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News|Articles|May 8, 2026

High-Resolution Drug Surveillance Using Liquid Chromatography–Tandem Mass Spectrometry in Wastewater Epidemiology

Author(s)John Chasse
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Key Takeaways

  • Wastewater surveillance in 2022 used 24-hour composite samples from 15 WWTPs spanning ~100,000 to >1 million population equivalents, enabling population-normalized, near-real-time consumption estimates.
  • Mortality and prevalence indicators showed escalating harm, including >4,900 drug-poisoning deaths in 2022, opioid involvement in nearly half, and ~1.1 million Class A users (16–59).
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Rapid liquid chromatography-tandem mass spectrometry (LC-MS/MS) analysis of wastewater samples across England revealed widespread and fluctuating community drug use patterns—particularly high cocaine and ketamine levels—highlighting the power of chromatography-based methods for real-time public health monitoring.

A joint study conducted by researchers at Imperial College London (United Kingdom) and the National and Kapodistrian University of Athens (Greece) monitored community-level consumption of 20 illicit drugs across urban areas of England using wastewater-based epidemiology (WBE) surveillance at high temporal resolution. Analysis was conducted using rapid liquid chromatography-tandem mass spectrometry (LC-MS/MS) methods. A paper based on their research was published in Addiction.1

What Are the Recent Trends Regarding Drug Use in England and Wales?


Over 4900 deaths related to drug poisoning were registered in England and Wales in 2022; this was the highest number since 1993.2Drug-related deaths were highest among people aged 40–49. Nearly half of these deaths involved opioids like heroin or morphine. Cocaine-related deaths have been rising for over a decade, and it remains the second most used drug after cannabis.3 Drug use overall is also increasing slightly, with about 9.5% of adults—around 3.1 million people—reporting frequent use by early 2023. Among these, about 1.1 million people aged 16–59 used Class A drugs, which are considered the most dangerous.3As a result, there are now escalating concerns of a public health crisis stemming from the adverse effects of drugs on human health and on social welfare.4,5

How Was the Study Conducted?


This study, conducted over a 12-month period in 2022, sampled 24-hour composite wastewater samples at 15 wastewater treatment plants (WWTPs) covering catchment population equivalents ranging from ~100 000 to >1 million. The sampled WWTPs collectively covered 21% of the national population. The researchers then adjusted the results based on population size and looked at samples collected throughout 2022. They also considered things like holidays, big events, and regional differences to understand patterns.1

What Were the Results?


Out of the 20 drugs, 18 showed up in at least one sample. Cocaine was used the most by a large margin. After that came heroin, ketamine, amphetamine, MDMA (ecstasy), and methamphetamine. Compared to other places in Europe, levels of cocaine and especially ketamine were higher in England. In fact, some locations in England had higher ketamine levels than anywhere else in Europe during the same period. Drug use tended to spike during holidays and major events. There was also a noticeable drop in cocaine use when a large shipment (3.7 tons) was seized, suggesting supply disruptions can affect use. Some drugs tended to appear together, indicating they’re often used at the same time or by similar groups of people.1

The researchers pointed out that these results shouldn’t be taken as representing all of England, because most of the wastewater plants studied were in urban (city) areas rather than a full mix of populations.1

“Wastewater analysis,” wrote the authors of the paper,1 “revealed widespread and temporally variable illicit drug use across England in 2022, with ketamine use exceeding European levels at multiple sites. The findings highlight wastewater-based epidemiology's capacity to monitor drug use trends and identify community-level impacts of interventions and events.”

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References

  1. Rapp-Wright, H.; Ng, K. T.; Grant, D. et al. High Temporal Resolution Monitoring of Illicit Drug Consumption across England via Wastewater Analysis. Addiction 2026. DOI: 10.1111/add.70398
  2. Office for National Statistics. Deaths Related to Drug Poisoning in England and Wales: 2022 registrations. Office for National Statistics website 2023 (accessed 2024-10-23) https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsrelatedtodrugpoisoninginenglandandwales/2022registrations
  3. Office for National Statistics. Drug Misuse in England and Wales: Year Ending March 2023 Office for National Statistics website 2023 (accessed 2024-03-27). https://www.ons.gov.uk/peoplepopulationandcommunity/crimeandjustice/articles/drugmisuseinenglandandwales/yearendingmarch2023
  4. Hahn, R. Z.; Augusto do Nascimento, C.; Linden, R. Evaluation of Illicit Drug Consumption by Wastewater Analysis Using Polar Organic Chemical Integrative Sampler as a Monitoring Tool. Front Chem. 2021, 9, 596875. DOI: 10.3389/fchem.2021.596875
  5. Rae, M.; Howkins, J.; Holland, A. Escalating Drug Related Deaths in the UK. BMJ. 2022,16, o2005. DOI: 10.1136/bmj.o2005

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