Prescription opioids have recently experienced a diversion of use in several countries causing a huge number of overdoses due to their high potency. The aim of this study was to develop a wastewater-based epidemiology (WBE) approach to assess the use of prescription opioids and evaluate the compliance to prescriptions to highlight the potential misuse of these substances in Italy. The most prescribed opioids have been selected and validated as WBE biomarkers and a nation-wide study has been conducted over a three-year period (2020-2022). Wastewater (WW) samples were collected as 24-hour composite samples in eight Italian cities and parent substances or metabolites were quantified using validated analytical methods based on liquid chromatography – tandem mass spectrometry (LC-MS/MS). Daily loads have been normalized to therapeutic doses to obtain a real figure of use that showed higher use of tapentadol and morphine compared to oxycodone and fentanyl. Back-calculation of consumption estimates was done by using the most reliable WBE biomarkers and were compared with prescription data. Spatial and temporal differences were found and highlighted a lower use in the south compared to the north and the center of Italy. Data comparison with prescriptions gave results in the same range indicating that the use of these substances in Italy seems to be predominantly from prescription for therapeutic purposes. This study highlighted the suitability of WBE to investigate the potential non-medical use of prescription pharmaceuticals in a population, providing relevant information for supporting public health emergencies and policies.

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通过废水分析估计处方阿片类药物的消费量：意大利的使用模式

处方阿片类药物最近在几个国家经历了分流使用，由于其高效性，导致大量过量服用。本研究的目的是开发一种基于废水的流行病学 （WBE） 方法来评估处方阿片类药物的使用情况并评估对处方的依从性，以突出意大利对这些物质的潜在滥用。处方最多的阿片类药物已被选择并验证为 WBE 生物标志物，并在三年内（2020-2022 年）进行了一项全国性研究。在意大利的 8 个城市收集了废水 （WW） 样品作为 24 小时复合样品，并使用基于液相色谱-串联质谱 （LC-MS/MS） 的经过验证的分析方法对母体物质或代谢物进行定量。每日负荷已标准化为治疗剂量，以获得真实的使用数据，该数字显示与羟考酮和芬太尼相比，他喷他多和吗啡的使用率更高。通过使用最可靠的 WBE 生物标志物对消耗估计进行反向计算，并与处方数据进行比较。发现了空间和时间差异，并突出了与意大利北部和中部相比，南部的使用率较低。与处方的数据比较得出的结果相同，表明这些物质在意大利的使用似乎主要来自用于治疗目的的处方。这项研究强调了 WBE 适合调查处方药在人群中的潜在非医疗用途，为支持公共卫生紧急情况和政策提供相关信息。