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Alcohol use has increased in the last years and is a priority public health issue worldwide. Wastewater-based epidemiology (WBE) is a reliable approach for estimating substance use at the population level and can complement population surveys and sales statistics to obtain objective and updated information on alcohol use in a community. This work reports the first nationwide study of alcohol consumption conducted in Italy by WBE, covering 11.4% of the Italian population. A total of 264 raw wastewater samples (24-h composite) were collected from 17 Italian cities in 2013–2014 and one large city (Milan) over a 7-year period (2013–2019). Besides of normal days, special periods/events (i.e. Halloween, Milan Fashion Week and summer holidays) were studied in Milan. The urinary biomarker of ethanol (namely, ethyl sulphate) was measured by liquid chromatography-tandem mass spectrometry and was used to estimate alcohol consumption. Results were statistically evaluated to assess spatial and temporal differences and were compared with data from other epidemiological indicators. In 2013, alcohol consumption was significantly higher in small cities than in large ones but no significant differences were observed in relation to the geographical position. An increase in alcohol use was observed in seven large cities from 2013 to 2014. The 7-year monitoring in Milan showed no marked changes, except for remarkable increases in 2014 and 2019. Alcohol consumption significantly increased (ca. 25%) during weekends in Italy and in Milan, and during special periods/events, for instance summer holidays and Halloween. WBE estimates were in agreement with national prevalence data, demonstrating that WBE is suitable for objectively evaluating geographic, annual and weekly patterns of alcohol consumption at local and national scales. WBE information would be helpful to implement and evaluate measures for reducing alcohol consumption and preventing the related health risks.

The quantitative determination of urinary biomarkers in raw wastewater has emerged in recent years as a promising tool for estimating the consumption of illicit drugs, tobacco and alcohol in a population and for comparing local and temporal trends. In this study, a three-year monitoring campaign (2012-2014) was conducted to compare alcohol and cocaine use in two European cities (Santiago de Compostela, Spain, and Milan, Italy) by wastewater analysis. Ethyl sulphate and benzoylecgonine were used, respectively, as biomarkers of ethanol and cocaine consumption and cocaethylene as an indicator of co-consumption of both substances. Biomarkers were measured using liquid chromatography-tandem mass spectrometry and concentrations were converted to rates of consumption using specific correction factors. Results were statistically compared in terms of geographic and temporal tendencies. Alcohol intake was significantly higher in Santiago than in Milan (13.6L versus 5.1L ethanol/1000 people day, averages). Cocaine use was higher in Milan than in Santiago de Compostela (800 versus 632 mg/1000 people day, averages). A significant higher consumption of both alcohol and cocaine was observed during the weekends (~23-75% more than on weekdays) in both cities. In terms of years, slight changes were observed, but no clear trends as representative of the whole year could be identified because of the limited number of days sampled. Co-consumption was evaluated using the cocaethylene/benzoylecgonine ratio, which was higher during the weekend in both cities (58% in Santiago and 47% in Milan over the non-weekend day means), indicating a greater co-consumption when cocaine is used as a recreational drug. Wastewater-based epidemiology gave estimates of alcohol and cocaine use in agreement with previous wastewater studies and with recent European surveillance and prevalence data, and weekly profiles of use and preferential patterns of consumption could be plot.