I Q): Australian Criminal Intelligence Commission National Wastewater Drug Monitoring Program—Report 4, March 2018 CONTENTS CEO FOREWORD.............................................................................................................................1 SNAPSHOT......................................................................................................................................3 INTRODUCTION..............................................................................................................................5 RESEARCH FINDINGS...................................................................................................................12 1: EXECUTIVE SUMMARY...........................................................................................................14 2: INTRODUCTION.......................................................................................................................16 2.1: Preamble..............................................................................................................................16 3: METHODS ................................................................................................................................17 3.1: Participating wastewater treatment plants (WWTPs)..........................................................18 3.2: Sample collection and preparation......................................................................................19 3.3: Presentation of data and interpretation of graphs..............................................................19 3.4: Refining the wastewater catchment population estimate...................................................21 4: RESULTS....................................................................................................................................23 4.1 Individual site comparison of drug use in December 2017...................................................23 4.2 State and territory comparison of drug use..........................................................................31 4.3 Drug profile for each state and territory...............................................................................42 5: ACKNOWLEDGEMENTS..........................................................................................................46 6: REFERENCES............................................................................................................................47 7: APPENDICES............................................................................................................................49 Appendix 1: Drug-specific parameters for analytical reporting and usage calculations.............49 Appendix 2: Number of sites assessed in each report................................................................50 Appendix 3: Further information on WWTPs..............................................................................51 Appendix 4: Population estimation: percentage overcount or undercount by site....................53 Appendix 5: Population estimation methodology...........................................................................55 Appendix 6: Percentage of samples above LOD (%) for each drug and period assessed............57 CONCLUSIONS..............................................................................................................................58 3 Australian Criminal Intelligence Commission National Wastewater Drug Monitoring Program—Report 4, March 2018 CEO FOREWORD The Australian Criminal Intelligence Commission has a national responsibility to provide information and intelligence on criminal activity. Much of the harm that Australians suffer at the hands of organised crime is due to the trade in illicit substances and abuse of licit substances at the instigation of serious and organised crime groups who profit from importing, trafficking, manufacturing and selling drugs. This National Wastewater Drug Monitoring Program report is the fourth in a series of nine public reports which will detail the findings of the national wastewater program until the end of 2019. This report provides statistically valid datasets of drug use and distribution patterns across a large number of sites in capital cities and regional areas. Wastewater analysis is widely applied internationally as a tool to measure and interpret drug use within national populations, with the current national program in Australia representing world best practice. Wastewater analysis provides a measure of one important aspect of national health—the demand for a range of licit and illicit drugs. An understanding of this behaviour allows governments to effectively direct resources to priority areas, and also to monitor the progress of demand and supply reduction strategies. EVOLUTION OF THE PROGRAM This report includes wastewater data from all states and territories, enabling the National Wastewater Drug Monitoring Program to provide a national picture of drug use. In December 2017, 45 wastewater sites were monitored nationally. Based on 2016 Census data, these sites cover approximately 54 per cent of the Australian population—around 12.7 million people. This report contributes further data to permit the identification of changes in usage patterns over the 17-month period from August 2016 to December 2017 and to build a comprehensive and increasingly detailed picture of national drug consumption. The content of this report involves a natural evolution of the existing National Wastewater Drug Monitoring Program. Changes of note in this report include the adoption of more sophisticated population estimates of wastewater treatment catchments, derived using the latest Census data from the Australian Bureau of Statistics and geographical information system analysis of populations reported within wastewater treatment catchments. These refinements increase both the precision and accuracy of consumption estimates and have been applied to all data presented in this report. We are grateful to our partners at the University of Queensland and University of South Australia for their ongoing efforts to enhance and deliver a leading edge program. TRENDS IDENTIFIED DURING THIS REPORTING PERIOD Of the drugs measured, consistent with previous reports, alcohol and nicotine continue to be the most consumed drugs in Australia. Methylamphetamine remains the most consumed illicit drug, with average consumption increasing since August 2017. 1 Consumption of other drugs measured by the program remains considerably lower. Although the previous report indicated a decrease in average cocaine consumption between April and August 2017, recent data indicate a noticeable increase in consumption. The consumption of MDA and MDMA remains low and variable across sites. In general, heroin consumption was lower than fentanyl and oxycodone consumption in most states and territories, with average regional consumption of fentanyl and oxycodone exceeding that in capital city sites. Mephedrone and methylone consumption remain low, at or below detection levels. ADDITIONAL INSIGHTS GAINED FROM WASTEWATER ANALYSIS Wastewater analysis provides a measure of the demand for a range of licit and illicit drugs. Analysis of wastewater data offers opportunities to address emerging problems, identify previously unknown drug threats and consumption patterns, and assists to measure the effectiveness of harm reduction initiatives and supply disruption strategies. On comparing drug seizure data published in the Australian Federal Police Annual Report 2016–17 and annual national drug consumption estimates derived from wastewater analysis for methylamphetamine, MDMA, cocaine and heroin, it is evident demand for harmful drugs remains robust. Based on the reported weights seized by the Australian Federal Police in 2016–17 and consumption estimates from the National Wastewater Drug Monitoring Program: ƒƒ the weight of heroin seized equated to around a quarter of the total estimated weight of heroin required to meet national demand ƒƒ the weight of methylamphetamine seized equated to over 40 per cent of the total estimated weight of methylamphetamine needed to meet national demand ƒƒ the weight of MDMA seized equalled the total estimated weight of MDMA needed to meet national demand ƒƒ the weight of cocaine seized exceeded the total estimated weight of cocaine needed to meet national demand. The above examples highlight the resilience of drug markets and the enduring demand for drugs in Australia. They again reinforce that no single strategy in isolation can achieve sustained impacts and the ongoing necessity to employ a shared approach that targets supply, demand and harm reduction. I would like to thank the Australian Government for contributing the funding which made this initiative possible, and to acknowledge the Australian Criminal Intelligence Commission officers who contributed to the project. I am grateful for the valuable support and specialist expertise of the University of Queensland and the University of South Australia, who undertook the data collection and analysis which underpins this report. Michael Phelan APM Chief Executive Officer Australian Criminal Intelligence Commission 2 Australian Criminal Intelligence Commission National Wastewater Drug Monitoring Program—Report 4, March 2018 SNAPSHOT 54% Alcohol and nicotine remain the highest consumed substances and methylamphetamine continues to be the most consumed illicit drug tested. The December 2017 collection covers 54.3 per cent of Australia’s population—about 12.7 million Australians. Capital city cocaine and heroin average consumption exceeded regional consumption. Regional nicotine, methylamphetamine, MDA, oxycodone and fentanyl average consumption exceeded capital city consumption. Use of new, sophisticated geospatial analysis methods incorporating water treatment catchment maps and 2016 Australian Census mesh blocks gives more accurate and precise consumption estimates. 3 Australian Criminal Intelligence Commission National Wastewater Drug Monitoring Program—Report 4, March 2018 Estimated annual consumption of methylamphetamine, cocaine, MDMA and heroin derived from wastewater data shows Australia is a stimulant nation. 