National Wastewater Reconnaissance of Analgesic Consumption in Australia

A wastewater-based epidemiology (WBE)
method is presented to estimate
analgesic consumption and assess the burden of treated pain in Australian
communities. Wastewater influent samples from 60 communities, representing
∼52% of Australia’s population, were analyzed to quantify
the concentration of analgesics used to treat pain and converted to
estimates of the amount of drug consumed per day per 1000 inhabitants
using pharmacokinetics and WBE data. Consumption was standardized
to the defined daily dose per day per 1000 people. The population
burden of pain treatment was classified as mild to moderate pain (for
non-opioid analgesics) and strong to severe pain (for opioid analgesics).
The mean per capita weighted total DDD of non-opioid analgesics was
0.029 DDD/day/person, and that of opioid-based analgesics was 0.037
DDD/day/person across Australia. A greater burden of pain (mild to
moderate or strong to severe pain index) was observed at regional
and remote sites. The correlation analysis of pain indices with different
socioeconomic descriptors revealed that pain affects populations from
high to low socioeconomic groups. Australians spent an estimated US
$3.5 (AU $5) per day on analgesics. Our findings suggest that WBE
could be an effective surveillance tool for estimating the consumption
of analgesics at a population scale and assessing the total treated
pain burden in communities.