Harmonizing Wastewater Generated Drug Consumption Trends with Epidemiological Indicators in NDEWS

摘要 在过去的二十年里，近100万人死于药物过量， 死亡率激增与阿片类药物，即芬太尼。监控项目对于了解 社区毒品趋势，但传统方法（如调查）并不是为了了解这类趋势， 正在浮现基于水的流行病学（WBE）是一种创新的方法， 药物使用模式的变化和转变，这些数据对于制定有效的公共政策至关重要。 健康应对措施。社区一级的毒品趋势已成功地从废水中产生， 当前关注的物质（例如，芬太尼）;然而，WBE作为一个整体框架的实施， 为利益相关者提供可靠，一致和可信的数据是迫切需要的。内部存在的几个明显差距 该框架包括需要先进的废水采样策略，快速准确的识别 紧急和/或新型药物，以及废水传统监测数据的整合。因此整体 本建议的目的是提高WBE作为预警系统的效用，以有效地推动公众 在受影响社区采取卫生措施。这将通过两个全面的具体目标来实现 包括：（1）通过考虑时间、粒度、频率和 新的精神活性物质出现时的检测，（2）WBE和现有流行病学的协调 通过定制的可视化工具进行数据分析、解释和及时传播。本研究 将是最近完成的芬太尼废水监测试点研究的延伸， 州城市。GatorWATCHTM由多元化的研究人员和社区合作伙伴组成， 所需的多学科专业知识已经取得了成功。此外，与 国家毒品预警系统（NDEWS）协调中心将为我们提供一个广阔的网络， 扩大和传播我们的成果。总体而言，通过推进毒品计量方法， 结合复杂的数据协调，将为WBE的扩展和使用提供蓝图， 作为打击当代和新出现的吸毒流行病的公共卫生干预措施的组成部分， 我们的社区遍布全国。

ABSTRACT Nearly 1 million individuals have died from drug overdoses over the past two decades with the most recent mortality surges associated with opioids, namely fentanyl. Surveillance programs are critical to understanding community drug trends, yet traditional methods (e.g. surveys) are not designed to inform on such trends as they are emerging. Wastewater-based epidemiology (WBE) is an innovative approach that can identify community drug use patterns as they change and shift in near real-time, data that is critical to developing effective public health responses. Community-level drug trends have been successfully generated from wastewater for substances of current concern (e.g., fentanyl); however, implementation of WBE as a holistic framework that contributes reliable, consistent, and trusted data to stakeholders is urgently needed. Several notable gaps within this framework include the need for advanced wastewater sampling strategies, rapid and accurate identification of emergent and/or novel drugs, and integration of wastewater traditional surveillance data. Therefore, the overall objective of this proposal is to enhance the utility of WBE as an early warning system to effectively drive public health measures in impacted communities. This will be accomplished through two comprehensive specific aims that include: (1) the generation of optimal sampling regimes by considering time, granularity, frequency and the detection of new psychoactive substances as they emerge, (2) harmonization of WBE and existing epidemiologic data for analysis, interpretation, and timely dissemination through customized visualization tools. This research will be an extension of a recently completed pilot study of wastewater surveillance of fentanyl in four United States cities. Comprised of a diverse team of researchers and community partners, GatorWATCHTM has secured the required multidisciplinary expertise that has already shown success. Furthermore, integration with the National Drug Early Warning System (NDEWS) Coordinating Center will afford us an expansive network for WBE expansion and dissemination of our results. Collectively, through advancing drug measurement methodology in tandem with sophisticated data harmonization will provide a blueprint for expansion and use of WBE as an integral part of public health interventions in the fight against contemporary and emerging drug use epidemics in our communities nationwide.