8,387 kg 3,075 kg 1,280 kg 765 kg Based on wastewater consumption estimates, in 2016–17 Australian Federal Police seized: Around a quarter of the heroin needed to meet national demand Over 40 per cent of the methylamphetamine needed to meet national demand The total weight of MDMA needed to meet national demand In excess of the total weight needed to meet national demand for cocaine 4 Australian Criminal Intelligence Commission National Wastewater Drug Monitoring Program—Report 4, March 2018 INTRODUCTION This is the fourth in a series of nine National Wastewater Drug Monitoring Program reports to be publicly released by the Australian Criminal Intelligence Commission. The program aims to deliver on the recommendations of the Final Report of the National Ice Taskforce. It is the first program to provide leading-edge, coordinated national research and intelligence on illicit and licit drugs, with a specific focus on methylamphetamine and 11 other substances. In 2016, the Australian Criminal Intelligence Commission received $3.6 million in funding under the Commonwealth Proceeds of Crime Act 2002 to deliver the National Wastewater Drug Monitoring Program over three years. The program provides a measure, rather than an estimate, of the use of a number of illicit drugs, as well as licit drugs including nicotine, alcohol and some pharmaceuticals. It gives us valuable insight into the trends and emerging issues of drug consumption across Australia and can identify new sources of threat. The findings presented in the nine reports will give law enforcement, policy, regulatory and health agencies additional and more objective data on the use of methylamphetamine and other drugs. This data creates opportunities to shape the response to both the demand and the supply side of the illicit drug market, particularly in high-use areas. IMPLEMENTATION The Australian Criminal Intelligence Commission has contracted the University of Queensland, and through it the University of South Australia, to deliver the program. Relationships have been built between the universities and the operators of wastewater facilities across Australia to permit the collection and analysis of samples. In this report, wastewater analysis from the National Wastewater Drug Monitoring Program measured the presence1 of the following substances: ƒƒ methylamphetamine ƒƒ amphetamine ƒƒ cocaine ƒƒ 3,4-methylenedioxymethylamphetamine (MDMA) ƒƒ 3,4-methylenedioxyamphetamine (MDA) ƒƒ heroin ƒƒ mephedrone ƒƒ methylone ƒƒ oxycodone ƒƒ fentanyl ƒƒ nicotine ƒƒ alcohol. 1 5 The contract recognises that threshold levels are substance dependent and will vary accordingly. Refer to the research findings for further information on detection levels, and whether it was possible to measure all substances. Australian Criminal Intelligence Commission National Wastewater Drug Monitoring Program—Report 4, March 2018 The first five substances are widely recognised illicit stimulants. Heroin is an illicit depressant. The next two substances, mephedrone and methylone, are illicit synthetic stimulants and are described as new psychoactive substances (NPS).2 Oxycodone and fentanyl are opioid pharmaceuticals with therapeutic application, but are also diverted to the illicit market. Nicotine and alcohol are licit drugs. The Australian Criminal Intelligence Commission will continue to review the appropriateness of the monitored substances with its partners, stakeholders and the universities. Both contracted universities will monitor wastewater at approximately 50 sites across Australia until the end of 2019. It is the intention of the program that capital city sites cover all state and territory capital cities, with the remaining sites covering regional cities and towns. Capital city sites will be monitored for the duration of the program, while the remaining sites will be reassessed periodically. Sites were selected to permit the Australian Criminal Intelligence Commission to provide data on major population areas, sites of actual or potential concern from a drug use perspective, and sites where the local authorities have established relationships with the two universities. In December 2017, 45 wastewater treatment plants participated nationally. The breakdown of sites by jurisdiction for December 2017 is as follows: 1 6 9 9 8 1 6 5 2 Two other NPS, JWH-018 and JWH-073, which are synthetic cannabinoids are no longer monitored by the National Wastewater Drug Monitoring Program as they have not been detected in sites across Australia since monitoring commenced in August 2016. 6 Australian Criminal Intelligence Commission National Wastewater Drug Monitoring Program—Report 4, March 2018 The Australian Criminal Intelligence Commission will continue engaging with all states and territories in an attempt to secure their ongoing participation in sampling for future reports. Participation from all states and territories is vital to informing our understanding of the national picture of drug use and demand. In the event that one or more states and territories decide not to participate in the national program in the future, the Australian Criminal Intelligence Commission will identify replacement sites from participating states and territories to ensure that the largest possible segment of the national population is sampled. Accordingly, the location of sites within and between states and territories may change over the three years of the contract. REPORTING National Wastewater Drug Monitoring Program reports will be published as comprehensive public reports three times a year, in line with the program contract. In accordance with current wastewater analysis conventions, the terms of the contract, and to protect the integrity of the program, the exact locations of wastewater treatment plants will not be publicly released by the Australian Criminal Intelligence Commission. To maintain the confidentiality of the participating sites, each site was allocated a unique code so that results could be de-identified. However, trends in particular states and territories are still able to be identified. The public reports will incorporate a discussion of trends in drug use where distinct trends are seen—for example, between regional areas and capital cities, or between states and territories and nationally—and will include comparisons with testing from previous years where that data is available. In order to inform appropriate responses, stakeholders in law enforcement, health and other relevant policy agencies may be provided with classified information identifying actual sampling locations. EXPLOITATION OF THE NATIONAL WASTEWATER DRUG MONITORING PROGRAM DATA The Australian Criminal Intelligence Commission intends that the findings of the National Wastewater Drug Monitoring Program analysis will be fundamental to the development of government policy and decision making, as the reports will provide a regular, timely, unambiguous and detailed measure of the level of demand for the listed commodities in the Australian population, complementing other drug datasets published in Australia. The fourth National Wastewater Drug Monitoring Program report measures drug use by approximately 54 per cent of the Australian population.3 It is hoped that wastewater data will be used with other available data sources to obtain a more comprehensive and accurate understanding of drug markets nationally and in the respective states and territories. 3 7 The December 2017 population estimate is based on the Australian Bureau of Statistics 2016 Census data and catchment data supplied by the operators of the wastewater facilities and service providers. Australian Criminal Intelligence Commission National Wastewater Drug Monitoring Program—Report 4, March 2018 The Australian Criminal Intelligence Commission continues to engage with academic institutions, industry and public sector agencies concerning potential uses for data generated by the National Wastewater Drug Monitoring Program. Discussions have centred upon focusing responses in particular high-risk areas, measuring drug use in particular local areas, estimating the size of specific illicit markets, comparing wastewater data with other drugrelated data and exploring options for monitoring the effectiveness of existing demand, supply and harm reduction initiatives. The advantage the National Wastewater Drug Monitoring Program offers in all these contexts is that the data is collected on an ongoing basis, is reported regularly and can be shaped to accommodate changing circumstances. Making the National Wastewater Drug Monitoring Program data available to the public and to public agencies enriches understanding and informs the national conversation on drug trends and related demand. Because the collection and analysis protocols are similar, it is also possible to compare domestic drug consumption with international drug consumption,4 which may stimulate further discussions on alternative responses to the threat posed by drug use. Wastewater has been identified as offering an important, unified and consistent guiding tool in developing holistic drug responses. The National Wastewater Drug Monitoring Program is based on a well-established and internationally recognised methodology which has been applied to varying extents by many other nations. Australia is one of the few countries in the world where the program is funded by a national government, with the scope of sampling in Australia generating data which will help governments at both a state and national level to formulate appropriate responses. ESTIMATED NATIONAL CONSUMPTION The Australian Criminal Intelligence Commission used wastewater data collected between August 2016 and August 2017 to estimate the annual weight of methylamphetamine, MDMA, cocaine and heroin consumed nationally (see Table 1). While the estimates are conservative, they provide valuable insight into Australia’s demand for illicit drugs that could not have been gained without the program. Table 1: Estimated annual national methylamphetamine, cocaine, MDMA and heroin consumption between August 2016 and August 2017. Drug Estimated consumption kilograms per year Methylamphetamine 8,387 Cocaine 3,075 MDMA 1,280 Heroin 765 4 International data from the Sewage analysis CORe group Europe (SCORE) was not available in time for it to be incorporated into this report. This information will be included in the fifth report, to be released in the third quarter of 2018. 