Occurrence, Mass Loading, and Wastewater-Based Epidemiology of 70 Drugs and Their Metabolites in Rural Central New York State, USA

We determined 70 drugs and metabolites in raw wastewater collected daily over 1 week in 2023 and 2024 from six rural wastewater treatment plants in central New York State, USA. Seventeen opioids, eight benzodiazepines, six cannabinoids, five stimulants, one novel stimulant/hallucinogen, xylazine, and gabapentin were frequently detected. The geometric mean concentrations of ∑All (sum concentration of all analytes) ranged from 12600 to 45900 ng/L, with an estimated mass loading of 4280–33100 mg/d/1000 inhabitants. Gabapentin concentration predominated among all drugs, accounting for 58–93% of ∑All, followed by cannabinoids (≤19%) and stimulants (≤17%). The highest community-level drug consumption rate was estimated for cannabis (GM: 271–3930 doses/d/1000 inhabitants), fentanyl (GM: 23–1550), and lorazepam (GM: 157–920). The consumption rate of fentanyl estimated using wastewater-based epidemiology was 100–1000 fold higher than that from pharmacy surveys (∼0.04 doses/d/1000 inhabitants), indicating that fentanyl mainly originated from illegal supplies. Positive correlations were found across different drug classes in wastewater. Several novel psychoactive drugs (e.g., fluorofentanyl) were detected in wastewater, and the mass loading of xylazine in 2024 was higher than that in 2023.