1. Occurrence of Z-drugs, benzodiazepines, and ketamine in wastewater in the United States and Mexico during the Covid-19 pandemic.
- Author
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Adhikari S, Kumar R, Driver EM, Bowes DA, Ng KT, Sosa-Hernandez JE, Oyervides-Muñoz MA, Melchor-Martínez EM, Martínez-Ruiz M, Coronado-Apodaca KG, Smith T, Bhatnagar A, Piper BJ, McCall KL, Parra-Saldivar R, Barron LP, and Halden RU
- Subjects
- Humans, United States epidemiology, Benzodiazepines, Alprazolam analysis, Wastewater analysis, Pandemics, Nordazepam analysis, Zolpidem analysis, Clonazepam analysis, Lorazepam analysis, Tandem Mass Spectrometry methods, Temazepam analysis, Mexico epidemiology, Diazepam, Ketamine, COVID-19 epidemiology
- 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., Competing Interests: Declaration of competing interest R.U.H. and E.M.D. are cofounders of AquaVitas, an Arizona State University startup company providing commercial services in wastewater-based epidemiology. R.U.H. also is the founder of OneWaterOneHealth, a nonprofit project of the Arizona State University Foundation. B.J. Piper is part of an osteoarthritis research team supported by Pfizer and Eli Lilly., (Copyright © 2022 Elsevier B.V. All rights reserved.)
- Published
- 2023
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