Students Research Committee, Department of Environmental Health Engineering, Kermanshah University of Medical Sciences, Kermanshah, Iran.
Social Development & Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
Environ Sci Pollut Res Int. 2020 Oct;27(29):36037-36051. doi: 10.1007/s11356-020-09818-6. Epub 2020 Jun 27.
Wastewater-based epidemiology (WBE) is a complementary, well-established comprehensive, cost-effective, and rapid technique for monitoring of illicit drugs used in a general population. This systematic review and meta-analysis is the first to estimate the rank and consumption rate of illicit drugs through WBE studies. In the current study, the related investigations regarding the illicit drug consumption rate based on WBE were searched among the international databases including Scopus, PubMed, Science direct, Google scholar, and local database, Magiran from 2012 up to May 2019. The illicit drug consumption rate with 95% confidence intervals was pooled between studies by using random effect model. The heterogeneity was determined using I statistics. Also, subgroup analyses were conducted to examine the possible effects of year and location of studies on observed heterogeneity. Meta-analysis of 37 articles indicates that the overall rank order of illicit drugs according to their pooled consumption rate can be summarized as tetrahydrocannabinol or cannabis (7417.9 mg/day/1000 people) > cocaine (655.7 mg/day/1000 people) > morphine (384.9 mg/day/1000 people) > methamphetamine (296.2 mg/day/1000 people) > codeine (222.7 mg/day/1000 people) > methadone (200.2 mg/day/1000 people) > 3,4-methylenedioxymethamphetamine (126.3 mg/day/1000 people) > amphetamine (118.2 mg/day/1000 people) > 2-ethylidene-1,5-dimethyl-3, 3-diphenylpyrrolidine (33.7 mg/day/1000 people). The pooled level rate was 190.16 mg/day/1000 people for benzoylecgonine (main urinary cocaine metabolite), 137.9 mg/day/1000 people for 11-nor-9-carboxy-delta9-tetrahydrocannabinol (main metabolite of cannabis), and 33.7 mg/day/1000 people for 2-ethylidene-1,5-dimethyl-3, 3-diphenylpyrrolidine (main metabolite of methadone). The I values for all selected drugs were 100% (P value < 0.001). The results of year subgroup indicated that the changes of heterogeneity for all selected drugs were nearly negligible. The heterogeneity within studies based on continents subgroup just decreased in America for drugs like 11-nor-9-carboxy-delta9-tetrahydrocannabinol (I = 24.4%) and benzoylecgonine (I = 94.1%). The outcome of this meta-analysis can be used for finding the illicit drugs with global serious problem in view of consumption rate (i.e., cannabis and cocaine) and helping authorities to combat them.
基于污水的流行病学（WBE）是一种补充性的、成熟的、全面的、具有成本效益且快速的监测普通人群中非法药物使用情况的技术。本系统评价和荟萃分析是首次通过 WBE 研究来估计非法药物的排名和消耗率。在目前的研究中，从 2012 年到 2019 年 5 月，我们在 Scopus、PubMed、Science Direct、Google Scholar 和本地数据库 Magiran 等国际数据库中搜索了基于 WBE 的非法药物消耗率相关调查。使用随机效应模型对研究间的非法药物消耗率进行合并。使用 I 统计量确定异质性。此外，还进行了亚组分析，以检查研究年份和地点对观察到的异质性的可能影响。对 37 篇文章的荟萃分析表明，根据其合并消耗率对非法药物的总体排名顺序可总结为四氢大麻酚或大麻（7417.9mg/天/1000 人）>可卡因（655.7mg/天/1000 人）>吗啡（384.9mg/天/1000 人）>甲基苯丙胺（296.2mg/天/1000 人）>可待因（222.7mg/天/1000 人）>美沙酮（200.2mg/天/1000 人）>3,4-亚甲基二氧基甲基苯丙胺（126.3mg/天/1000 人）>苯丙胺（118.2mg/天/1000 人）>2-乙基-1,5-二甲基-3,3-二苯基吡咯烷（33.7mg/天/1000 人）。苯甲酰爱康宁（可卡因的主要尿代谢物）的合并水平率为 190.16mg/天/1000 人，11-去甲-9-羧基-Δ9-四氢大麻酚（大麻的主要代谢物）为 137.9mg/天/1000 人，2-乙基-1,5-二甲基-3,3-二苯基吡咯烷（美沙酮的主要代谢物）为 33.7mg/天/1000 人。所有选定药物的 I 值均为 100%（P 值<0.001）。年份亚组的结果表明，所有选定药物的异质性变化几乎可以忽略不计。基于大陆的研究内异质性亚组仅降低了美国的 11-去甲-9-羧基-Δ9-四氢大麻酚（I=24.4%）和苯甲酰爱康宁（I=94.1%）等药物的异质性。这项荟萃分析的结果可以用于根据消耗率（即大麻和可卡因）来发现全球存在严重问题的非法药物，并帮助当局与之作斗争。
