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Journal Article Ppublish 30 citations

PubMed: 36243065 DOI: 10.1016/j.scitotenv.2022.159351

Occurrence of Z-drugs, benzodiazepines, and ketamine in wastewater in the United States and Mexico during the Covid-19 pandemic.

Sci Total Environ 857(Pt 2):159351

Authors: Sangeet Adhikari, Rahul Kumar, Erin M Driver, Devin A Bowes, Keng Tiong Ng, Juan Eduardo Sosa-Hernandez, Mariel Araceli Oyervides-Muñoz, Elda M Melchor-Martínez, Manuel Martínez-Ruiz, Karina G Coronado-Apodaca, Ted Smith, Aruni Bhatnagar, Brian J Piper, Kenneth L McCall, Roberto Parra-Saldivar, Leon P Barron, Rolf U Halden

Affiliations

  • School of Sustainable Engineering and the Built Environment, Arizona State University, Tempe 85281, AZ, USA; Biodesign Center for the Environmental Health Engineering, Biodesign Institute, Arizona State University, Tempe 85281, AZ, USA.
  • Biodesign Center for the Environmental Health Engineering, Biodesign Institute, Arizona State University, Tempe 85281, AZ, USA.
  • Environmental Research Group, School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom.
  • Tecnologico de Monterrey, School of Engineering and Sciences, Monterrey 64849, Mexico; Tecnologico de Monterrey, Institute of Advanced Materials for Sustainable Manufacturing, Monterrey 64849, Mexico.
  • Tecnologico de Monterrey, School of Engineering and Sciences, Monterrey 64849, Mexico; Tecnologico de Monterrey, Institute of Advanced Materials for Sustainable Manufacturing, Monterrey 64849, Mexico; MARTEC, Tecnológico de Monterrey, School of Engineering and Sciences, Monterrey 64849, Mexico.
  • Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, KY 40202, USA.
  • Geisinger Commonwealth School of Medicine, Scranton, PA 18509, USA; Center for Pharmacy Innovation and Outcomes, Forty Fort, PA 18704, USA.
  • Binghamton University, Johnson City, NY 13790, USA.
  • School of Sustainable Engineering and the Built Environment, Arizona State University, Tempe 85281, AZ, USA; Biodesign Center for the Environmental Health Engineering, Biodesign Institute, Arizona State University, Tempe 85281, AZ, USA; OneWaterOneHealth, Nonprofit Project of the Arizona State University Foundation, Tempe, AZ 85287, USA; Global Futures Laboratory, Arizona State University, 800 S. Cady Mall, Tempe, AZ 85281, USA.

Abstract

Z-drugs, benzodiazepines and ketamine are classes of psychotropic drugs prescribed for treating anxiety, sleep disorders and depression with known side effects including an elevated risk of addiction and substance misuse. These drugs have a strong potential for misuse, which has escalated over the years and was hypothesized here to have been exacerbated during the COVID-19 pandemic. Wastewater-based epidemiology (WBE) constitutes a fast, easy, and relatively inexpensive approach to epidemiological surveys for understanding the incidence and frequency of uses of these drugs. In this study, we analyzed wastewater (n = 376) from 50 cities across the United States and Mexico from July to October 2020 to estimate drug use rates during a pandemic event. Both time and flow proportional composite and grab samples of untreated municipal wastewater were analyzed using solid-phase extraction followed by liquid chromatography-tandem mass spectrometry to determine loadings of alprazolam, clonazepam, diazepam, ketamine, lorazepam, nordiazepam, temazepam, zolpidem, and zaleplon in raw wastewater. Simultaneously, prescription data of the aforementioned drugs were extracted from the Medicaid database from 2019 to 2021. Results showed high detection frequencies of ketamine (90 %), lorazepam (87 %), clonazepam (76 %) and temazepam (73 %) across both Mexico and United States and comparatively lower detection frequencies for zaleplon (22 %), zolpidem (9 %), nordiazepam (<1 %), diazepam (<1 %), and alprazolam (<1 %) during the pandemic. Average mass consumption rates, estimated using WBE and reported in units of mg/day/1000 persons, ranged between 62 (temazepam) and 1100 (clonazepam) in the United States. Results obtained from the Medicaid database also showed a significant change (p < 0.05) in the prescription volume between the first quarter of 2019 (before the pandemic) and the first quarter of 2021 (pandemic event) for alprazolam, clonazepam and lorazepam. Study results include the first detections of zaleplon and zolpidem in wastewater from North America.

MeSH

Diazepam, Pharmaceutical Preparations, Benzodiazepines, Ketamine, Prescriptions, Covid-19, Alprazolam, Clonazepam, Research, Pandemics, Wastewater-Based Epidemiological Monitoring, Environmental Health, Temazepam, Environment, Nordazepam, Zolpidem, Lorazepam

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