8 Australian Criminal Intelligence Commission National Wastewater Drug Monitoring Program—Report 4, March 2018 To put the size of the Australian methylamphetamine market into context, the total combined estimated weight of cocaine, MDMA and heroin consumed annually equates to around 60 per cent of the estimated weight of methylamphetamine consumed annually. This data also illustrates the variation in the size of these markets, with the estimated weight of methylamphetamine consumed annually being 6½ times that of MDMA and the estimated weight of cocaine consumed annually being four times that of heroin. In addition to providing insight into how the different drugs in the program compare, these consumption estimates also enable comparisons with seizure data. On comparing the estimated weight of methylamphetamine, cocaine, MDMA and heroin consumed annually with the weight of related drug seizures reported in the Australian Federal Police Annual Report 2016–17: ƒƒ The weight of heroin seized equated to around a quarter of the total estimated weight of heroin required to meet national demand. ƒƒ The weight of methylamphetamine seized equated to over 40 per cent of the total estimated weight of methylamphetamine needed to meet national demand. ƒƒ The weight of MDMA seized equalled the total estimated weight of MDMA needed to meet national demand. ƒƒ The weight of cocaine seized exceeded the total estimated weight of cocaine needed to meet national demand. From the above data it is evident that demand for these drugs remains robust and that a shared approach that targets supply, demand and harm reduction is critical to addressing drug use in Australia. Drug consumption estimates derived from wastewater data, when used in combination with other data such as seizure, arrest, price, purity and availability data, provide greater insight into the related markets and the potential impact of supply, demand and harm reduction strategies. EVOLUTION OF THE PROGRAM The Australian Criminal Intelligence Commission will continue to work with the participating universities to enhance the program. Since its launch, the program has explored and implemented various enhancements that contribute to the delivery of better data and a better and more granular understanding of drug consumption in Australia. These enhancements include the ability to compare Australia’s drug consumption with measured consumption in different countries, and the inclusion of additional substances in the monitoring program as new methodologies are developed and endorsed by the scientific community. Discussions also include whether it may be possible to use alternative metabolites of some substances to more precisely measure their consumption in the community. The fourth National Wastewater Drug Monitoring Program report reflects a further evolution of the program. For the first time the program implemented a new, more sophisticated methodology to estimate populations captured by wastewater treatment plant catchments, with the population estimate of usual residents within each catchment being refined using catchment maps provided by wastewater treatment authorities and 2016 Australian Census mesh blocks. This methodology incorporates the latest Australian Census data and will result in more precise and accurate population estimates for the areas covered by the program. 9 Australian Criminal Intelligence Commission National Wastewater Drug Monitoring Program—Report 4, March 2018 Wastewater data is an important part of the suite of datasets available to increase our understanding of drug consumption, demand and supply in Australia. Existing and future work incorporating wastewater data will include a comparison of consumption data with drug seizures in Australia. The Australian Criminal Intelligence Commission is working to ensure the broadest possible range of stakeholders are engaged throughout the life of the program, consulting with stakeholders through existing drug forums and direct discussions with agencies. This includes working with industry to increase our understanding of drug markets in Australia. RESULTS FROM THE FOURTH REPORT This fourth report of the National Wastewater Drug Monitoring Program builds on national drug consumption data contained in the preceding three public reports identifying drug use patterns across states, territories and the nation. It provides data on capital city and regional drug use and, where possible, comparisons with previous levels of use in sites across Australia. This and future reports will contribute further data to identify trends, changes in patterns of use and emerging issues, building a comprehensive and increasingly detailed picture of national drug consumption. Benefits of longitudinal wastewater data include the identification of emerging trends and patterns of use. This is illustrated through the cocaine data, where the population-weighted averages for cocaine consumption have doubled in capital city sites since August 2016, with almost a three fold increase observed in regional sites. Reported results reflect per capita use in all locations and, with the exception of MDA, are expressed in terms of both the number of doses and the weight or volume per capita of the respective substances, to facilitate comparison between substances. 10 RESEARCH FINDINGS Prepared by the University of Queensland (B Tscharke, R Mackie, J O’Brien, S Grant, J Mueller) and University of South Australia (M Ghetia, H Aghera, R Bade, C Gerber, J White). 12 Australian Criminal Intelligence Commission National Wastewater Drug Monitoring Program—Report 4, March 2018 LIST OF ABBREVIATIONS ABS Australian Bureau of Statistics ACIC Australian Criminal Intelligence Commission ACT Australian Capital Territory GIS Geographic information system LC-MS/MS Liquid chromatography tandem mass spectrometry LOD Limit of detection LOR Limit of reporting MDA 3,4-methylenedioxyamphetamine MDMA 3,4-methylenedioxymethylamphetamine NPS New psychoactive substances NSW New South Wales NT Northern Territory NWDMP National Wastewater Drug Monitoring Program QLD Queensland SA South Australia SPE Solid phase extraction TAS Tasmania VIC Victoria WA Western Australia WWTP Wastewater treatment plant TERMINOLOGY Methylamphetamine is also commonly known as methamphetamine. In this report, consistent with the preferences of the Australian Criminal Intelligence Commission, ‘methylamphetamine’ is used. MDMA is commonly known as ecstasy. Alcohol consumption in this report refers to ethanol consumption but the more general term ‘alcohol’ is used throughout. Nicotine consumption has replaced tobacco consumption in this report as the target metabolites may also be derived from nicotine replacement products, such as gums and patches. 13 Australian Criminal Intelligence Commission National Wastewater Drug Monitoring Program—Report 4, March 2018 1: EXECUTIVE SUMMARY Wastewater analysis is now a standard method for measuring population-scale use of a range of different chemical compounds. The underlying concepts involved in wastewater analysis were demonstrated in the first national Australian report released in March 2017. Estimates of drug usage in a population were back calculated from measured concentrations of drug metabolites (excreted into the sewer system after consumption) in wastewater samples. Spatial and temporal trends in drug use have now been included using this approach for several sites across Australia. The National Wastewater Drug Monitoring Program (NWDMP) of the Australian Criminal Intelligence Commission (ACIC) monitors selected substances of concern in most populated regions of Australia. The study now focuses on twelve licit and illicit drugs, including nicotine, alcohol, methylamphetamine, cocaine, MDMA (ecstasy) and heroin. Trends in estimated drug consumption will be established over the three-year project. Wastewater treatment plants (WWTPs) located across capital cities and regional Australia, covering all states and territories, have been invited to participate in this program. Previous reports used population estimates provided by the wastewater treatment authorities. For the first time the estimate of the usual residents within each catchment has been refined. Catchment maps provided by the wastewater treatment authorities were layered on the smallest available units of Census population counts (mesh blocks) in geographic information systems (GIS) software to yield the highest resolution population estimate available for the catchments based on Census data. The resulting overlapping usual resident population within each catchment was calculated and has been applied to all data presented in this report, which increases both the precision and accuracy of the consumption estimates. For this fourth report, wastewater samples were collected during weeks of October and December 2017. A total of 20 WWTPs in capital cities and a further 25 regional sites participated in the project for the December 2017 period, covering a population of more than 12 million Australians. Data from this report equates to coverage of approximately 48 per cent and 54 per cent of Australia’s population for October and December, respectively. A total of 1,839 individual daily samples have been assessed since the beginning of the program, with new results from 414 additional samples added in this report. The collected samples provide relatively comprehensive, Australia-wide baseline data against which subsequent data can continue to be compared to ascertain both spatial and temporal trends. Twenty-four-hour composite wastewater samples were collected using time-proportional or flow-proportional autosamplers at the influent of each WWTP by plant operators. Samples were collected for up to seven consecutive days. Concentrations of drug metabolites were determined in the wastewater using liquid chromatography-tandem mass spectrometry (LC-MS/MS) analytical methods. Drug consumption estimates for each catchment population were calculated from these measured concentrations using flow volumes and estimates of the catchment population size by Census data vs. catchment maps evaluation, together with excretion and dose data derived from the scientific literature. To maintain treatment plant confidentiality, each site was allocated a unique code and site names are not included in this report. 