SinS - Abstract

Abstract Information :

Opioid misuse in England and Wales accounted for over 2,219 deaths in 2021: approximately 46 % of drug-related registered deaths for that year. After consumption heroin is metabolised by deacetylation to produce 6-monoactylmorphine (6-MAM), morphine and morphine-3-glucuronide. In this study, 6-MAM was used as a target for analysis due to its existence in wastewater being implicitly linked with only heroin use unlike morphine and its higher stability than morphine-3-glucuronide. Wastewater can be analysed to measure drug consumption from a specific population at near real-time. By measuring concentrations of metabolites, like 6-MAM, estimations of consumption can be back-calculated. This study shows the first monitoring programme of heroin (6-MAM) where 24-hour composite samples of wastewater were collected monthly for a year from more than 10 sites across England. Wastewater samples were prepared via solid-phase extraction, drying and filtering in less than 5 hours before being analysed by LC-MS/MS in 3 minutes. Heroin consumption ranged from not detected up to 2,118 mg 1000 people-1 day-1 across all samples and sites with an average of419 ± 454 mg 1000 people-1 day-1. These results are much higher than those measured by the Australian National Wastewater Drug Monitoring Program, which is expected when comparing to drug-related registered deaths in both Australia and England. Spaciotemporal analysis of the heroin consumption data will be further explored as well as comparisons with consumption data of other opioids such as prescription opioids like tramadol. One trend of note is that heroin consumption has been found to have no statistical difference across days of the week. This trend meets expectations in that the addictive nature of heroin means that it is not a drug which is taken recreationally. Thus, the consumption of heroin and the concentration of 6-MAM would remain consistent across the week, rather than spiking at weekends. These results and the method used to produce them are being used in developing a quantifiable, high-throughput method to monitor other opioids such as fentanyl. Fentanyl is a synthetic opioid which is 50 to 100 times more potent than morphine. Due to its potency, the amount of fentanyl needed to be taken by users is much lower than heroin or morphine and so the concentration of its metabolites is also lower. However, by both heroin and fentanyl being opioids, the sites with high heroin (and thus, opioid) usage identified in this study will be used for samples and the analytical method can be adjusted for fentanyl monitoring.