WITH COVID-19 restrictions around the country having eased late in 2021, dance parties and music festivals resumed. While many people were locked down, the production of new psychoactive substances (NPS) continued unabated. The apparent reduction of MDMA (ecstasy) consumption in Australia combined with increased dance party activity could lead to an increase in the use of NPS.
NPS are drugs which mimic the effects of more “traditional” illicit drugs such as MDMA, amphetamine, LSD and cannabis. They are often more potent than these traditional drugs (here, here and here) and very little is known about safe (if any) doses, side effects and toxicity. It is therefore important for public health purposes to monitor the use of NPS so that appropriate health and policing interventions can be introduced in a timely way.
Current methods used to monitor NPS use – population surveys, border seizure data, emergency department and forensic toxicology information – are expensive to collect and typically only reported annually, a substantial time after their collection. A promising novel approach to NPS is wastewater analysis – the analysis of human-specific biomarkers in wastewater samples to provide population-scale information on human activity in a catchment. Wastewater-based epidemiology (WBE) has been used during the COVID-19 pandemic to identify COVID-19 exposure sites (here and here). It has also been used for many years to measure the population use of alcohol and drugs, pharmaceutical use, exposures to pesticides and other industrial chemicals and more recently, biomarkers of stress, food and diet. It has also been used to measure the impact of COVID-19 on traditional illicit drug use in Australia.
The analysis of wastewater is a complementary tool to surveys. It can provide anonymous, near-real time information on the type of NPS that are being used within a community. Wastewater analysis has already been accepted as a reliable means to monitor drug use in Australia through the National Wastewater Drug Monitoring Program, funded by the Australian Criminal Intelligence Commission. Similar programs are now in place in New Zealand, Spain, China and Canada. We have developed methods that allow the trace detection of NPS in influent wastewater in ways that can measure spatial and temporal trends across Australia and enable comparisons to be made to the international use of these compounds (here and here).
In mid-2020, studies of the online social media platform Reddit found increased interest in the NPS eutylone and flualprazolam. Eutylone is similar in its effects to MDMA and flualprazolam is a benzodiazepine with effects like alprazolam. There has been an increase in toxicological findings of these drugs in the US. In Australia, there are reports of heroin and cocaine being adulterated with NPS, making their consumption more dangerous to unknowing users.
Music festivals have been the primary site of concern for NPS. In the 2018–19 summer period, there were five drug-related deaths of young Australian festival-goers. The dangerous synthetic cathinone N-ethylpentylone was found in pill testing at the Groovin the Moo Festival in Canberra in 2019.
In New Zealand, there was great concern around the circulation of eutylone at music festivals over the 2020–21 summer. According to drug checking group, KnowYourStuff, more than half of the samples tested at New Year’s festivals were dangerous stimulants from the cathinones family. The most common was eutylone. Although it has effects similar to MDMA, they take longer to kick in. A user can potentially take more of the drug before they are aware of the effects and as a result experience serious side effects, such as agitation, anxiety, racing heart and, at high doses, hallucinations and psychosis.
As the summer festival season continues, and with it, reduced COVID-19 border restrictions, allowing easier movement, it is important to keep a look out for these dangerous compounds. Wastewater analysis is a valuable approach – a form of pill testing for the population – that could provide timely warnings to health services about drugs whose users may require treatment in emergency departments. Like pill testing, it can warn users of drugs in festival and club settings about the potentially dangerous contents in the drugs that they may be using.
Richard Bade is with the Queensland Alliance for Environmental Health Sciences (QAEHS) at the University of Queensland.
Wayne Hall is with QAEHS and the National Centre for Youth Substance Use Research at the University of Queensland.
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.