14 Australian Criminal Intelligence Commission National Wastewater Drug Monitoring Program—Report 4, March 2018 The estimated drug usage across the 45 sites (December 2017) was consistent with previous reports. After normalising the amount of drug measured in wastewater for population size and average dose consumed, alcohol and nicotine were consistently the highest consumed drugs in all states and territories. Estimated consumption of nicotine was generally higher in regional areas compared to capital cities. In the case of alcohol, the difference was less pronounced. The Northern Territory had the highest consumption of nicotine and alcohol, but with only one participating site, the result may not be representative of the Territory as a whole. In other parts of Australia, alcohol consumption was similar for the most part, except for regional South Australia, where it was relatively low. This may be a consequence of samples being provided for weekdays only, when consumption is typically lower. Nicotine use across the nation was fairly consistent. Methylamphetamine remains the highest of the illicit drugs included in the report, in both capital cities and regional sites, and shows no tendency to decline. The highest methylamphetamine levels were seen in South Australia (capital city) and Western Australia (regional). Amphetamine is a metabolite of methylamphetamine and measured amphetamine concentrations across the sites were consistent, with the observed levels being primarily related to methylamphetamine metabolism rather than sourced from direct consumption. Compared to methylamphetamine, estimated usage of other stimulants was generally much lower, although no consistent pattern (profile) of usage for these other drugs could be observed between states and territories. Cocaine consumption in Australia is mostly centred in New South Wales across several capital city and regional sites. Levels in Queensland and the Australian Capital Territory have both increased to become nearly second highest in the nation. In comparison, usage was low at sites elsewhere around the country. MDMA usage was similarly low across most sites with a few site-specific exceptions. Oxycodone and fentanyl, which are both prescription pharmaceutical substances with abuse potential, had elevated consumption levels at several regional sites. Regional areas had average oxycodone use well above capital city sites in many states. Consumption of heroin varied widely, with minimal amounts detected in the Northern Territory and high levels recorded in sites in Victoria and the Australian Capital Territory, as well as a few individual sites in other states. After removing the proportion of MDA attributable from MDMA metabolism, use of the drug appeared variable across the nation, with South Australia being the lowest. A feature was a site in regional Queensland where measured levels were extremely high. For the other drugs included in this study, methylone and mephedrone concentrations were generally at or below detection levels at all participating sites. The collection of wastewater samples at regular intervals allowed for the temporal comparison of consumption data. While small overall changes were evident at both a site and a state or territory level, more data are required to draw longer term conclusions. The recent declines in methylamphetamine use in Queensland and Western Australia, and to a lesser extent South Australia, were clear reversals in longer term trends. A gradual reduction in pharmaceutical opioid use, particularly oxycodone, was also apparent. 15 Australian Criminal Intelligence Commission National Wastewater Drug Monitoring Program—Report 4, March 2018 2: INTRODUCTION 2.1. PREAMBLE Wastewater analysis is a technique for delivering population-scale consumption of substances. The University of Queensland and University of South Australia have been commissioned to provide drug consumption data to the ACIC for a period of three years, beginning in August 2016. Wastewater treatment sites are assessed bimonthly in the case of capital city sites and every four months for regional sites. The aim is to acquire data on the population-scale use of substances that cause potential harm, either through addiction, health risks, or criminal and antisocial behaviour. The intention is to establish baseline data of substance use across Australia. This fourth National Wastewater Drug Monitoring Program report compares consumption data from the first three reports with results obtained subsequently from October and December 2017. Compounds of concern include nicotine (cigarettes, gum, patches, e-cigarettes, etc), ethanol from alcohol intake, pharmaceutical opioids with abuse potential, illicit substances such as methylamphetamine, MDMA, cocaine and heroin, as well as a number of new psychoactive substances (NPS). The compounds amphetamine and MDA were measured but not included in the initial reports. Amphetamine is a by-product of methylamphetamine pyrolysis and also one of its metabolites and we found the levels to correspond fully to the excretion of methylamphetamine. MDA is a metabolite of MDMA, but since the proportion of MDA derived from MDMA is known, the difference between measured MDA and MDMA metabolite has now been included in the current report. The amount of MDA was calculated by subtracting 1.65 mg of MDA for every 100 mg of MDMA consumed (Pizarro et al. 2002; Khan & Nicell 2011). The report presents patterns of substance use across Australia, showing differences in levels between capital cities and regional centres, within states and territories, and nationally. 16 Australian Criminal Intelligence Commission National Wastewater Drug Monitoring Program—Report 4, March 2018 3: METHODS The method underlying wastewater based monitoring of drug use in a given population is based on the principle that any given compound that is consumed (irrespective of whether it is swallowed, inhaled/smoked or injected) will subsequently be excreted (either in the chemical form it is consumed and/or in a chemically modified form that is referred to as a metabolite). The excreted compound or metabolite will eventually arrive in the sewer system. The drugs and their metabolites of interest in this study are given in the first National Wastewater Drug Monitoring Program report (available at www.acic.gov.au), as well as an in-depth description of the methodologies involved.1 Collectively, waste products in the sewer system arrive at a WWTP where wastewater samples are collected over a defined sampling period. Measuring the amount of target compound in the wastewater stream allows for a back calculation factor to be applied to determine the amount of drug that was used over the collection period (Figure 1). The method is non-invasive and is done on a population-scale level, so individuals are not targeted and privacy is respected. Figure 1: Schematic of the population catchment area and methodology employed to convert measured concentration of substances in wastewater to mass loads or doses consumed per day per normalised population. DOSES OF DRUG CONSUMED/1000 PEOPLE (calculated) (number of doses of drug consumed on average by 1000 people in the catchment in 24 hours) Divide by the mass of drug typically consumed in one go (i.e. the standard dose) Community MASS OF DRUG CONSUMED/1000 PEOPLE (calculated) Community-wide facilities e.g. shopping malls/ hotels/events/ offices/ CATCHMENT industry POPULATION (grams of drug consumed on average by 1000 people in the catchment in 24 hours) Community services e.g. hospitals/ universities/ prisons Divide by excretion rate i.e. the mass of metabolite excreted for every unit of drug consumed, and multiply by the difference in molecular weight between the drug and its’ metabolite MASS OF METABOLITE EXCRETED/1000 PEOPLE (calculated) (grams of metabolite excreted on average by 1000 people in the catchment in 24 hours) CONCENTRATION OF EXCRETED METABOLITE (measured) (wastewater entering the WWTP is sampled over a 24 hour period. The average concentration of metabolite is measured, i.e. grams of metabolite per litre of wastewater) Wastewater treatment plant (WWTP) Autosampler at WWTP inlet Divide by catchment population (thousands of people) TOTAL MASS OF METABOLITE EXCRETED Multiply concentration by total volume of wastewater flowing into WWTP over 24 hours (calculated) (total grams of excreted metabolite that reaches the WWTP from the catchment in 24 hours) To obtain an estimate of drug use, representative samples are collected over a given period (typically 24 hours) using autosamplers that collect time or flow proportional samples. Wastewater treatment plant operators provide assistance with collecting the samples from the influent autosampler (where the wastewater enters the treatment plants). Details of the calculation methods are given in the first National Wastewater Drug Monitoring Program report. 1 17 Information in relation to heroin appears in Report 3. Australian Criminal Intelligence Commission National Wastewater Drug Monitoring Program—Report 4, March 2018 Collected wastewater samples were analysed at the University of South Australia and the University of Queensland laboratories. The steps routinely performed in our laboratories are based on filtration of the samples followed by an enrichment/concentration step where the concentrated sample is injected, or (for chemicals with sufficiently high concentrations) direct injection of samples into the analytical instruments. The instrumental analysis consists of chromatographic separation and subsequent compound specific detection. A summary of the extraction and analytical methods is given in the first National Wastewater Drug Monitoring Program report. An updated excretion and dose table including the heroin metabolite, 6-monoacetylmorphine, is found in Appendix 1. 3.1. PARTICIPATING WASTEWATER TREATMENT PLANTS (WWTPS) Forty-five WWTPs across Australia participated in this study for the December 2017 collection (Figure 2). Of these, 20 sites were located in capital cities and a further 25 were regional sites covering a wide range of catchment population sizes. Sites were selected by the ACIC. The number of participating sites for October and December 2017 are listed in Table 2 and Appendix 2. A complete list of participating sites, number of samples and relative catchment sizes are listed in Appendix 3. To maintain the confidentiality of participating sites, all sites were allocated a unique code to de-identify their results. Only site codes are presented in the results sections. Figure 2: Participating WWTPs in December 2017, showing the split between capital city and regional plants by state and territory. The colours in this figure are used in the remainder of the report to identify results relating to individual states and territories. Participating WWTPs WWTPs per per State/Territory State/Territory Participating 3C 3C 3R 3R 1C 1C 0R 0R 3C 3C 6R 6R 4C 4C 5R 5R C = Capital city WWTP C = Capital city WWTP R = Regional WWTP R = Regional WWTP 3C 3C 5R 5R 3C 3C 2R 2R 1C 1C 2C 2C 4R 4R 18 Australian Criminal Intelligence Commission National Wastewater Drug Monitoring Program—Report 4, March 2018 Table 2: Number of participating WWTPs for the periods covered in this report. Every second collection period aims to collect data from both regional (R) and capital city (C) sites (December), while the in-between collection periods (October) aim to collect data from capital city sites only. Oct-17 Dec-17 State/territory C R C R ACT 1 – 1 – NSW 3 – 3 5 NT – – 1 – QLD 3 – 3 6 SA 4 – 4 5 TAS 3 – 3 2 VIC 2 – 2 4 WA 3 – 3 3 11.2 – 11.2 1.5 Population (millions) C & R         Total Population (millions) 11.2 12.7 % of Australian population 47.9% 54.3% 3.2. SAMPLE COLLECTION AND PREPARATION Composite samples were collected by treatment plant staff daily on seven consecutive days from Monday to Sunday, or where seven days was not feasible, across as many consecutive days as possible. Samples were stored at 4oC or were frozen prior to transport to Adelaide or Brisbane. Further details of the sampling protocol and relevant quality controls are included in Irvine et al. (2011), Lai et al. (2011), Lai et al. (2015), Tscharke et al. (2016). All other descriptions of calculations, extractions and analytical methods are outlined in the first National Wastewater Drug Monitoring report (available at www.acic.gov.au). 