The number of deaths in a year in B.C. due to drug overdoses now exceeds the combined number of motor vehicle fatalities, suicides and homicides, according to the B.C. Coroners Service.
Last year, B.C. saw 118 homicides, about 300 deaths due to vehicle accidents and about 500 suicides. The province reported 1,489 suspected illicit-drug overdose deaths in 2018.
The supply of illicit drugs is unpredictable. New shipments can arrive at any time. Although police and public-health officials can’t predict exactly when to expect overdose spikes, they always know within hours after dodgy drugs do hit the streets.
Researchers are exploring new ways around the unpredictability. The growing field of sewage epidemiology — the study of population health by way of its bowels — is one option for determining how many people in a community are taking what kinds of drugs, when and even where. People might be reluctant to admit they use illicit drugs, but their excrement always comes clean.
Wastewater testing can supplement existing information and estimates about drug use. If testing is frequent, it can even reveal patterns — drug-use hot spots within the community or changes in use over time.
For example, sewage says cocaine users in Oregon typically get their fixes on weekends, while meth heads score throughout the week. London, U.K., appears to be a heroin hotspot, while Las Vegas residents and visitors process high quantities of methamphetamines — most of which stay behind in Vegas after many flushes, royal or not. Another U.S. study found that use of methamphetamines, cocaine and marijuana spiked during events such as Fourth of July festivities and even the 2017 solar eclipse.
Sewage sampling can provide early warning to public-health officials as new shipments of drugs arrive in town. This can help hospitals and emergency-response, social-services and police agencies assign resources to cover those periods. The tests can also indicate when new drug labs might be coming online in a community.
Repeated testing over time can show whether naloxone programs, safe-injection sites, and other initiatives and policies work.
But there’s no reason to limit monitoring to street drugs. Wastewater contains as much information about over-the-counter and prescription drug use. Standard recommended-dose data allow the researchers to estimate how many people contributing to a sewage-collection system are taking birth control pills, antidepressants, antipsychotics, pain relievers, chemotherapy drugs, fungicides and so on. They can do this because anything we eat that our bodies don’t metabolize and absorb flushes out the other end, and ends up — not in our waists — but in our waste.
One study measured concentrations of carbamazepine, an anti-epileptic drug, and ciprofloxacin, a common antibiotic, in rivers around the world. It found levels of the two prescription drugs have increased significantly over the past two decades. Levels of the ciprofloxacin, in particular, have reached the point of causing ecological harm, with its potential of increasing antibacterial resistance in the environment.
Antibiotic-resistant bacteria are immune to the drugs designed to kill them. Some researchers say resistance is one of the most urgent threats to public health, as it renders medications typically given for infections and illnesses obsolete.
According to a recent southern Ontario study, antibiotic-resistant bacteria could be far more widespread than we think. Researchers tested the prevalence of bacteria resistant to the antibiotic tetracycline in lakes and rivers — and found them everywhere.
River samples contained more resistant bacteria than lake samples, and rivers that flowed through farmland upstream of the sampling sites had higher levels. However, tetracycline resistance was highest in samples taken from Toronto’s wastewater treatment plant, where frequencies were two to nine times those of the highest results from rivers.
Although doctors don’t prescribe tetracycline as often as they once did, the drug continues to be used to treat acne, cholera, brucellosis, plague, malaria and syphilis. It is also widely used to treat livestock.
Widespread presence of antibiotic resistance in the environment is a concern. Bacteria promiscuously exchange genes among themselves — even among different species. Eventually, drug-resistance genes will cycle through the environment and end up back on our plates, in our water bottles, in our hospitals … and in our toilets.
All the more reason to keep an eye on our own waste cycle.
