Prevalence of illicit drug consumption in a population of Hanoi: an estimation using wastewater-based epidemiology

Illicit drug use is a serious issue in Vietnam, but information about their prevalence is scarce, mainly based on seizure data. Wastewater-based epidemiology (WBE) is an alternative tool for obtaining such information, especially when stigma related to drug use can hinder survey approaches. The study aimed to apply WBE to assess the prevalence of use of a range of illicit drugs in an urban population of Vietnam. A total of 184 wastewater samples were collected at two different sites along a sewage canal, receiving sewage from over 400,000 people in Hanoi, Vietnam, in three different periods between 2018 and 2020. Illicit drugs and their metabolites were measured by direct injection using liquid chromatography-tandem mass spectrometry. The results were back-estimated, normalised to per capita daily consumption for assessement of consumption patterns and trends. Most drugs were detected in all the samples except cocaine, benzoylecgonine, amphetamine indicating a low prevalence of cocaine and amphetamine use. The estimated consumption level of methamphetamine was varied from 119.5 to 553.5 mg/d/1000 pp. The market of illicit drugs in Vietnam has changed from opiates to amphetamine-type simulants, and methamphetamine has replaced heroin as the No.1 drug, its use can be as much as 3 times more than heroin use. Moreover, we observed the considerable and potentially increasing level of ketamine consumption in Hanoi. No statistical difference was found in daily consumption per capita among days of the week for any drugs, both legal (codeine, methadone) and illegal (methamphetamine, MDMA, ketamine and heroin), suggesting the drugs were consumed mainly by regular users. This study provides important information related the illicit drug consumption in Vietnam, which will help to formulate appropriate drug control policies in this country.