Title:

Advancing harm reduction strategies in Ontario: Analysis of opioid consumption through wastewater-based epidemiology in the Durham region

Abstract:

The opioid crisis, intensified by the COVID-19 pandemic, remains a severe public health challenge in Canada, with Ontario observing a steady increase in opioid-related harms for more than a decade, including a significant increase in the Durham Region with 129 deaths in 2021, seven times the number in 2013. This epidemic, therefore, demands informed and targeted interventions, and acquiring accurate data on opioid usage is critical for implementing effective harm-reduction strategies. Traditional monitoring methods of opioid consumption, such as clinical overdose data, are often expensive, cumbersome, and subject to potential biases. As an alternative, this study explores the application of wastewater-based epidemiology (WBE), a novel approach to assess drug consumption by analyzing municipal wastewater for drugs and their metabolites. We employ WBE to monitor opioid consumption patterns within the Region of Durham, leveraging its capability to provide non-invasive, comprehensive, and real-time data. The selected opioids for this study include morphine, codeine, oxycodone, fentanyl, hydromorphone, methadone, and heroin, as these represent the compounds most closely associated with opioid-related mortalities within Ontario. Our methodology involves collecting 24-hour composite wastewater samples from six regional treatment plants, analyzed through liquid chromatography quadrupole time-of-flight mass spectrometry (LC-QTOF). This approach not only allows for accurate quantification of opioids but also enables the identification of spatial and temporal patterns in opioid usage. The anticipated outcomes of this research include an enhanced understanding and management of the opioid crisis in the Durham Region. By integrating WBE with traditional monitoring methods, we expect to provide more detailed and timely insights into opioid consumption trends, contributing to more effective public health strategies and harm reduction efforts.