Jan 16, 2024 - News

San Francisco is now wastewater testing for fentanyl

Photo of two workers in hazmat suits handling samples of wastewater

In 2020, wastewater control inspectors in Oakland transfer sewer water into bottles that will be sent to labs for testing. Photo: Paul Chinn/The San Francisco Chronicle via Getty Images

San Francisco began wastewater testing this month for fentanyl and other substances in a bid to better track trends and inform intervention efforts.

State of play: Wastewater testing gained new prominence during the pandemic as it took a central role in monitoring COVID. Epidemiologists say it's an important tool that can bolster existing public health infrastructure.

Driving the news: San Francisco will send samples from wastewater treatment plants every other week to Biobot Analytics, a laboratory services company that will analyze it for fentanyl, methamphetamine, amphetamine, cocaine and xylazine.

  • "We're really looking at emerging substances that are complicating the fentanyl crisis," Biobot epidemiologist Alex Buben told Axios.
  • Biobot will also track the presence of naloxone, the antidote to an opioid overdose, in the samples.
  • The San Francisco Public Health Department is expected to receive initial results this month, then every two weeks thereafter. Biobot will store the data in an internal dashboard, but the city may choose to make it public as the program continues, Buben said.

Why it matters: Wastewater testing has proved effective for measuring rates of actual substance use, transmission and locations of interest.

  • The real-time data can help public health officials respond quickly to early-warning signs around usage and overdoses and inform efforts to prevent hospitalizations and deaths, Hillary Kunins, the city's director of behavioral health services, said in a news release.

How it works: The presence of illicit drugs can be identified in wastewater via excrement, which reflects ingestion, and unmetabolized batches that have been discarded, like in the sewer system or storm drains.

Of note: Though figures for 2023 are not yet finalized, trends through November show the city could surpass its 2020 record as San Francisco's deadliest year for overdose deaths, which exceeded 720.

Details: San Francisco treatment facilities are among 70 sending wastewater samples to Biobot as part of the company's federal contract with the National Institute on Drug Abuse.

  • The program is slated to end late August, but the scale of the project means Biobot will be able to provide benchmarks in comparison to other sites.
  • Through wastewater testing, communities like Marin County have been able to set up thresholding alert systems so medical workers are looped in and prepared to have conversations with patients around risk, Buben noted.
  • Cary, North Carolina also used wastewater to better target locations for prescription drug drop boxes.

What to watch: Biobot is planning to expand its surveillance to treatment drugs for alcohol use disorder, prescription opioids and other emerging threats.

  • The goal is to adapt to emerging threats as they "pop up on the streets" and destigmatize the issue so people understand its impact beyond crime reports, Buben added.
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