Wastewater will reveal consumption of drugs of abuse among Danes

Through wastewater analysis from six major cities, the Department of Forensic Medicine at Aarhus University will monitor Danes' consumption of common drugs of abuse, such as cocaine and opioids.

Wastewater is increasingly used as a source of information to improve public health.

Now, the Department of Forensic Medicine at Aarhus University and the Danish Health Authority have launched a wastewater measurement project across six cities—Copenhagen, N?stved, Odense, Esbjerg, Aarhus, and Aalborg—to monitor the consumption of common drugs of abuse.

Wastewater treatment plants collect the samples, and the Department of Forensic Medicine at Aarhus University analyze the presence of substances such as cocaine, amphetamines, methamphetamines, heroin, THC, MDMA, and ketamine. Samples are also tested for multiple opioids used both medically and recreationally, including morphine, methadone, codeine, tramadol, oxycodone, and fentanyl.

The measurements are highly valuable, as wastewater from these six cities covers approximately 1.2 million people, explains Christian Lindholst, Head of the Department of Forensic Medicine at Aarhus University.

“These results will be a strong supplement to other studies on substance use in Denmark. One advantage is that the data is independent of accurate responses to survey questions,” he says.

“It’s a relatively cost effective way to gather large amounts of data, which can help estimate the level of substance use in Denmark and monitor its development over time. Because this project could include wastewater from a large portion of Denmark's population, we can generate very precise data,” explains Lindholst.

Wastewater sampling in these six cities began in 2024. Samples are collected daily over one week, and measurements are repeated every six months.

Experience from COVID-19

Wastewater analysis for drugs of abuse has previously been used in Denmark on a limited basis but never in connection with a monitoring program of this scope.

“Wastewater monitoring is a new technology that is developing rapidly. It’s an exciting tool for tracking the consumption of commonly used substances across the country,” says Lindholst.

The measurements are conducted in collaboration with Statens Serum Institut (SSI), which has gathered wastewater samples from various treatment plants in Denmark as part of COVID-19 monitoring. When the COVID-19 pandemic struck, wastewater analysis was first employed to systematically monitor the disease in Denmark. This method proved effective, as wastewater analyses and PCR tests provided similar pictures of infection levels in the population, according to an SSI analysis. SSI has since established a logistical framework for sampling, shipment, data reporting, and coordinating with treatment facilities, which this new project can use.

“Once implemented in the lab, these analyses are relatively easy to perform,” Lindholst explains. “However, data interpretation can be challenging and requires experience and an understanding of the limitations of wastewater analysis.”

“For this reason, it’s essential for us to participate in a major European collaboration, EUDA, where we can seek guidance and support from highly experienced experts in this field,” he adds.

Going forward, wastewater data will be included in the annual report, Drugs on Street level in Danmark, published through a collaboration between the Danish Health Authority, the National Police, local police districts, and forensic institutes.

A tool with great potential

The new Danish monitoring program focused on drugs of abuse is registered with EU-WISH (Wastewater Integrated Surveillance for Public Health), which further develops disease surveillance through wastewater.

In collaboration with the Greek public health institute, Statens Serum Institut leads EU-WISH, involving participation from numerous European countries. The goal is to enable authorities to respond swiftly when new epidemics arise.

EU-WISH will run for three years, aiming to help participating countries improve and expand wastewater surveillance for public health benefit.

Source: Statens Serum Institut and EU-WISH

EUDA monitors wastewater across the EU

In 2024, the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) was renamed to the European Union Drugs Agency (EUDA). The agency continues to collect, analyse, and disseminate data from EU member states. EUDA now also has the mandate to:

• Issue warnings through a new European drug alert system when high-risk substances appear on the market, supplementing national warning systems and the EU’s early warning system for new psychoactive substances.
• Monitor and address the use of new substances that are becoming more common and may pose health risks.
• Establish a network of forensic laboratories to promote information sharing on new trends and train national forensic drug experts.
• Play a stronger international role to support the EU’s drug policy.
• Support and strengthen national stakeholders to ensure that member states can provide relevant drug-related data to EUDA.
• Learn more about EUDA’s wastewater monitoring here

Contact

Christian Lindholst, Head of Department

Aarhus University, Department of Forensic Medicine

Phone: +45 20 93 92 23

Email: [email protected]