Monitoring drug consumption in Innsbruck during coronavirus disease 2019 (COVID-19) lockdown by wastewater analysis

Abstract

The coronavirus disease 2019 (COVID-19) has developed into a serious pandemic with millions of cases diagnosed worldwide. To fight COVID-19 pandemic, over 100 countries instituted either a full or partial lockdown, affecting billions of people. In Tyrol, first lockdown measures were taken on 10 March 2020. On 16 March 2020, a curfew went into force which ended on 1 May 2020. On 19 March 2020, Tyrol as a whole was placed in quarantine which ended on 7 April 2020. The governmental actions helped reducing the spread of COVID-19 at the cost of significant effects on social life and behaviour. Accordingly, to provide a comprehensive picture of the population health status not only input from medical and biological sciences is required, but also from other sciences able to provide lifestyle information such as drug use. Herein, wastewater-based epidemiology was used for studying temporal trends of licit and illicit drug consumption during lockdown and quarantine in the area of the Tyrolean capital Innsbruck (174,000 inhabitants). On 35 days between 12 March 2020 and 15 April 2020, loads of 23 markers were monitored in wastewater. Loads determined on 292 days between March 2016 and January 2020 served as reference. During lockdown, changes in the consumption patterns of recreational drugs (i.e. cocaine, amphetamine, 3,4-methylenedioxymethamphetamine, methamphetamine, and alcohol) and pharmaceuticals for short-term application (i.e. acetaminophen, codeine, and trimethoprim) were detected. For illicit drugs and alcohol, it is very likely that observed changes were linked to the shutdown of the hospitality industry and event cancelation which led to a reduced demand of these compounds particularly on weekends. For the pharmaceuticals, further work will be necessary to clarify if the observed declines are indicators of improved population health or of some kind of restraining effect that reduced the number of consultations of medical doctors and pharmacies.

Keywords: Alcohol; COVID-19; Illicit drug; Pharmaceuticals; Tobacco; Wastewater-based epidemiology.

Graphical abstract

Fig. 1

Overview on the five validated analytical workflows used for quantification of 23 targeted compounds in raw 24-h composite wastewater samples.

Fig. 2

Population normalized loads observed for the 23 targeted compounds between March 2016 and January 2020.

Fig. 3

Timeline of the COVID-19 lockdown in Tyrol, including information on (a) the wastewater sampling period (2020-03-12 to 2020-04-15), (b) important government interventions, and (c) the number of acute cases.

Fig. 4

Temporal trends in population normalized loads of (a) benzoylecgonine, (b) amphetamine, (c) MDMA, and (d) methamphetamine between March 2016 and April 2020. Coloured lines are representing the lockdown period. (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)

Fig. 5

Weekly patterns in population normalized loads of (a) benzoylecgonine, (b) amphetamine, (c) MDMA, (d) ethyl sulfate, (e) cotinine, and (f) lidocaine during lockdown and the reference period (March 2019 to January 2020).

Fig. 6

Temporal trends in population normalized loads of (a) caffeine, (b) oxazepam, (c) morphine, (d) codeine (e) acetaminophen, and (f) trimethoprim during lockdown. The population normalized loads determined between March 2016 and January 2020 were used as reference.