Drug overdose deaths rose by close to 30% in the United States in 2020, hitting the highest number ever recorded, according to a report the CDC issued in July 2021. The data indicates more than 93,000 people died from drug overdoses in 2020—a 29% increase from the 72,151 deaths projected for 2019.
Now, a team of researchers from Kentucky is shedding light on increased drug consumption in the early days of the pandemic through wastewater epidemiology analysis.
Between March and June 2020, Murray State University’s Bikram Subed and his team collected raw sewage samples from treatment facilities in two towns in western Kentucky and northwest Tennessee. Using wastewater epidemiology methods, they measured the levels of easily abused prescription medications, illicit drugs and their metabolites.
The results showed that consumption of hydrocodone—one of the most abused prescription opioids and the most prescribed controlled substance in Kentucky—spiked by 72% in March to June. The researchers suggest the change was at least partially because people had easier access to doctors as the world was forced to switch to telemedicine appointments.
Conversely, the data shows the use of illicit stimulants dropped by 16% for methamphetamine and 40% for cocaine, presumably because stay-at-home orders significantly limited local, interstate and international drug trafficking.
However, the early drop in synthetic opioid use did not remain a trend, especially once lockdown ended and travel became possible again. Subed’s team did test their wastewater samples for fentanyl and were able to detect it, but said they were unable to quantify it in the same way as hydrocodone or cocaine since fentanyl dosage tends to be very small.
The CDC says deaths related to synthetic opioids played a large role in the overdose explosion seen in 2020. Multiple studies have pointed to elevated drug use and higher-risk usage, such as cutting or mixing drugs from an unreliable supply and using in isolation, as potential factors in the pandemic’s deadly surge. Based on its data from July, the CDC says deaths at least partially attributable to synthetic opioids likely increased by around 20,000 (54%) in 2020, while deaths involving cocaine (21%) and other psychostimulants like methamphetamine (46%) also rose dramatically. For context, in 2015, synthetic opioids were involved in 18 percent of all overdose deaths; in 2020, that appears to be the case in more than 60 percent of deaths.
Subed says the main advantage of employing a wastewater epidemiology method for drug trend analysis is its ability to determine drug use in in near real-time.
His team used a method that relies on 24-hour sample collection to provide a more representative sample of wastewater. Once collected, the samples are brought back to the lab, where researchers complete sample preparation, which takes about 2 to 3 hours, and then 30 minutes of sample analysis.
“Overall, within 5 to 6 hours, the data will be ready to demonstrate how many drugs have been used yesterday and even today,” said Subed during a presentation of his research at the fall meeting of the American Chemical Society (ACS).
The research team says their results match other sources pertaining to drug estimations in the community in the early days of the pandemic, including data from city and state police. But, Subed stressed, his method is more efficient.
“The conventional approaches like tracking the number of drug seizures, syringe exchanges and hospital admissions requires the involvement of different stakeholders,” said the chemistry professor and researcher. “It is more time-consuming and cost-intensive compared with the wastewater epidemiology approach.”
Although the pandemic is somewhat receding, Subed said his team continues to collect wastewater samples that can be used to monitor drug trends at the community-level.
Photo: Screenshot from video of Subed’s team collecting raw sewage samples. Credit: Murray State University.