Not long ago, sampling wastewater to track the spread of the virus was considered a novelty in the United States. Today, wastewater monitoring is providing one of the most comprehensive pictures anyone has of the summer surge of COVID-19. This kind of monitoring has been so effective at predicting the risk of the virus rising or falling that local governments are now exploring other ways to use it. That means turning from tracking infections to tracking illegal, risky drug use.
Monitoring sewage for the virus is useful because infected people excrete tiny amounts of viral material. Similarly, people who take drugs shed biomarkers from their bodies. Drugs tend to show up in sewage before they cause overdoses, so city officials can spot and warn residents when, say, powerful fentanyl may be mixed with other drugs. One town launched an aggressive prescription opioid disposal campaign after discovering large amounts of drugs in its sewage. Other communities are using sewage tracking to allocate Narcan or to study the effectiveness of programs funded by opioid settlement funds.
Wastewater monitoring for drug use has been routine in Europe and Australia for at least a decade, but it is rapidly spreading across the United States. A reliable lab The project, which aims to track COVID-19 wastewater, is currently receiving federal funding from the National Institute on Drug Abuse and is working with 70 sites in 43 states to monitor for illicit drugs in wastewater. Other commercial and academic organizations are also working on similar efforts.
Over 100,000 Americans die from overdoses every yearand more precise data from wastewater tracking could help public health departments focus their interventions. But getting that kind of specific data requires taking samples closer together and from smaller population groups — small enough that, in theory, police could use such information to target specific communities or neighborhoods. This surveillance isn’t limited to municipalities; prisons and office buildings also contract with Biobot to track illegal drug use. If wastewater monitoring is made granular enough, many researchers and public health officials worry that law enforcement could use it against the people it’s meant to help.
It’s easy for governments to monitor drug use through wastewater: Last year, for example, Marin County in Northern California expanded a pandemic-era wastewater program to address drug overdoses. Leading causes of death among people under 55Samples from the sewage treatment plant are mailed to Biobot, which uses mass spectrometry to determine which drugs are prevalent in the area. Using this information, Marin County developed an early warning system for overdoses, and was the first to find xylazine (or an anesthetic) in the area through sewage. Haley Hanna, a senior analyst with the Marin County Health Department, said this method allows public officials to avoid some of the bad outcomes that traditional monitoring relies on emergency medical records and autopsy reports. (The county can’t yet say whether the sewage monitoring has directly reduced overdoses.) Each watershed serves more than 100,000 people, and Marin County purposefully inflates sample sizes and reduces collection sites to cut costs and avoid ethical concerns.
For Biobot, this kind of program fits into the company’s ambition to “make policy and medicine work in new ways,” Biobot CEO and co-founder Mariana Matus told me. In her view, wastewater monitoring could inform health authorities about sexually transmitted diseases, smoking, and even dietary habits. When I asked her about concerns about generating this kind of data without people’s consent and how it might be used, she told me she considered those to be “academic” concerns that have nothing to do with “what’s really going on.” For now, Matus is right: collection sites are currently so large that the information can’t be traced back to a single person or even a single household. And from a legal perspective, Precedent Sewage is there to be treated as trash: Once it’s on the street, anyone can take it away. But some experts question what would happen if sewage was like our cell phone location, following us wherever we go and something we have no control over. After all, people can choose where and how they dispose of their sensitive waste, but for most people in the United States, using the public sewer system is unavoidable.
But as sample sizes get smaller and wastewater data gets more detailed, public health officials will have to confront the question of “how granular is too granular?” Tara Sabo Atwood, a professor at the University of Florida who studies wastewater monitoring for drugs, told me. Experts I spoke to agreed that taking samples block by block risks identifying specific households. Most experts seem OK, at least at the scale of a watershed of a few thousand people. That question needs to be clarified before cities or companies collect data that’s too specific and can violate people’s privacy or be used to prosecute anyone, said Lance Gable, a public health law professor at Wayne State University.
Simply collecting and sharing this data could have an impact beyond its intended public health purposes. Some governments are treating drug data as openly as virus data. Tempe, Arizona, which tracked opioids through its sewage before the pandemic, is using its data to Public Online Maps A dashboard showing weekly opioid use in eight collection areas. Recently, New Mexico monitored illegal and prescription drug use in public high schools through sewer water and published the results for each school. These dashboards provide data transparency and do not reflect personally identifiable information. Still, police departments may use the data to increase their presence in certain areas, setting off a self-reinforcing cycle of increased policing and drug detection. Drug use patterns may affect real estate values and teachers may avoid working in certain schools.
For Nielke Doorn, a professor of water engineering ethics at Delft University of Technology in the Netherlands, these impacts are starting to look like function stretching, where a technology is redirected from its original purpose to new, potentially problematic ones. The barriers between public health data and law enforcement have been breached before—for example, when hospitals passed on pregnant women’s positive drug tests to the police, Gable noted. And the lines between public health and law enforcement are already blurring in wastewater monitoring. National Institutes of Health and Department of Justice The study was funded by the National Institute of Drug Administration. If drug monitoring in sewers were to expand to more detailed testing of neighborhood blocks, for example, the data could justify searches and arrests, undermining the original purpose. After all, criminalizing drug abuse is Not displayed And Szabo-Attwood warns that, like many parts of public health, wastewater monitoring relies on trust, and that trust can evaporate if people fear their data will be used for nefarious purposes.
Monitoring buildings’ wastewater for drugs only exacerbates these problems, because that level of data makes it easier to identify individuals. Such monitoring is not yet widespread, but it is already on the rise. Currently, in the United States, private companies can test buildings’ wastewater for illegal drugs without notifying employees or residents, Gable said. Early in the pandemic, some college campuses Monitoring individual dorms through wastewater Virus analysis – an approach that can be repurposed to detect illicit drug use.
At first glance, collecting data from sewage may be less biased and intrusive than other drug testing methods. But Dorn cautions that this is only true if samples are taken from all areas, or at least randomly, rather than testing specific areas. But in prisons, where drug testing is already routine, Research suggests Wastewater analysis is actually less invasive and more accurate Alternative to individual urine testsAnd it could help move the criminal justice system toward taking a public health approach to drug use.
Marin County has attempted to navigate this murky ethical situation by actively seeking input from people who use drugs. Initially, only 13 percent of county focus group members opposed wastewater monitoring, while the remaining 44 percent supported monitoring or were neutral. Not surprisingly, the most pressing concern was that the data might be used for other purposes, particularly by law enforcement. But if the county’s strategy can maintain the community’s trust, potentially controversial monitoring methods could have significant benefits for the people they are meant to help.
