San Francisco Chronicle - (Sunday)
S.F. starts wastewater testing to combat overdose crisis
San Francisco has begun testing wastewater for traces of fentanyl, xylazine and other illicit drugs in an attempt to better track and address the local drug overdose crisis that has led to a record 752 deaths this year.
The new wastewater surveillance program, announced by public health officials Thursday, will also track the presence of cocaine, methamphetamine and amphetamine, as well as naloxone, the overdose-reversing drug often referred to by the brand name Narcan. It marks an evolution of wastewater surveillance, a once little-known tactic that expanded greatly during the COVID-19 pandemic to help health officials track viral surges in real time.
San Francisco is one of 70 U.S. communities participating in the wastewater program, which is run by the National Institute on Drug Abuse to gauge the presence of substances associated with overdoses and other adverse health outcomes through wastewater testing. It comes at no cost to the city, local officials said.
Wastewater surveillance for drugs is a relatively new practice adopted by public health officials to tackle the opioid overdose epidemic. In the Bay Area, Marin County and Sewer Authority Mid-Coastside, the sewage district that includes the city of Half Moon Bay, were the first to deploy the strategy earlier this year and late last year, respectively. Nationally,
Tempe, Ariz., and Cary, N.C., are believed to have been the first U.S. jurisdictions to test wastewater for opioids, in 2018.
“San Francisco is seeing record numbers of fentanyl-driven overdose deaths,” Dr. Hillary Kunins, the public health department’s director of behavioral health services, said in a statement. “We need all the tools available to identify the presence of substances that may be used to halt and reverse this deadly epidemic. Data from wastewater testing will help provide information about the presence of risky substances in San Francisco and prompt more strategic interventions aimed at saving lives.”
The concept is similar to COVID wastewater surveillance, which seeks to better track COVID patterns and trends by providing more up-to-date data than official case counts. These case counts are often incomplete and lag real time because they include only tests reported by health care providers and leave out results from at-home tests.
Wastewater surveillance for drugs may be able to fill in some gaps in drug-use tracking data, which can be incomplete and fragmented because overdoses are often measured only when someone dies. Other ways of tracking drug use, such as when paramedics are called to treat a suspected overdose, or when people seek treatment for substance use, can be inconsistently reported or incomplete.
Similar to COVID wastewater surveillance, wastewater analysis for drugs cannot be traced to individuals or households. The information will not be used by law enforcement, only for academic research and public health purposes.
Unlike COVID wastewater surveillance, which detects the presence of the virus’ genetic material, testing for the presence of drugs involves analyzing wastewater for metabolites — the metabolized version of chemical compounds in the drugs.
San Francisco began sending wastewater samples from two treatment plants earlier this month to Biobot, a Massachusetts lab services company that is doing similar work for dozens of jurisdictions around the country. The city expects to receive the first results by January, and every two weeks after that until August, when the program is slated to end.