Monitoring Calgary wastewater could help drug users avoid harm. Here's how.

A Calgary research facility that developed the most comprehensive wastewater monitoring program in the country during the COVID-19 pandemic is setting its sights on another burgeoning public health issue: illicit drug use. 

Advancing Canada Water Assets (ACWA), a joint initiative between the City of Calgary and the University of Calgary, is applying the same techniques it used to monitor COVID-19 case numbers to track illicit drugs in the province's wastewater.

Dr. Mike Parkins, an infectious disease physician and a professor at the University of Calgary Cummings School of Medicine, is a founding member of the wastewater surveillance team. He hopes the findings of the pilot project will ultimately help reduce harm to drug users by identifying dangerous toxins as soon as they appear.

"As this platform grows we have the potential to provide warning information to health-care workers, policymakers and ultimately substance users about the changing nature of the drug supply," said Parkins.

Parkins said that wastewater is the great equalizer, making it an ideal data source for public health issues that affect vast segments of the population and are potentially difficult to measure.

"One of the challenges we have in understanding population health is the metrics that we use are all very biased, we're only sampling the tip of the iceberg," said Parkins. 

"Wastewater which [is collected] from everybody is intrinsically inclusive, comprehensive, and unbiased and provides objective data on the populations that are being monitored."

Kayla Moffett, an analytical chemist at ACWA, said she and her team are currently testing wastewater samples for opiates, fentanyl, psychedelics and cocaine, as well as dangerous cutting agents — substances used to increase the bulk of drugs — such as levamisole and xylazine.

"We have multiple municipalities that we are testing [in], and we are testing 48 different analytes that are related to illicit drugs," said Moffett.

Parkins said that based on the data provided by researchers like Moffet, he's been able to identify some worrying trends in the current drug supply in the province.

One is the intermittent appearance of carfentanil in wastewater samples, a synthetic opioid that is 100 times more toxic than fentanyl. Originally created as a tranquilizer for large animals, carfentanil has cropped up across the country causing drug poisoning deaths.

"When carfentanil enters the drug supply its potency is dramatically greater and the potential for overdoses is significantly [higher]," said Parkins. 

The data also shows the introduction of cutting agents like levamisole into the drug supply, a toxin which can have various side-effects, from causing severe rashes to suppressing a person's immune system. 

Parkins said that because toxins like levamisole can cause a wide range of symptoms, it would help save doctors time, money and lives if health officials knew what was present in the drug supply at any given time.