Tracking pharmaceuticals and illicit drugs in urban wastewater: drug consumption trends in Patras

Abstract Urban wastewater surveillance is a crucial tool for public health monitoring and environmental epidemiology. This study investigates the presence of pharmaceutical compounds and illicit drugs in the wastewater of Patras, Greece, aiming to identify consumption patterns and health indicators within the population. A plethora of antidepressants, antipsychotics, antibiotics, antidiabetics, and illicit drugs were detected and quantified using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Key findings show significant levels (mean values in mg per day per 1,000 residents) of various substances such as venlafaxine (155.12), valsartan (406.51), metformin (657.48), rosuvastatin (254.22), acetaminophen (1,059.44), levetiracetam (1,035.74), gabapentin (607.71), cimetidine (642.88), caffeine (604.30), and nicotine (487.94). These results highlight prevalent public health trends and challenges. Additionally, the detection of illicit drugs such as cocaine (average 169.71 mg/1000 persons·day) and methamphetamine (average 13.15 mg/1000 persons·day) underscore the ongoing illicit drug circulation in the city, warranting closer public health monitoring. This research demonstrates the value of Wastewater-Based Epidemiology (WBE) as an efficient, non-invasive method for tracking population health, lifestyle behaviors, and environmental contamination, offering critical insights for public health interventions and sustainable wastewater management strategies. Key messages • Wastewater analysis in Patras reveals high levels of pharmaceuticals and illicit drugs, reflecting population health trends and substance use patterns. • This study confirms WBE as a vital, non-invasive tool for monitoring public health, guiding interventions, and informing wastewater management policies.