Wastewater monitoring underway for opioids and other lethal drugs

Dr. Monty Ghosh, BSc'03, MBT'04, MD'09, was saddened but not surprised when he heard deaths due to drug overdoses spiked in June. He is monitoring wastewater for opioids and other illicit drugs as part of a research study and has been seeing a disturbing trend. Use of carfentanyl, a synthetic opioid used in veterinary medicine to tranquilize large animals, rose dramatically when the deaths were recorded.  

“There was four times the amount of carfentanyl present in wastewater in June compared to earlier in the year,” says Ghosh, an internist, addictions specialist and assistant professor at the University of Calgary and University of Alberta, in Edmonton. “I don’t think people were aware of what was in the drug supply.”

Ghosh shared the data with his network; however, he wondered what the impact could be if he had a way to share the information with various groups that may benefit from or act on the knowledge like emergency responders, health-care providers, and government officials.

“If there was a formal way to share the information it could be used as an early warning to provide more information about what is going on with the level of toxicity of the drug supply and possibly prevent deaths,” says Ghosh. 

Ghosh is one of the principal investigators (PI) on the study, working with Advancing Canadian Water Assets (ACWA) the same facility that was part of the team monitoring wastewater in Alberta for SARS-CoV-2 during the pandemic. Providing additional data of the abundance of COVID-19 and its emerging strains proved to be a beneficial public health tool. That same detection system has been revised to look for 48 substances connected to the use of illicit drugs. 

“We are also monitoring for toxic agents that are added to illicit substances during their processing. Several of these dilutants are associated with specific toxicities that can result in a range of rare adverse events that are difficult to diagnose,” says Dr. Michael Parkins, BSc'98, MSc'00, MD'03, co-PI, infectious disease specialist and founding member of the wastewater surveillance team.

“Wastewater surveillance through our sentinel network offers the potential to warn health providers to be alert for those presenting with compatible symptoms.”

“This research has the potential to have a positive impact for many people. ACWA is one of a few places in Canada that has the capability to do this work,” says Kevin Frankowski, BSc'94, executive director of ACWA. “We have the leading-edge analytical lab, intellectual talent and highly specialized instrumentation necessary for this work.”

Frankowski says the method detects trace amounts of chemicals and confirmed that xylazine has also been detected in the wastewater. Xylazine is another drug used for veterinary care that has started to circulate in the drug supply throughout North America.

“We are in the very early stages of this study. The first step was to validate drug testing in wastewater, which we’ve completed,” says Ghosh. “The next phase of the study is to determine the best way to share the information with key groups in a sustainable way.”

The team is partnering with C.E.C Analytics, a Calgary company supplying the technology to collect the wastewater samples.

“Monitoring strategies that use innovative sampling technologies, such as the CEC Sampler, allow for wastewater samples to be collected across a wide range of locations,” says Paul Westlund, PhD, chief executive officer and company founder.

“The combination of leading-edge technologies developed by C.E.C. Analytics and the extensive knowledge of the wastewater surveillance team allows for this type of proactive monitoring to be extremely effective and applicable for any community across Canada. ”

The study is supported by pilot funding from The Mathison Centre for Mental Health Research & Education at the Cumming School of Medicine and Calgary Health Foundation.

“Calgary Health Foundation is pleased to fund initiatives that advance our understanding and ability to act on the health-related matters that impact our community so prevalently,” says Murray Sigler, president and CEO of Calgary Health Foundation.

“The study’s validation of the wastewater testing allows us to look forward at how this knowledge will build our capacity as a community to respond to such a significant crisis.”

Wastewater testing is done weekly at six sites throughout the province. The research team is not disclosing the location of the sites, as Ghosh says that may increase stigma in these areas and leave the impression that illegal drug use is only happening in a few specific locations.

The pilot study will end in the fall.