Publication

Scotland faces a critical public health crisis with one of the highest drug-related death rates in the developed world. Polysubstance use further complicates this issue, creating unpredictable health risks for users. Efforts to address this crisis include the National Drugs Mission Plan (2022–2026), which emphasizes reducing drug-related deaths through improved data collection and harm reduction strategies. The RADAR system (Rapid Action Drug Alerts and Response) plays a pivotal role in providing early warnings about emerging drug trends, such as the rise of potent synthetic opioids like nitazenes, enabling timely policy responses. However, existing approaches to monitor psychoactive substance use are limited by their time-consuming nature and inability to provide real-time data on drug consumption dynamics. Wastewater-Based Epidemiology (WWBE) offers a promising solution by analysing psychoactive substance residues in wastewater to deliver robust, dynamic, and timely insights into drug use patterns. This project explored the feasibility of leveraging Scotland’s existing wastewater monitoring infrastructure to enhance early warning systems like RADAR and support public health initiatives.

Objectives and Approach

The objectives of the project were to address the following questions:

1. Which specific target substances should be monitored to address the highest public health threats for Scotland? For which are there recognised analytical strategies internationally?
2. What are the characteristics of (a) existing infrastructure and (b) different analytical approaches available internationally and in Scotland for supporting the monitoring of target psychoactive substances and their metabolites?
3. What are the characteristics of existing early warning reporting systems on drug use – internationally and in Scotland – that the different monitoring activities feed into?
4. What are the options for monitoring and reporting of target psychoactive substances and their metabolites that are currently a) feasible and b) infeasible to do in Scotland and why, based on: - existing infrastructure for influent sampling of wastewater and its capacities - speed of turnaround to fit in with current reporting times (e.g. in RADAR updates) - availability of licenced laboratories with the appropriate skillset and technology in Scotland and the UK - restricted funding environment - capacities in relation to laboratory analysis - existing reporting systems?
5. What are the potential benefits afforded by such a recommended monitoring approach to support the existing systems of early warning surveillance data to inform Public Health Scotland action and international public health organisations?
6. What is the most feasible recommended approach to implement post-project (through limited trials or nationwide use of all appropriate Scottish Water sampling sites)?

Objectives were addressed through systematic literature review, evidence mapping, engagement of key stakeholders (Scottish Water, Public Health Scotland, European Drugs Agency) and experts through informal discussion, and a formal focus group.

Project Outputs