Estimation of the consumption of illicit drugs during special events in two communities in Western Kentucky, USA using sewage epidemiology.

Sewage epidemiology is a cost-effective, comprehensive, and non-invasive technique capable of determining semi-real-time community usage of drugs utilizing the concentration of drug residues in wastewater, wastewater inflow, and the population size served by a wastewater treatment plant. In this study, semi-real-time consumption rates of ten illicit drugs were determined using sewage epidemiology during special events including Independence Day, the 2017 solar eclipse, and the first week of an academic semester in the Midwestern United States. The average per-capita consumption rate of amphetamine, methamphetamine, cocaine, and THC were significantly different between two similar-sized communities during Independence Day observation week (p<0.046) and a typical week (p<0.001). Compared to a typical day, the consumption rate of amphetamine, methamphetamine, cocaine, morphine, and methadone was significantly higher on Independence Day (p<0.021) and during solar eclipse observation (p=0.020). The estimated percentage of the population that consumed cocaine in a community is similar to the conventionally estimated consumption of cocaine; however, the combined estimated population that consumed amphetamine and methamphetamine based on sewage epidemiology was ~2 to 4 fold higher than the conventional estimates. This study is the first to compare community use of drugs during special events in the USA using sewage epidemiology.