RESUMO
BACKGROUND: Substance use disorder and associated deaths have increased in the United States, but methods for detecting and monitoring substance use using rapid and unbiased techniques are lacking. Wastewater-based surveillance is a cost-effective method for monitoring community drug use. However, the examination of the results often focuses on descriptive analysis. OBJECTIVE: The objective of this study was to explore community substance use in the United States by analyzing wastewater samples. Geographic differences and commonalities of substance use were explored. METHODS: Wastewater was sampled across the United States (n=12). Selected drugs with misuse potential, prescriptions, and over-the-counter drugs and their metabolites were tested across geographic locations for 7 days. Methods used included wastewater assessment of substances and metabolites paired with machine learning, specifically discriminant analysis and cluster analysis, to explore similarities and differences in wastewater measures. RESULTS: Geographic variations in the wastewater drug or metabolite levels were found. Results revealed a higher use of methamphetamine (z=-2.27, P=.02) and opioids-to-methadone ratios (oxycodone-to-methadone: z=-1.95, P=.05; hydrocodone-to-methadone: z=-1.95, P=.05) in states west of the Mississippi River compared to the east. Discriminant analysis suggested temazepam and methadone were significant predictors of geographical locations. Precision, sensitivity, specificity, and F1-scores were 0.88, 1, 0.80, and 0.93, respectively. Finally, cluster analysis revealed similarities in substance use among communities. CONCLUSIONS: These findings suggest that wastewater-based surveillance has the potential to become an effective form of surveillance for substance use. Further, advanced analytical techniques may help uncover geographical patterns and detect communities with similar needs for resources to address substance use disorders. Using automated analytics, these advanced surveillance techniques may help communities develop timely, tailored treatment and prevention efforts.
RESUMO
BACKGROUND: Emergency departments represent a unique opportunity to intervene in mental health and substance use crises. For people residing in frontier and remote locations (greater than 60 min from cities of 50,000 people), emergency departments may be a critical source of mental healthcare, given limited local access to mental health professionals. The purpose of the current study was to investigate emergency department usage for substance use disorders and suicidal ideation in patients residing in frontier and non-frontier locations. METHODS: South Dakotan syndromic surveillance data from 2017-2018 were obtained for this cross-sectional study. ICD-10 codes were queried to identify substance use disorder and suicidal ideation during emergency department visits. Differences in substance use visits were investigated in frontier and non-frontier patients. Additionally, logistic regression was used to predict suicidal ideation in cases and age- and sex-matched controls. RESULTS: Frontier patients had a higher percentage of emergency department visits with a diagnosed nicotine use disorder. Conversely, non-frontier patients were more likely to use cocaine. Substance use for other categories of substances was similar between the frontier and non-frontier patients. Alcohol, cannabis, nicotine, opioid, stimulant, and psychoactive substance diagnoses all increased the patient's odds of receiving a suicidal ideation diagnosis. Further, residing in a frontier location also increased the odds of suicidal ideation. CONCLUSION: Patients residing in frontier locations differed in some forms of substance use disorders and in suicidal ideation. Increasing access to mental health and substance use treatment may be critical for those residing in these remote locations.