3.3. PRESENTATION OF DATA AND INTERPRETATION OF GRAPHS Reported averages: All averages for state/territory or Australia-wide drug consumption data are presented throughout this report as population weighted averages. The number of people in the catchment population is used as the weighting for the respective drug consumption data for that population. For example, to calculate the population weighted average of capital city methylamphetamine consumption, the methylamphetamine consumption data for each WWTP was multiplied by the respective population number; all data were then summed and divided by the total population across all capital city sites. Reported average values are therefore not skewed towards usage data from small, non-representative populations. Per capita consumption: The per capita consumption estimates presented in this report are calculated using the total estimated catchment population (which includes children). For example, per capita alcohol consumption has previously been reported by the Australian Bureau of Statistics (ABS) based on population numbers for people aged 15 and over. The consumption values presented in the current report will be under-estimated compared to those determined for an adult-only population. For consistency, data from other studies included in this report were recalculated where necessary using estimated total population. 19 Australian Criminal Intelligence Commission National Wastewater Drug Monitoring Program—Report 4, March 2018 Graphical presentation of data: An overview of how the data is presented in the graphs for the individual sites is given in Figure 3. This includes information on interpreting the consumption data presented on the vertical axes in all graphs in this report. In some graphs, the values plotted in the graph can be read as either mass of drug consumed (left axis) or doses of drug consumed (right axis). For the specific case of MDA, the amount of MDA excreted following MDA consumption is not known, and therefore for this drug we can only express the results as how much drug was excreted into the sewer network, e.g. the mg excreted per 1,000 people per day. Figure 3: Explanation of the graphical representation of data for individual sites. General concepts relevant to all graphs in the report are also outlined (unique site codes, explanation of vertical axes, colour coding).2 2 For specific parameters and equations included in Figure 3 see Report 1. 20 Australian Criminal Intelligence Commission National Wastewater Drug Monitoring Program—Report 4, March 2018 Instrumental method limits of detection and limits of reporting: Since the wastewater samples contain very low quantities of particular drugs, the limit of detection (LOD) was determined analytically as the lowest concentration of that drug that could be distinguished in the sample (using the methods described in Report 1). A drug may be present at a concentration below the LOD. However, trace quantities may actually be present at undetectable levels. The limit of reporting (LOR) is a concentration (higher than the LOD), above which we have high confidence that the concentration measured on the analytical instrument is accurate. Above the LOD but below the LOR there may be some uncertainty as to the actual concentration. To be conservative (a drug may be present but there is uncertainty as to its concentration) and in line with current practice, for back calculations to estimate per capita consumption, a concentration below the LOD is included at a value of LOD. A concentration above the LOD but below LOR is included at the midpoint between the LOD and LOR (i.e. (LOD + LOR)/2). Weekly pattern of drug use: The pattern of drug use over the sampling week for the sites in this report cannot be elucidated from the data included in the current report. We present only maximum, minimum and average (for the individual sites) (Figure 3) and only average (or population weighted average, see above) values for all other graphs. Consistent patterns of drug use in Australia from previous wastewater-based epidemiology studies indicate that some illicit drugs such as cocaine, MDMA, mephedrone and methylone have high variation in weekly consumption rates, with higher consumption on weekends. Other drugs such as methylamphetamine, oxycodone and fentanyl appear to have lower daily variation suggesting that their consumption is consistent throughout the week (Lai et al. 2015, Tscharke et al. 2016). 3.4. REFINING THE WASTEWATER CATCHMENT POPULATION ESTIMATE In reports one to three, the estimate of the residential population living within the boundary of the wastewater catchments has been provided by the wastewater treatment authorities. These populations have been used to calculate the consumption of substances to units of mg/day/1,000 people or doses/day/1,000 people. These populations have been estimated in various ways, including the number of water connections, the number of municipal wheelie bins within the catchment, the total flow volume received at the treatment plant, plant capacity projections, or the organic nutrient loads within the wastewater. For the first time in this report, we have refined the population estimate using a new methodology, which will increase the accuracy of the population estimate. The catchment maps that were provided by wastewater treatment authorities were geo-referenced (input into GIS software) and merged with the 2016 ABS mesh blocks (the smallest unit of population published by the ABS, typically containing between 30 to 60 dwellings). An example of a hypothetical catchment, typical of this study, is shown in Figure 4. The population within the overlapping catchment and mesh block areas was summed to provide the population estimate for the catchment. In instances where the mesh block was not contained fully within the catchment boundary, the ratio of the population was estimated based on the proportion of area within the catchment (for instance, if 50 per cent of an individual mesh block area was within the catchment, then 50 per cent of the population of that mesh block was used in the estimate). Overall, an estimate of the possible 21 Australian Criminal Intelligence Commission National Wastewater Drug Monitoring Program—Report 4, March 2018 catchment population undercount or overcount using this estimation method was calculated and is included in Appendix 4. This is discussed further in Appendix 5, along with a diagram. On average, the total population overcount or undercount was very low at around four per cent, indicating a high precision of the refined population estimate method. The resulting population estimates for each catchment are the most accurate using the 2016 Australian Census and should well-reflect the average resident population. Figure 4: Example catchment boundary map (red line) and ABS mesh block data (black lines) layered on top of Google satellite imagery (background). Note: map does not depict a real wastewater catchment. 1 0 1 2 3 4 km 22 Australian Criminal Intelligence Commission National Wastewater Drug Monitoring Program—Report 4, March 2018 4: RESULTS Estimated drug consumption data are presented in several different ways in the following sections to allow comparisons of drug use at the individual site level (Section 4.1), between states and territories (Section 4.2) and within each state and territory (Section 4.3). We recommend exercising caution when comparing results between sites. A list of the detection frequency for each drug is found in Appendix 6. For this report we have refined the current population estimates for higher accuracy by integrating the specific wastewater catchment areas against the high-resolution population data recently released from the 2016 Census. The uncertainties in individual population estimates have less impact when data are averaged, for example when broader comparisons at the state/territory or international level are undertaken. The uncertainties in population numbers are particularly evident in smaller regional communities or sites where short-term population changes occur due to employment opportunities, tourism or festival events. 4.1. INDIVIDUAL SITE COMPARISON OF DRUG USE IN DECEMBER 2017 4.1.1 NICOTINE AND ALCOHOL Tobacco consumption was estimated by measuring two nicotine metabolites. The method does not distinguish between nicotine intake from tobacco or electronic cigarettes and nicotine replacement therapies, such as patches and gums. Therefore, for the sake of accuracy, the estimate is reported as nicotine in this report. Estimated nicotine consumption varied significantly between sites and regions (Figure 5). Sites in regional areas across all states and territories showed noticeably higher per capita consumption levels during December 2017 than capital city precincts. This was evident from the regional vs. capital city averages for the December sampling period (red horizontal and dotted blue lines, Figure 5). South Australia was the only region where consumption in capital city sites matched rural levels. Alcohol was measured using a specific metabolite of ethanol. Differences between the average capital city and regional centre alcohol consumption were less pronounced than for nicotine (Figure 6). Many sites showed a wide range over the collection week. Alcohol consumption in some regional areas of Western Australia, South Australia and parts of Queensland were well below the national average. However, many regional sites did not sample on weekends, when consumption of alcohol is typically higher. The Northern Territory, capital sites of Tasmania and a couple of Western Australian sites were above the national capital city and regional averages. 