Estimating population-level of alcohol, tobacco and morphine use in a small Russian region using wastewater-based epidemiology

Introduction Alcohol, tobacco and illicit drug use combined are the largest modifiable health risk factors. Wastewater-based epidemiology (WBE) is a complementary approach for monitoring substance use in the population. In this study we applied WBE technique to a community in the Moscow region to estimate population-level consumption of alcohol, tobacco and morphine. Methods Wastewater sampling was carried out over 47 days, in 2018 and 2019, including the New Year period. Analysis of the samples for consumption biomarkers (ethyl sulphate, cotinine and morphine) were undertaken using liquid chromatography tandem mass spectrometry (LC-MS/MS). Daily consumption estimates were then compared with sales/production/prescription data and between different days of the week using Mann-Whitney U test. Results Alcohol consumption was significantly higher on Sundays and during the New Year and Russian Christmas period compared to weekdays and Saturdays. Tobacco consumption estimates were largely consistent throughout the week. Morphine was detected by WBE during the monitoring period but was inconsistent with prescription record data. Discussion and Conclusions This study provides evidence for the feasibility of conducting WBE in Russia. Estimates of alcohol consumption derived from WBE were higher than average alcohol sales data for the country. The estimated consumption of nicotine is generally consistent with the production data, with estimates higher than in most other countries. Our results also suggest potential illegal use of opioids (morphine-based) in the population. Given the considerable health and economic costs of substance use in Russia, more extensive WBE testing is recommended to inform and evaluate public health policies.