Estimating the consumption of prescription opioids through wastewater analysis: the patterns of use in Italy

IF 11.4 1区环境科学与生态学 Q1 ENGINEERING, ENVIRONMENTAL

Water Research Pub Date : 2025-05-31 DOI:10.1016/j.watres.2025.123938

Sara Castiglioni, Noelia Salgueiro-Gonzalez, Oscar Corli, Frederic Béen, Lubertus Bijlsma, Tim Boogaerts, Barbara Kasprzyk-Hordern, João Matias, Félix Hernández, Alexander L.N. van Nuijs, Pim de Voogt, Ettore Zuccato

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Abstract

Prescription opioids have recently experienced a diversion of use in several countries causing a huge number of overdoses due to their high potency. The aim of this study was to develop a wastewater-based epidemiology (WBE) approach to assess the use of prescription opioids and evaluate the compliance to prescriptions to highlight the potential misuse of these substances in Italy. The most prescribed opioids have been selected and validated as WBE biomarkers and a nation-wide study has been conducted over a three-year period (2020-2022). Wastewater (WW) samples were collected as 24-hour composite samples in eight Italian cities and parent substances or metabolites were quantified using validated analytical methods based on liquid chromatography – tandem mass spectrometry (LC-MS/MS). Daily loads have been normalized to therapeutic doses to obtain a real figure of use that showed higher use of tapentadol and morphine compared to oxycodone and fentanyl. Back-calculation of consumption estimates was done by using the most reliable WBE biomarkers and were compared with prescription data. Spatial and temporal differences were found and highlighted a lower use in the south compared to the north and the center of Italy. Data comparison with prescriptions gave results in the same range indicating that the use of these substances in Italy seems to be predominantly from prescription for therapeutic purposes. This study highlighted the suitability of WBE to investigate the potential non-medical use of prescription pharmaceuticals in a population, providing relevant information for supporting public health emergencies and policies.

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通过废水分析估计处方阿片类药物的消费量：意大利的使用模式

处方阿片类药物最近在若干国家出现了滥用现象，由于其效力高，造成大量过量使用。本研究的目的是制定一种基于废水的流行病学（WBE）方法来评估处方阿片类药物的使用情况，并评估处方的依从性，以突出意大利可能滥用这些物质的情况。处方最多的阿片类药物已被选择并验证为WBE生物标志物，并在三年（2020-2022年）期间进行了一项全国性的研究。采用液相色谱-串联质谱法（LC-MS/MS）对意大利8个城市的废水（WW）样品进行了24小时复合采样，并对母质或代谢物进行了定量分析。每日负荷已被标准化为治疗剂量，以获得一个真实的使用数字，显示与羟考酮和芬太尼相比，他他多和吗啡的使用量更高。使用最可靠的WBE生物标志物进行消费估计的反向计算，并与处方数据进行比较。与意大利北部和中部相比，南部的使用率较低，这在空间和时间上存在差异。与处方的数据比较得出了相同范围的结果，表明这些物质在意大利的使用似乎主要来自用于治疗目的的处方。这项研究强调了WBE在调查人群中潜在的处方药非医疗使用方面的适用性，为支持突发公共卫生事件和政策提供了相关信息。

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来源期刊

Water Research 环境科学-工程：环境

CiteScore

20.80

自引率

9.40%

发文量

1307

审稿时长

38 days

期刊介绍： Water Research, along with its open access companion journal Water Research X, serves as a platform for publishing original research papers covering various aspects of the science and technology related to the anthropogenic water cycle, water quality, and its management worldwide. The audience targeted by the journal comprises biologists, chemical engineers, chemists, civil engineers, environmental engineers, limnologists, and microbiologists. The scope of the journal include: •Treatment processes for water and wastewaters (municipal, agricultural, industrial, and on-site treatment), including resource recovery and residuals management; •Urban hydrology including sewer systems, stormwater management, and green infrastructure; •Drinking water treatment and distribution; •Potable and non-potable water reuse; •Sanitation, public health, and risk assessment; •Anaerobic digestion, solid and hazardous waste management, including source characterization and the effects and control of leachates and gaseous emissions; •Contaminants (chemical, microbial, anthropogenic particles such as nanoparticles or microplastics) and related water quality sensing, monitoring, fate, and assessment; •Anthropogenic impacts on inland, tidal, coastal and urban waters, focusing on surface and ground waters, and point and non-point sources of pollution; •Environmental restoration, linked to surface water, groundwater and groundwater remediation; •Analysis of the interfaces between sediments and water, and between water and atmosphere, focusing specifically on anthropogenic impacts; •Mathematical modelling, systems analysis, machine learning, and beneficial use of big data related to the anthropogenic water cycle; •Socio-economic, policy, and regulations studies.