Spatial differences and temporal changes in illicit drug use in Europe quantified by wastewater analysis.
To perform wastewater analyses to assess spatial differences and temporal changes of illicit drug use in a large European population. Analyses of raw wastewater over a 1-week period in 2012 and 2013. Catchment areas of wastewater treatment plants (WWTPs) across Europe, as follows 2012 25 WWTPs in 11 countries (23 cities, total population 11.50 million) 2013 47 WWTPs in 21 countries (42 cities, total population 24.74 million). Excretion products of five illicit drugs (cocaine, amphetamine, ecstasy, methamphetamine, cannabis) were quantified in wastewater samples using methods based on liquid chromatography coupled to mass spectrometry. Spatial differences were assessed and confirmed to vary greatly across European metropolitan areas. In general, results were in agreement with traditional surveillance data, where available. While temporal changes were substantial in individual cities and years (P ranging from insignificant to <10(-3) ), overall means were relatively stable. The overall mean of methamphetamine was an exception (apparent decline in 2012), as it was influenced mainly by four cities. Wastewater analysis performed across Europe provides complementary evidence on illicit drug consumption and generally concurs with traditional surveillance data. Wastewater analysis can measure total illicit drug use more quickly and regularly than is the current norm for national surveys, and creates estimates where such data does not exist.