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Wastewater Is Providing Valuable Data on Community Drug Use

In Marin County, Calif., technology is being used to analyze wastewater samples to provide health officials with a population-level perspective of drug use. That data is shaping response and intervention efforts.

A view into an underground wastewater pipe with rushing water.
Marin County, Calif., is using cutting edge technology to analyze wastewater samples to help make informed decisions about drug use intervention and response throughout the community.

Data has played a major role in understanding the opioid epidemic, and technology has offered innovative paths to this data, as seen in places like Paterson, N.J. During the COVID-19 pandemic, wastewater monitoring increased in popularity as a way to help communities understand the prevalence of the disease in their areas.

This type of technology has also been highlighted as a valuable method of monitoring community drug use. This is the case in Marin County, where county officials are working with Biobot Analytics to understand what drugs are being used at a population level.

The county had been monitoring wastewater for community COVID-19 levels since around May 2020, and started monitoring for drugs in February 2023, specifically testing for methamphetamine, fentanyl, nicotine and cocaine, according to Haylea Hannah, senior department analyst for the county of Marin Department of Health and Human Services.

“We have kind of an appetite and interest in innovative things to address the overdose epidemic in Marin,” explained Hannah, citing a community collaborative that dates back to 2014 as one example. “We were really interested in piloting [this technology] and seeing if it was a tool that could help fill in some of the gaps that we know we have in our existing drug surveillance overall, and if it could help at all with overdose prevention.”

The technology itself does not greatly differ from the tools used to monitor levels of COVID-19, Alex Buben, an epidemiologist at Biobot Analytics, explained. The same basic sampling technology is used on the same samples that are tested for COVID-19.

“The only difference is when it actually arrives at the laboratory for analysis,” Buben said. “Instead of using viral sequencing analysis, we use what's called liquid chromatography–mass spectrometry, which is just used for chemical biomarkers as opposed to biological markers.”

The goal is for this data to help improve the county’s response to changes in drug supply or drug use habits, said Hannah.

“Wastewater data might be able to provide warning signs of increased use that we can address and provide services for before we see them downstream as fatal or nonfatal overdoses,” Hannah stated.

The data can lead the county to implement a targeted communication strategy to medical providers and harm reduction providers, increase naloxone distribution, and ideally, improve the county’s ability to evaluate the impact of population-level interventions.

Prior to this pilot, the county was limited to clinical data sources, and although those do provide an important piece of the picture, that data is limited to those who are accessing health services.

The collaboration process between the county and the company has involved frequent meetings, typically weekly, to review the data and address questions as needed.

Over the course of the six months that the technology is being piloted, the county ultimately hopes to see whether this can provide new information to complement other surveillance data sources already in use.

And the other major piece of this pilot is to share the data back with the community so that others who work in overdose prevention in other sectors can also leverage the information that is gathered with this technology. It can open the lines of communication to better understand whether the data is accurately telling the story of what those on the ground are seeing.

As Buben put it, the goal is that communities will be able to better respond to shifts in drug use, rather than actual outcomes, taking a more proactive approach.

Maintaining public trust has been an important piece of implementing this new technology, as the county wanted to assure the public that the data, which does not include personal identifiable information, will be collected to be used for policymaking, not punishment.

“I like to distinguish: there’s a difference between being used by law enforcement and being used for law enforcement — in other words, prosecuting people for possession of drugs,” Buben said.

The data is aggregated information from thousands of people; as such, the data is not useful for prosecution or investigations, but it can be used to help improve response from a public health standpoint.

Looking forward, Hannah believes that this could be a potential tool to monitor substances that are emerging into the drug supply, whether those substances are affecting people in the community and to what extent.

Buben added that this month, the company is working with the county to conduct real-world research and development for detection of Xylazine, something that the Biden administration has deemed an emerging threat.
Julia Edinger is a staff writer for Government Technology. She has a bachelor's degree in English from the University of Toledo and has since worked in publishing and media. She's currently located in Southern California.