Sci Total Environ. 2014 Jul 15;487:613-20. doi: 10.1016/j.scitotenv.2013.10.034.
Illicit drug use is a global phenomenon involving millions of individuals, which results in serious health and social costs. The chemical analysis of urban wastewater for the excretion products of illicit drugs is a potent approach for monitoring patterns and trends of illicit drug use in a community. The first international and multidisciplinary conference on this topic was recently organized to present the epidemiological knowledge of patterns in drug use and the information obtained from wastewater analysis. This paper gives an overview of the main issues that emerged during the conference, focusing on the identified research gaps and requirements and on the future challenges and opportunities from bringing together wastewater analysis and drug epidemiology. The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) uses an established multi-indicator system to monitor illicit drug use and to identify the emergence of new psychoactive substances. The methodological challenges of monitoring a hidden and stigmatized behavior like drug use include the limitations of self-report data and reporting delays. An increasing evidence base suggests that wastewater analysis can address some of these problems. Specifically this technique can: monitor temporal and spatial trends in drug use at different scales, provide updated estimates of drug use, and identify changing habits and the use of new substances. A best practice protocol developed by a Europe-wide network of experts is available to produce homogeneous and comparable data at different sites. The systematic evaluation of uncertainties related to wastewater analysis has highlighted which areas require careful control and those that need further investigation to generally improve the approach. Wastewater analysis has considerable potential to complement existing approaches for monitoring drug use due to its ability to produce objective, real-time estimates of drug use and to give timely information of any change in the patterns of use.
非法药物使用是一个全球性现象，涉及数以百万计的个人，导致严重的健康和社会成本。对城市污水中的非法药物排泄产物进行化学分析，是监测社区内非法药物使用模式和趋势的有力手段。最近组织了第一次关于这一主题的国际多学科会议，介绍了药物使用模式的流行病学知识以及从污水分析中获得的信息。本文概述了会议期间出现的主要问题，重点关注已确定的研究差距和需求，以及将污水分析与药物流行病学结合起来所面临的未来挑战和机遇。欧洲毒品和毒瘾监测中心（EMCDDA）使用既定的多指标系统来监测非法药物使用情况，并确定新出现的精神活性物质。监测像药物使用这样隐蔽和污名化的行为存在一些方法学挑战，包括自我报告数据的局限性和报告延迟。越来越多的证据表明，污水分析可以解决其中的一些问题。具体而言，这种技术可以：监测不同规模的药物使用的时间和空间趋势，提供药物使用的最新估计，并确定习惯的变化和新物质的使用。一个由欧洲专家网络制定的最佳实践方案可用于在不同地点产生同质和可比的数据。对与污水分析相关的不确定性进行系统评估，突出了需要仔细控制的领域和需要进一步调查的领域，以普遍改进该方法。由于能够对药物使用进行客观、实时的估计，并及时提供使用模式变化的信息，污水分析在监测药物使用方面具有很大的潜力，可以补充现有的方法。
