Occurrence of Z-drugs, benzodiazepines, and ketamine in wastewater in the United States and Mexico during the Covid-19 pandemic
File(s)
Accepted version
Author(s)
Type
Journal Article
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. Both groups of 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.
Date Issued
2023-01-20
Date Acceptance
2022-10-07
Citation
Science of the Total Environment, 2023, 857 (Part 2), pp.1-9
ISSN
0048-9697
Publisher
Elsevier
Start Page
1
End Page
9
Journal / Book Title
Science of the Total Environment
Volume
857
Issue
Part 2
Copyright Statement
© 2022 Elsevier B.V. All rights reserved. This manuscript is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International Licence http://creativecommons.org/licenses/by-nc-nd/4.0/
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/36243065
PII: S0048-9697(22)06450-6
Subjects
Humans
United States
Benzodiazepines
Alprazolam
Waste Water
Ketamine
Pandemics
Nordazepam
Zolpidem
Clonazepam
Lorazepam
Tandem Mass Spectrometry
COVID-19
Temazepam
Mexico
Diazepam
Humans
Ketamine
Benzodiazepines
Alprazolam
Clonazepam
Diazepam
Nordazepam
Lorazepam
Temazepam
Mexico
United States
Tandem Mass Spectrometry
Pandemics
Waste Water
Zolpidem
COVID-19
Environmental Sciences
Publication Status
Published
Coverage Spatial
Netherlands
Article Number
ARTN 159351
Date Publish Online
2022-10-12