23 Australian Criminal Intelligence Commission National Wastewater Drug Monitoring Program—Report 4, March 2018 Figure 5: Estimated nicotine consumption for December 2017 in mass of nicotine consumed per day (left axis) and number of cigarettes per day (right axis) per thousand people. The number of collection daysAverage varied fromAverage 4–7. Average Nicotine 6000 4000 3500 4000 3000 2500 3000 2000 2000 1500 Estimated Consumption (Cigarettes / 1000 People / Day) 5000 Estimated Consumption (mg Nicotine / 1000 People / Day) 4500 ƒƒ High regional average ƒƒ Variable consumption 1000 1000 500 * * * * * * ** * * * * * * * 0 009 003 006 008 021 071 016 025 040 051 068 081 115 010 085 078 002 005 011 012 020 024 028 029 033 039 053 077 007 013 027 059 017 022 063 076 117 119 004 019 041 018 038 048 058 001 067 037 046 061 062 066 114 101 103 104 102 116 118 120 0 ACT NSW NT QLD SA All Site Average Regional Capital Capital Average TAS VIC WA Regional Average * No Data Figure 6: Estimated alcohol consumption for December 2017 in volume consumed per day (left axis) and standard drinks per day (right axis) per thousand people. The number of collection days varied from 4–7. Alcohol 70 Estimated Consumption (Litres of Ethanol / 1000 People / Day) 40 3000 30 2000 20 1000 10 ** * * * * * * * * * * * 0 009 003 006 008 021 071 016 025 040 051 068 081 115 010 085 078 002 005 011 012 020 024 028 029 033 039 053 077 007 013 027 059 017 022 063 076 117 119 004 019 041 018 038 048 058 001 067 037 046 061 062 066 114 101 103 104 102 116 118 120 * * Estimated Consumption (Standard Drinks / 1000 People / Day) 4000 50 0 Dose 10000 5000 ƒƒ Capital city and regional averages similar ƒƒ Wide weekly spread ƒƒ Relatively high level in NT 60 ACT NSW Capital NT Regional QLD SA All Site Average Capital Average TAS VIC Regional Average WA * No Data 4.1.2 STIMULANTS The relative estimated consumption levels across the participating sites for four stimulants— methylamphetamine, cocaine, MDMA and MDA—are described in more detail below. 24 Australian Criminal Intelligence Commission National Wastewater Drug Monitoring Program—Report 4, March 2018 4.1.2.1 METHYLAMPHETAMINE Estimated mass loads of methylamphetamine were high compared to other illicit substances. The average regional and capital city consumption were at similar levels. However, large site differences were evident. The high variability in consumption was observed across all states. Mass loads in capital city South Australia were the highest in the nation in December 2017 (Figure 7), while a site in Victoria had the highest regional mass load. Figure 7: Estimated methylamphetamine consumption for December 2017 in mass consumed per day (left axis) and doses per day (right axis) per thousand people. The number of collection days varied from 4–7. Methylamphetamine 4500 Estimated Consumption (mg / 1000 People / Day) 3500 140 Capital city and regional averages similar Capital city SA and regional WA high Highest mass load in a regional Victoria site Variable across sites 120 3000 100 2500 80 2000 60 1500 40 1000 Estimated Consumption (Doses / 1000 People / Day) ƒƒ ƒƒ ƒƒ ƒƒ 4000 20 500 ** * * * * * * * * * * * * * 0 009 003 006 008 021 071 016 025 040 051 068 081 115 010 085 078 002 005 011 012 020 024 028 029 033 039 053 077 007 013 027 059 017 022 063 076 117 119 004 019 041 018 038 048 058 001 067 037 046 061 062 066 114 101 103 104 102 116 118 120 0 ACT NSW Capital NT Regional QLD SA All Site Average Capital Average TAS VIC Regional Average WA * No Data 4.1.2.2 AMPHETAMINE The concentration of amphetamine observed in the August 2016 and December 2017 samples strongly correlated with the methylamphetamine concentrations, with approximately seven times higher methylamphetamine measured than amphetamine for both periods (see Appendix 4 of Report 1) which is consistent with the reported amphetamine excretion range following methylamphetamine consumption (Gracia-Lor et al. 2016). Therefore, we assumed that the levels of amphetamine measured were predominantly metabolites of methylamphetamine. It is possible that some of the amphetamine measured could be a result of amphetamine ingestion, but due to the much higher methylamphetamine consumption and excretion profile, this cannot be confirmed by our present data. 4.1.2.3 COCAINE Cocaine was measured using its specific metabolite, benzoylecgonine. Unlike methylamphetamine, capital city areas on average had higher cocaine use than regional centres (Figure 8). However, it has to be recognised that many regional sites did not provide weekend samples, unlike capital cities, when consumption of cocaine is known to peak (Lai et al., 2016 and Tscharke et al., 2016). Western Australia had relatively low consumption in both regional and capital city areas. In contrast, capital city New South Wales showed the highest levels nationwide, while consumption in regional parts of the state was also higher than the national average. Nevertheless, the scale of cocaine use in Australia remained noticeably lower than methylamphetamine levels. 25 Australian Criminal Intelligence Commission National Wastewater Drug Monitoring Program—Report 4, March 2018 Figure 8: Estimated cocaine consumption for December 2017 in mass consumed per day per thousand people (left axis) and doses per day (right axis). The number of collection days varied from 4-7. Cocaine 4000 ƒƒ High levels in NSW, QLD and ACT city sites ƒƒ Regional consumption low, but may be effect of week day sampling 3500 35 30 2500 25 2000 20 1500 15 1000 10 500 5 ** * * * * * * * * * * * * * 0 009 003 006 008 021 071 016 025 040 051 068 081 115 010 085 078 002 005 011 012 020 024 028 029 033 039 053 077 007 013 027 059 017 022 063 076 117 119 004 019 041 018 038 048 058 001 067 037 046 061 062 066 114 101 103 104 102 116 118 120 0 Estimated Consumption (Doses / 1000 People / Day) 3000 Estimated Consumption (mg / 1000 People / Day) 40 ACT NSW NT Capital QLD SA All Site Average Regional Capital Average TAS VIC Regional Average WA * No Data 4.1.2.4 MDMA (3,4-METHYLENEDIOXYMETHYLAMPHETAMINE) In comparison with other illicit substances, estimated consumption of MDMA was low across the country (Figure 9). Site 10 in capital city Northern Territory had relatively high levels on some days of the week, but in general, levels were comparable across the nation. The regional average was slightly lower than capital city sites. A direct comparison of regional and capital city sites in some states (e.g. South Australia) may be inappropriate, as many regional sites did not sample on weekends when MDMA consumption is typically higher. Figure 9: Estimated MDMA consumption for December 2017 in mass consumed per day (left axis) and doses per day (right axis) per thousand people. The number of collection Average Average Average days varied from 4–7. MDMA 1600 16 ƒƒ Low use across the country ƒƒ Wide weekly spread indicates higher weekend use 14 1200 12 1000 10 800 8 600 6 400 4 200 2 ** * * * * * * * * * * * * * 0 009 003 006 008 021 071 016 025 040 051 068 081 115 010 085 078 002 005 011 012 020 024 028 029 033 039 053 077 007 013 027 059 017 022 063 076 117 119 004 019 041 018 038 048 058 001 067 037 046 061 062 066 114 101 103 104 102 116 118 120 0 Estimated Consumption (Doses / 1000 People / Day) Estimated Consumption (mg / 1000 People / Day) 1400 ACT NSW Capital NT Regional QLD SA All Site Average Capital Average TAS VIC Regional Average WA * No Data 26 Australian Criminal Intelligence Commission National Wastewater Drug Monitoring Program—Report 4, March 2018 4.1.2.5 MDA (3,4-METHYLENEDIOXYAMPHETAMINE) MDA previously had low overall detection frequency using a direct injection method. In this latest report, the compound was detected after concentrating the sample using solid phase extraction (SPE) prior to analysis to improve the sensitivity of the method. Data is not available in the scientific literature for the proportion of MDA that is eliminated after MDA consumption. However, data is available detailing the proportion of MDA eliminated after MDMA consumption. Therefore, the proportion of MDA attributable from MDMA metabolism was subtracted from the total measured amount of MDA for each site. Data for MDA is expressed as mg excreted per 1,000 people per day and cannot be expressed as consumption due to the lack of metabolic information of MDA elimination following MDA consumption. Although the dosage of MDA is not known, it is likely to be similar to that of MDMA, of around 100 mg. The daily mass loads for regional sites were on average higher than capital cities (Figure 10). Site 12 in Queensland had very high levels compared to other sites in the state and elsewhere and may have distorted the average value for regional centres. Since the parent drug is measured in wastewater, disposal of unused drug into the sewer system may result in unusually high values being recorded. South Australia generally had the lowest levels of MDA, both in regional and capital city centres. Figure 10: Estimated MDA consumption for December 2017 in mass consumed per day per thousand people. The number of collection days varied from 4-7.Average Average Average 102 MDA 80 ƒƒ Higher regional average ƒƒ Very high level at QLD Site 12 ƒƒ Raises regional average from 9.8 to 12.4 70 70 60 50 50 40 40 30 30 20 20 10 10 ** * * * * * * * * * * * * * 0 009 003 006 008 021 071 016 025 040 051 068 081 115 010 085 078 002 005 011 012 020 024 028 029 033 039 053 077 007 013 027 059 017 022 063 076 117 119 004 019 041 018 038 048 058 001 067 037 046 061 062 066 114 101 103 104 102 116 118 120 0 ACT NSW Capital NT Regional QLD SA All Site Average Capital Average TAS VIC Regional Average WA * No Data The arrow above the graph indicates the maximum of QLD Site 012. The axes remain at a smaller value to allow comparison between areas of lower MDA excretion. 