigenous communities across Canada because Indigenous people are dying from drug overdoses at rates far higher than non-Indigenous people. The pilot is only being conducted at six undisclosed sites across Alberta.
A Europe-wide network, SCORE, conducted its first wastewater monitoring campaign in 2011 in 19 cities in the continent to track regional difference in substance use. Its success led to the largest continental study to date by the European Monitoring Centre for Drugs and Drug Addiction that analyzed six substances, including ketamine for the first time, through wastewater in more than 100 cities and towns.
The findings, which were published earlier this year, showed a “continued rise in cocaine detections,” a trend observed since 2016, and reported traces of methamphetamine on the rise. EMCDDA director Alexis Goosdeel said in a press release that wastewater surveillance is now an “established science,” and that his agency is “encouraged by its growing potential for targeting and evaluating localized public health responses and policy initiatives.”
In Australia, a research team from the University of Queensland detected 18 new psychoactive substances through an international wastewater surveillance program in 47 cities both at home and in Europe, Canada, the United States, New Zealand, China, Brazil and the Republic of Korea between 2019 and 2022. These drugs are designed to mimic the effects of established illicit drugs while evading legal restrictions.
The United Nations Office of Drugs and Crime runs an early warning advisory for the public on new psychoactive substances, which sees increased traffic during festivals. Experts have concluded that wastewater monitoring could help fill an information gap on these emerging drugs, helping to identify and monitor substances so that public-health impacts can be evaluated.
Hunter Baril, press secretary to Alberta’s Minister of Mental Health and Addiction, Dan Williams, declined to comment on whether the government has engaged the University of Calgary research team about its findings and whether there are plans to publish the drug data as it does with COVID-19 wastewater surveillance.
“Wastewater monitoring evolved during the pandemic as a strategy for detecting and monitoring a variety of infectious and non-infectious issues of interest,” Mr. Baril said in a statement. “As the technology and its applications are new, we continue to learn how best to use the information and apply it.”
On the Government of Alberta webpage for COVID-19 wastewater tracking, it states that wastewater monitoring is “one of many tools in understanding the overall burden of infection in a community and provides a broad picture of infection in a community.” Former premier Jason Kenney said during the height of the pandemic that the government invested significantly in the tracking program so that “good data” was available on transmission.
However, Mr. Baril confirmed that Alberta is not funding wastewater testing and surveillance for illicit drugs. Instead, he pointed to the province’s substance use surveillance dashboard as the “most transparent and comprehensive data reporting system” of its kind.
It provides information on drug toxicity deaths province-wide, by health zone and within six municipalities, in addition to information on only the most common substances involved in drug-related deaths. But unlike wastewater, it does not provide real-time information on street drugs in circulation, nor does it track emerging drugs.
Five people are dying daily, on average, from unintentional overdoses in the province.