Can Sewage Provide Clues On How To Combat Opioid Crisis?

By Beth Leipholtz 06/05/18

Sewage studies could prove to be more beneficial than hospital data and surveys when it comes to getting a closer look at residents' drug intake.

workers cleaning out a sewage pipe

As cities continue searching for ways to combat the opioid crisis, some are turning to sewage for answers. 

In fact, about six cities have asked Arizona State University to study their sewage for “chemical signatures that may help save lives,” according to Scientific American

Rolf Halden, who is the director of ASU’s Biodesign Center for Environmental Health Engineering, says sewage is “the information superhighway under your feet.” Since 2003, Halden’s Human Health Observatory has been studying sewage in more than 300 municipalities across the world. 

In the past, Scientific American notes, the team has searched for anything that can tell them about a community’s health, such as stress hormones, dietary choices, nicotine presence and hazardous chemicals. 

But now, cities have begun asking for help when it comes to the opioid crisis by searching for evidence of opioid use. Currently, Halden and his team provide about six municipalities with monthly data about residents' intake of substances such as heroin, fentanyl, oxycodone and other opioids. 

This could prove more beneficial than hospital data and surveys, as used in the past, since people can’t lie about use through sewage, and it doesn’t take as long to collect. 

“History has taught us that when you ask people about drug use, you often don’t get a truthful answer,” Halden told Scientific American. But, he says, “sewage doesn’t lie.” 

When it comes to testing the sewage, researchers put it through what is called liquid chromatography, Scientific American states. In other words, the compounds in the sewage got separated and sorted.

Researchers then put a solution through a device that can recognize and measure which drugs are present and how much. Researchers take these numbers and establish an estimate of the number of doses per 1,000 people. 

Because it only takes researchers one or two days to test sewage, the results reflect nearly current patterns of drug use. 

“If a city shuts down a pill mill—a clandestine operation where medical workers inappropriately prescribe powerful narcotics—or arrests a ring of dealers, it can measure the immediate impact,” Scientific American reports. “If opioids start to disappear from the wastewater, it could be an early indication of success. But if the sewage is suddenly flush with fentanyl, it may indicate that legal users deprived of their prescriptions are seeking street drugs instead.”

This can be beneficial for various reasons. For example, if a large increase in drugs like fentanyl is observed, it allows first responders to be prepared to give the opioid antidote naloxone, and to make sure they have enough on hand.  

Another benefit to testing sewage is that it allows officials to determine the impact of drug education programs. 

According to Scientific American, sewage testing costs about $10,000 per year for cities, but that number can change depending how often testing is done and what is measured for. 

“Right now people are surprisingly skeptical of what one can measure in wastewater,” Halden told Scientific American. But, he added, “I think this will become a common way of thinking in the future.”

Please read our comment policy. - The Fix

Beth is a Minnesota girl who got sober at age 20. By day she is a website designer, and in her spare time she enjoys writing about recovery at, doing graphic design and spending time with her boyfriend and three dogs. Find Beth on LinkedInInstagram and Twitter.