The burden of city's pain treatment – A longitudinal one year study of two cities via wastewater-based epidemiology

A longitudinal wastewater-based epidemiology study of Bath and Keynsham reveals significant seasonal variation in pain medication use, with NSAIDs and paracetamol peaking in winter months, while chronic pain treatments show minimal seasonality. The research demonstrates that a substantial portion of NSAIDs—particularly naproxen—is disposed of directly into sewerage systems due to topical application, bypassing metabolism. This finding challenges conventional assumptions about NSAID metabolism, which typically overestimate intake when based on parent compound excretion. By integrating wastewater monitoring with NHS prescription data, the study proposes a novel approach to estimate total pain medication usage, accounting for both oral and topical administration while addressing gaps in over-the-counter drug tracking.

Kannan, A., Sims, N., Hold, A. J., Jagadeesan, K., Standerwick, R., Barden, R., & Kasprzyk-Hordern, B. (2023). The burden of city’s pain treatment – A longitudinal one year study of two cities via wastewater-based epidemiology. Water Research, 229, 119391. https://doi.org/10.1016/j.watres.2022.119391