27 Estimated Consumption (mg / 1000 People / Day) 60 Estimated Consumption (mg / 1000 People / Day) 80 Australian Criminal Intelligence Commission National Wastewater Drug Monitoring Program—Report 4, March 2018 4.1.3 OPIOIDS Two pharmaceutical opioids were measured, as well as heroin, an illicit drug. 4.1.3.1 PHARMACEUTICAL OPIOIDS Although oxycodone and fentanyl are legally prescribed pharmaceuticals, they are substances with abuse potential. The metabolism and excretion of both compounds are well characterised. The major metabolite of each compound was measured to estimate drug consumption. Consumption of oxycodone in regional sites was well above capital city levels, with the regional national average being higher than that of the capital cities (Figure 11). Regional Queensland and parts of Tasmania and Victoria were amongst the highest overall users of oxycodone, while Tasmania was highest of the capital city sites and Victoria the highest of the regional sites. The extent of fentanyl use was very variable across the nation. Some regional centres in almost every state had values well above the national average (Figure 12). Two locations in particular, Site 81 and Site 16 in New South Wales, gave values that were almost 2–3 fold higher than the next highest measurement. Except for Tasmania, regional consumption was substantially higher than capital city areas. Rates of fentanyl use in capital cities across Australia were of comparable levels, with relatively small differences in per capita consumption per day between sites. Figure 11: Estimated oxycodone consumption for December 2017 in mass consumed per day (left axis) and doses per day (right axis) per thousand people. The number of Average Average Average collection days varied from 4–7. Oxycodone 600 ƒƒ Higher and variable regional average ƒƒ Highest capital sites in Tasmania 500 25 400 20 300 15 200 10 100 5 ** * * * * * * * * * * * * * 0 009 003 006 008 021 071 016 025 040 051 068 081 115 010 085 078 002 005 011 012 020 024 028 029 033 039 053 077 007 013 027 059 017 022 063 076 117 119 004 019 041 018 038 048 058 001 067 037 046 061 062 066 114 101 103 104 102 116 118 120 0 Estimated Consumption (Doses / 1000 People / Day) Estimated Consumption (mg / 1000 People / Day) 30 ACT NSW Capital NT Regional QLD SA All Site Average Capital Average TAS VIC Regional Average WA * No Data 28 Australian Criminal Intelligence Commission National Wastewater Drug Monitoring Program—Report 4, March 2018 Figure 12: Estimated fentanyl consumption for December 2017 in mass consumed per day (left axis) and doses per day (right axis) per thousand people. TheAverage number of collection Average Average days varied from 4–7. Fentanyl 10 ƒƒ Higher and variable regional average ƒƒ NSW Site 81 unusually high at ƒƒ 7.7 mg/1 000/day and Site 16 with 6.6 mg/1 000/day 9 8 7 25 20 6 15 5 4 10 3 2 Estimated Consumption (Doses / 1000 People / Day) Estimated Consumption (mg / 1000 People / Day) 30 5 1 ** * * * * * * * * * * * * * 0 009 003 006 008 021 071 016 025 040 051 068 081 115 010 085 078 002 005 011 012 020 024 028 029 033 039 053 077 007 013 027 059 017 022 063 076 117 119 004 019 041 018 038 048 058 001 067 037 046 061 062 066 114 101 103 104 102 116 118 120 0 ACT NSW NT Capital QLD SA All Site Average Regional Capital Average TAS VIC WA Regional Average * No Data 4.1.3.2 HEROIN Heroin is metabolised by users and excreted in low amounts as the unique metabolite, 6-monoacetylmorphine (6-MAM). A method to detect heroin by 6-monoacetylmorphine was described in a paper by Tscharke et al., 2016. Since 6-MAM is characteristic of heroin use, it can be used to distinguish heroin from other opioids such as morphine and codeine. Heroin consumption in Australia in December 2017 was relatively low (Figure 13). Some regional areas of Tasmania and New South Wales recorded the highest levels of all measured locations. South Australia remains lower nationally. Figure 13: Estimated heroin consumption for December 2017 in mass consumed per day (left axis) and doses per day (right axis) per thousand people. The number of collection Average Average Average days varied from 4–7. Heroin 300 ƒƒ Lower regional use, with some clear exceptions ƒƒ Higher consumption in VIC 200 12 10 8 150 6 100 4 50 2 ** * * * * * * * * * * * * * 009 003 006 008 021 071 016 025 040 051 068 081 115 010 085 078 002 005 011 012 020 024 028 029 033 039 053 077 007 013 027 059 017 022 063 076 117 119 004 019 041 018 038 048 058 001 067 037 046 061 062 066 114 101 103 104 102 116 118 120 0 ACT NSW Capital 29 14 NT Regional QLD SA All Site Average Capital Average TAS VIC Regional Average WA * No Data 0 Estimated Consumption (Doses / 1000 People / Day) Estimated Consumption (mg / 1000 People / Day) 250 Australian Criminal Intelligence Commission National Wastewater Drug Monitoring Program—Report 4, March 2018 4.1.4 NEW PSYCHOACTIVE SUBSTANCES Methylone and mephedrone were included in the study. Limited information is available on the human metabolism and excretion of these drugs. Therefore, the parent compound was measured. It is probable that a significant proportion of the ingested drug is converted into different metabolites. Apart from sporadic instances of methylone detections in Queensland, only a few sites showed evidence of methylone and mephedrone use. The measured levels were mostly below the limits of reporting. Sites that showed the presence of the two compounds are qualitatively listed in Table 3 for the December 2017 period. The temporal changes in detections per state (number of samples above LOD) are shown in Figure 14. Table 3. The number and code of sites per state and territory where mephedrone and methylone were detected in December 2017. The total number of daily samples that were assessed was 288. Number of detections Dec 2017 State/territory Sites detected Dec 2017 Mephedrone Methylone Mephedrone Methylone NT 0 3 010 ACT 0 1 009 NSW 18 31 006, 008, 068 003, 006, 008, 016, 025, 068, 115 QLD 5 10 002, 012, 029 005, 012 SA 0 4 063 TAS 0 3 018 VIC 0 13 001, 067, 061, 114 WA 0 0 Total 23 65     Figure 14: The percentage of all samples where mephedrone and methylone were detected. Mephedrone detections 80 60 40 ACT NSW Capital NT Regional QLD All Site Average SA TAS Capital Average Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - 0 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - 20 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - Percentage detections within each capital or regional area by jurisdiction (%) 100 WA VIC Regional Average * No Data 30 Australian Criminal Intelligence Commission National Wastewater Drug Monitoring Program—Report 4, March 2018 Figure 14 (continued): The percentage of all samples where mephedrone and methylone were detected. Methylone detections 80 60 40 ACT NSW Capital Percentage detection of all samples (%) 50 40 NT Regional QLD All Site Average SA TAS Capital Average Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - 0 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - 20 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - Percentage detections within each capital or regional area by jurisdiction (%) 100 VIC Regional Average WA * No Data Total detections by sampling period Aug 2016 Oct 2016 Dec 2016 Feb 2017 Apr 2017 Jun 2017 Aug 2017 Oct 2017 Dec 2017 30 20 10 0 Mephedrone Methylone 4.2. STATE AND TERRITORY COMPARISON OF DRUG USE The total level of each drug outlined in the preceding reports per state or territory was compared with subsequent collection periods included in the current report. Every effort was made to assess the same sites for each period. However, as the individual sites and the number of sites used to generate the population-weighted averages may have changed between periods, comparing between time points should be done with caution. This would be most evident for the regional averages, which had more variation in participation between each period (see Appendix 3 for a comprehensive list of participating sites and number of days assessed per sampling campaign). Note: the lines on each graph representing averages are the cumulative average across all sampling time points. 31 Australian Criminal Intelligence Commission National Wastewater Drug Monitoring Program—Report 4, March 2018 4.2.1 NICOTINE AND ALCOHOL Average nicotine consumption in samples collected from regional sites was generally higher when compared to the capital cities (Figure 15). In some states and territories, nicotine consumption showed steady levels over the total collection periods. Western Australia showed an overall decrease for both capital city and regional areas. In the case of alcohol, the difference between overall capital city and regional centre consumption within each state or territory was less pronounced, except for South Australia, where regional use is almost half that of the capital city (Figure 16). For the most part, consumption levels remained steady with no apparent trend in terms of changes in use over time within each region. Figure 15: Estimated average consumption of nicotine by state/territory, where 1 cigarette contains 1.25 mg of nicotine. Nicotine 3500 2500 3000 2500 2000 2000 1500 1500 1000 1000 500 * * ** ** * *** Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - * ACT NSW Capital NT QLD SA All Site Average Regional TAS Capital Average Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - 500 0 3000 Estimated Nicotine Consumption (Cigarettes / 1000 People / Day) Estimated Consumption (mg Nicotine / 1000 People / Day) 3500 ƒƒ Mostly small changes in consumption over the year ƒƒ NT high capital city and regional values 4000 Estimated Consumption 4500 VIC Regional Average 0 WA * No Data Figure 16: Estimated average consumption of alcohol by state/territory. A standard drink is 10.0 g or 12.5 mL. Alcohol 3000 35 2500 30 25 2000 20 1500 15 1000 10 500 ACT NSW Capital NT Regional QLD All Site Average SA TAS Capital Average Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - ** ** Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - *** * Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - * Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - * Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - * Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - 0 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - 5 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - Estimated Consumption (Litres Ethanol / 1000 People / Day) 40 3500 Estimated Alcohol Consumption (Standard Drinks / 1000 People / Day) ƒƒ Mostly small changes in consumption over the year ƒƒ NT high capital city and regional values ƒƒ No weekend sampling in some regional sites may cause underestimation 45 Estimated Consumption 50 VIC Regional Average 0 WA * No Data 32 Australian Criminal Intelligence Commission National Wastewater Drug Monitoring Program—Report 4, March 2018 4.2.2 ILLICIT DRUGS The trend in methylamphetamine use was variable in many parts of the country (Figure 17). Consumption in the Australian Capital Territory, New South Wales, Tasmanian and Victoria remains stable, while Queensland is increasing, particularly in city sites. South Australia had the highest capital city consumption, but no clear trend was apparent. Western Australia had the highest regional levels of methylamphetamine consumption. When plotted against historical levels recorded in the three regions, the previously described decline or levelling off in methylamphetamine consumption in South Australia was largely maintained, while Western Australia is increasing. Levels in Victoria showed a decline (Site 67) or remained steady (Site 1) over the current and historical periods (Figure 18). It is not yet clear whether these are part of longer term trends. Figure 17: Estimated average consumption