Integrating Wastewater-Based Epidemiology into the National Drug Early Warning System Coordinating Center to Track Community Health Trends

总结 基于水的流行病学（WBE）是一种创新和具有成本效益的方法， 传统但重要的自我报告方法和生物样本检测，以构建药物使用趋势， 社区规模。WBE已成功应用于估计目标非法药物的消费量， 最近被应用于检测新的精神活性物质（ESTA）的出现， 诸如大型城市社区的环境以及在较小的集中事件期间/之后（例如，节日，体育 事件）。然而，这一办法尚未正式纳入国家毒品预警系统 （NDEWS）协调中心，一个为专家和社区提供最及时 通过传统和新的监测数据提供的关于新出现的药物使用趋势的信息，以及关于 地面流行病学调查。因此，本建议旨在提供准确的最新信息， 来自NDEWS协调的指定合作伙伴地点的废水化学品/药物监测数据 中心和废水处理行业，计算一段时间内的药物消耗，并使我们的方法与 现有的NDEWS监测数据，以帮助确定热点或新出现的趋势， 在全国范围内的社区。这将通过两个目标来实现：1）协调收集和 分析来自NDEWS Sentinel站点位置的废水样本，以确定已知药物/代谢物和代谢物 使用高端质谱方法，2）通过以下方式收集和传播可操作的WBE数据： 将作为NDEWS一部分的正在进行的药物使用监测研究的数据与WBE生成的药物进行比较 趋势，将WBE数据与公共卫生和公用事业信息集成，以开发可视化工具， 通过NDEWS协调中心和通过双向定期沟通传播信息， 我们的水行业和公共卫生合作伙伴及其当地社区。我们的概念验证提案将 提供了将WBE轻松集成到现有NDEWS框架中的好处， 立即提供给NDEWS合作伙伴，重要的是，这将告知当前和新出现的药物使用情况 可以用来改进公共卫生措施的趋势。

SUMMARY Wastewater-based epidemiology (WBE) is an innovative and cost-effective approach that complements traditional, yet important, self-reporting methods and biospecimen testing to construct drug use trends on a community scale. WBE has been successfully applied to estimate consumption of targeted illegal drugs and has more recently been applied to detect the emergence of new psychoactive substances (NPS) in varied settings such as large urban communities and during/after smaller focused events (e.g., festivals, sports events). Yet, this approach has not formally been integrated into the National Drug Early Warning System (NDEWS) Coordinating Center, a platform which provides experts and communities with the most timely information on emerging substance use trends through traditional and novel surveillance data as well as on- the-ground epidemiologic investigations. Therefore this proposal aims to provide accurate up-to-date wastewater chemical/drug surveillance data from designated partner sites of the NDEWS Coordinating Center and wastewater industry, calculate drug consumption over time, and align our approach with existing NDEWS surveillance data to help identify hot spots or new emerging trends across communities on a national scale. This will be accomplished through 2 aims: 1) Coordinate collection and analysis of wastewater samples from NDEWS Sentinel Site locations for known drugs/metabolites and NPS using high-end mass spectrometry approaches and 2) Validate and disseminate actionable WBE data by comparing data from on-going drug use surveillance studies as part of NDEWS with WBE generated drug trends, integrate WBE data with public health and utility information to develop a visualization tool and disseminate information via the NDEWS Coordinating Center and through 2 way regular communication with our water industry and public health partners and their local communities. Our proof-of-concept proposal will provide the benefits of easy integration of WBE into the existing NDEWS framework, and data sets that are immediately available to the NDEWS partners which will, importantly, inform current and emerging drug use trends that can be used to refine public health measures.