Wastewater-based epidemiology in low Human Development Index states: bias in consumption monitoring of illicit drugs.

Wastewater-based epidemiology, which monitors community drug use by analyzing sewage, is expanding from well-managed networks in developed countries to non-advanced economies. This review provides toxicokinetic data for locally used narcotic drugs expected to emerge in developed nations, outlines excretion differences due to human genetic variation, and summarizes practical obstacles such as sewer coverage, maintenance efficiency, and network type. A case study from Martinique shows compliance with OECD health standards but not with population and urban dynamics, highlighting challenges for accurate monitoring in the global south.

Study at a glance

Abstract

Wastewater-based epidemiology is a promising approach worldwide, and its application is currently being developed in non-advanced economies. This technology, based on known toxicokinetic data initially used to detect illicit drugs in well-managed and maintained local sewer networks, has been extended to assess other products such as pesticides, alcohol, flame retardants, nicotine, and other substances. This technology is also used in countries with non-advanced economies. The present review aims to support future wastewater-based epidemiology in such countries by providing toxicokinetic data for locally used narcotic drugs that are expected or known to be emerging in developed countries, outlining the excretion differences due to human polymorphism, and summarising the practical obstacles due to the coverage, maintenance efficiency, or type of local sewage network.Case study feedback from Martinique is presented as an example; the Martinique field study complies with the Organisation for Economic Co-operation and Development standards for health issues, but not with regard to population and urban dynamics.