of methylamphetamine by state/territory. Methylamphetamine 3000 2500 90 70 2000 60 1500 50 40 1000 30 20 500 ACT NSW Capital NT Regional QLD SA All Site Average TAS Capital Average Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - * * ** Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - *** * Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - * Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - * Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - * Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - 0 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - 10 VIC Regional Average 0 WA * No Data 33 1800 60 QLD: Regional (012) 1200 40 600 20 0 No Data No Data No Data No Data 2009 2010 2011 2012 2013 2014 2015 Aug Oct Dec Feb Apr Jun Aug Oct Dec 2016 2016 2016 2017 2017 2017 2017 2017 2017 0 Estimated Methylamphetamine Consumption [Doses / 1000 People / Day] Estimated Methylamphetamine Consumption [mg / 1000 People / Day] Figure 18: Change in methylamphetamine consumption for sites with historical data. Estimated Consumption 80 Estimated Consumption (Doses / 1000 People / Day) Estimated Consumption (mg / 1000 People / Day) 100 ƒƒ Slight increase in WA and QLD ƒƒ Small variations elsewhere Australian Criminal Intelligence Commission National Wastewater Drug Monitoring Program—Report 4, March 2018 Estimated Methylamphetamine Consumption [mg / 1000 People / Day] 1200 40 600 20 0 1800 No Data No Data No Data No Data No Data 2009 2010 2011 2012 2013 2014 2015 Aug Oct Dec Feb Apr Jun Aug Oct Dec 2016 2016 2016 2017 2017 2017 2017 2017 2017 VIC: Melbourne (067) One or two weeks assessed per year 0 60 1200 40 600 20 0 1800 No Data 2009 2010 2011 2012 2013 2014 2015 Aug Oct Dec Feb Apr Jun Aug Oct Dec 2016 2016 2016 2017 2017 2017 2017 2017 2017 VIC: Melbourne (001) One or two weeks assessed per year 0 60 1200 40 600 20 0 SA: Adelaide (average of 007, 013, 027 & 059) 0 100 2400 80 1800 60 1200 40 600 20 0 2009 2010 2011 2012 2013 2014 2015 Aug Oct Dec Feb Apr Jun Aug Oct Dec 2016 2016 2016 2017 2017 2017 2017 2017 2017 0 Estimated Methylamphetamine Consumption [Doses / 1000 People / Day] 3000 No Data 2009 2010 2011 2012 2013 2014 2015 Aug Oct Dec Feb Apr Jun Aug Oct Dec 2016 2016 2016 2017 2017 2017 2017 2017 2017 Estimated Methylamphetamine Consumption [Doses / 1000 People / Day] Estimated Methylamphetamine Consumption [mg / 1000 People / Day] 60 QLD: Regional (033) Estimated Methylamphetamine Consumption [Doses / 1000 People / Day] Estimated Methylamphetamine Consumption [mg / 1000 People / Day] 1800 Estimated Methylamphetamine Consumption [Doses / 1000 People / Day] Estimated Methylamphetamine Consumption [mg / 1000 People / Day] Figure 18 (continued): Change in methylamphetamine consumption for sites with historical data. 34 Australian Criminal Intelligence Commission National Wastewater Drug Monitoring Program—Report 4, March 2018 3000 100 WA: Perth (average of 101, 103, 104) 2400 80 1800 60 1200 40 600 20 No Data 0 2009 2010 2011 2012 2013 2014 2015 Aug Oct Dec Feb Apr Jun Aug Oct Dec 2016 2016 2016 2017 2017 2017 2017 2017 2017 0 Estimated Methylamphetamine Consumption [Doses / 1000 People / Day] Estimated Methylamphetamine Consumption [mg / 1000 People / Day] Figure 18 (continued): Change in methylamphetamine consumption for sites with historical data. The consumption of cocaine in capital city sites in New South Wales remained high for the duration of the monitoring period compared to other Australian regions (Figure 19). The upward trend in consumption observed in the previous report for the Australian Capital Territory continued after April 2017. Small increases were evident in other states, but these are from a very low base. Regional consumption was noticeably lower than in capital cities in every state and territory, except Queensland. Western Australia and Tasmania remained well below the national average. Figure 19: Estimated average consumption of cocaine by state/territory. Cocaine 14 ƒƒ Increased use in capital city ACT, NSW, QLD and SA ƒƒ Variable changes elsewhere 12 600 6 400 4 200 2 ACT NSW Capital NT Regional QLD All Site Average SA * * ** Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - *** * Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - * Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - * Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - * Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - 0 TAS Capital Average Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - 8 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - 800 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - 10 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - 1000 VIC Regional Average Estimated Consumption (Doses / 1000 People / Day) Estimated Consumption (mg / 1000 People / Day) 1200 0 WA * No Data MDMA use in Australia appeared to be on the decline in all states and territories, except the South Australian capital city region (Figure 20). Use in the Northern Territory remained high compared to other parts of the country, but the August 2017 figure was well down on the initial value recorded a year ago. Regional centres showed levels slightly below the capital city locations. However, this may be attributable to some regional sites not providing weekend samples, when consumption is typically higher. The actual trend would not be affected by sampling day and is a reasonable measure of changes in consumption over the study period. 35 Estimated Consumption 1400 ACT NSW Capital Capital NSW Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - Regional NT * NT Regional 100 QLD All Site Average QLD All Site Average Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - *** * SA SA Capital Average Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - Capital Average TAS * * ** TAS Regional Average Regional Average Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - ƒƒ Large variations amplified by relatively low consumption ƒƒ Declining rates of use in many areas 800 8 600 6 400 4 200 2 VIC MDA ƒƒ No historical data ƒƒ High use in regional QLD 80 80 70 70 60 60 50 50 40 40 30 30 20 20 10 10 0 0 VIC Estimated Consumption MDMA Estimated Excretion (mg / 1000 People / Day) ACT * Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - 1000 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - * Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - 0 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - 90 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - Estimated Consumption (mg / 1000 People / Day) 1200 Estimated Consumption (Doses / 1000 People / Day) Estimated Excretion (mg / 1000 People / Day) Australian Criminal Intelligence Commission National Wastewater Drug Monitoring Program—Report 4, March 2018 Figure 20: Estimated average consumption of MDMA by state/territory. 12 10 0 WA * No Data MDA use, corrected for the proportion derived from MDMA (Khan & Nicell 2011), showed that regional Queensland had the highest levels, while most other states and territories were very similar (Figure 21). South Australia and capital city New South Wales were at levels below average. The regional and overall national averages were skewed somewhat by the high MDA levels detected at Site 012 in Queensland. Figure 21: Estimated average consumption of MDA by state/territory. 100 90 * No Data WA 36 * ACT * Capital NSW Regional NT 3.5 * QLD All Site Average Capital Average TAS *** * SA Capital Average Regional Average * * ** TAS Regional Average Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - 4.0 SA Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - * * ** Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - Regional All Site Average *** * Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - QLD Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - Capital NT Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - NSW * Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - ACT Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - * Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - 300 16 250 14 12 200 10 150 8 100 6 50 4 2 VIC Fentanyl ƒƒ Consistently higher regional use in many states and territories ƒƒ Small overall annual changes in capital cities 3.0 2.5 2.0 1.5 1.0 0.5 VIC * No Data WA 0 WA * No Data Figure 23: Estimated average consumption of fentanyl by state/territory. 20 18 16 14 12 10 8 6 4 2 0 Estimated Consumption ƒƒ High regional use showing declining trends ƒƒ Capital city consumption trending downwards except in the ACT and TAS Estimated Consumption Oxycodone Estimated Consumption (Doses / 1000 People / Day) 37 * Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - 350 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - 400 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - Estimated Consumption (mg / 1000 People / Day) 450 Estimated Consumption (Doses / 1000 People / Day) 0.0 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - 0 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - Estimated Consumption (mg / 1000 People / Day) Australian Criminal Intelligence Commission National Wastewater Drug Monitoring Program—Report 4, March 2018 4.2.3 OPIOIDS The average levels of oxycodone and fentanyl use were higher in regional areas of a number of states (Figure 22 and Figure 23). Since the first report in March 2017, which contained analysis of samples collected in August 2016, consumption of the pharmaceutical opioids declined in some regions; for example, regional New South Wales, South Australia and Western Australia. Capital cities of the Australian Capital Territory and Tasmania showed an increase in consumption, particularly for oxycodone. Some fluctuations in use were evident for the most part in other states and territories. The variation in participating rural sites (and hence the sampled populations) may also have an effect on the observed trend of the population-weighted averages. Figure 22: Estimated average consumption of oxycodone by state/territory. 22 20 18 Australian Criminal Intelligence Commission National Wastewater Drug Monitoring Program—Report 4, March 2018 While heroin was included for the second time and historical data are lacking for most sites, a state and territory comparison of the use of the substance showed that consumption was highest in Victoria (Figure 24). In general, regional areas of each state had lower levels of heroin use, with New South Wales the only exception. The extent of heroin consumption has been measured in capital city South Australia since 2013. Together with the current reporting period, levels of heroin consumption for the region have been slightly declining (Figure 25). Figure 24: Estimated average consumption of heroin by state/territory. