Wastewater monitoring pilot expands new technology looking to make the drug supply safer

By Kimberly Taylor, October 1 2023—

Most of us simply flush the toilet, wash our hands and walk away. Some researchers, however, are keenly interested in the ways our wastewater provides a window into the health of a population. One of those researchers is Dr. Michael Parkins, MD with the Cumming School of Medicine. In an interview with the Gauntlet, he explained what wastewater monitoring is and its ongoing development in Calgary during the COVID-19 pandemic and beyond.

“Wastewater monitoring is a platform technology where we try and understand different aspects of a population’s health by measuring analytes in the wastewater,” Parkins said. “The sky’s the limit in terms of understanding populations and population behaviour through wastewater monitoring. This is big-picture technology used to understand large groups of people.” 

Parkins wanted to highlight that wastewater monitoring is a public health tool that individuals can use to manage their own health, but it is not used on an individual basis to gather information on an individual person.

“No one is trying to invade any individual person’s privacy. We’re trying to mobilize information across large swaths of people and correlate it with health information,” Parkins continued. 

Prior to the COVID pandemic, there were no wastewater monitoring platforms in Calgary or even Canada. During the pandemic, wastewater monitoring was developed locally to provide more epidemiological information about the spread of COVID and the variants present. 

Samples are taken from the wastewater and tested in a lab for specific “signature” such as a specific sequence of RNA in the case of COVID. Parkins explained the advantages of using wastewater to monitor respiratory outbreaks lie in its ability to capture everyone, not just the sickest people seeking healthcare.

“The big advantage of wastewater monitoring versus conventional surveillance, wastewater monitoring captures an entire population comprehensively and inclusively — nobody is marginalized, nobody is excluded. It allows for a comprehensive understanding versus our clinical diagnoses which are typically just the tip of the iceberg.”

Wastewater monitoring for COVID continues to occur, and the data is available from both the government of Alberta and the government of Canada on dedicated websites. This real-time information allows individuals to know the amount of COVID-19 circulating in their area, and to adjust their behaviour accordingly.

Parkins said that wastewater monitoring was consistently correlated with COVID diagnoses in the community and that spikes in monitoring usually preceded spikes in confirmed cases by about a week.

“[Wastewater monitoring] provided a leading signal, it was a leading signal to cases by about a week’s time. This technology has the potential to forecast and allow health systems to prepare for a large number of cases,” explained Parkins.

Over the past nine months researchers from Medicine, Science, and Engineering have been working with community partners such as AHS and Advancing Canadian Water Assets (ACWA) have created a pilot project looking at substances of abuse in four municipalities in Alberta. Parkins explained the dynamic nature of the drug supply and the need for information about the actual substances present to prevent drug poisonings and overdoses. They have been able to track 48 substances of potential abuse and see some patterns.

“The substances of potential abuse are a particularly problematic situation that unfortunately is one that’s challenged by lots of stigma in the community, and we have had to approach wastewater surveillance very cautiously,” said Parkins. “There is a very dynamic supply of drugs that come into our cities and what people think they are taking isn’t necessarily what they are taking and it changes from day to day and that results in drug poisonings. Some of those poisonings are caused by opiates and some are related to additives or adulterants.”

The stigma around drug use and the dynamic nature of the supply makes it difficult for health workers and people who use substances to have information about the safety of the drugs being taken.

“One of the big challenges is that our understanding of the drug supply is very limited. A tiny fraction of the drug supply that users may volunteer because they’re concerned it’s not safe,” said Parkins. “The government can collect those samples and run an analysis but that’s expensive and very slow. The advantage of wastewater surveillance is that we can monitor an entire population’s use of substances and try to understand how that correlates over time.”

Due to the stigmatization of drug use, information on the local drug supply can be difficult to obtain, and difficult to share with those who are using drugs, leading to a situation where individuals may not know what is actually in the drugs they are using. This lack of knowledge puts lives at risk and Parkins hopes the project can eventually create an app for people to check on the presence of dangerous substances in the drug supply daily and change their behaviour accordingly.

“The potential of this, if we can scale it up and do it more often at more sites, is to be able to provide information to health care workers, those that work with people who substance, and potentially even substance users themselves, about changes we’ve observed in the drug supply to provide lead time warning about what might be occurring. So if Carfentanyl is in the drug supply that is going to change behaviour and sharing that information may help to reduce drug poisonings.”

This pilot program involves not only researchers from different disciplines and locations but also community partners in different municipalities, addiction specialists like Dr. Monty Ghosh and people with lived experience with substance use. Due to the stigma surrounding drug use, many of these partners wish to remain anonymous to preserve the confidence and privacy of those they are caring and advocating for. 

Funding for the project came from the U of C Mathison Center and The Calgary Health Foundation. As a pilot project, this effort is at the leading edge of wastewater monitoring technology and application and there is a need to secure further funding to expand the project.

“The next steps are to work through the stigma of this information that we’ve collected and try to mobilize it to the right folks and then to use it to inform discussions. Ultimately, wouldn’t it be grand if we were able to roll out an app that people could access this data in real-time and adjust their behaviour based on what they observe, just like we would with a weather app.”

Parkins believes that the University of Calgary is an innovator in this space with a new application of a relatively new technology.

“Calgary is in a very unique position relative to other parts of Canada,” said Parkins. “We’re way out in front in terms of this technology and lots of groups are reaching out to us to see if we’ll be able to do this on a contracted basis. Our goal of course is to try and make this information available for Albertans just like we did with the COVID -19 pandemic. Real-time, actionable, health information sharing.”

To learn more about this innovative pilot program, visit their feature on CBC news.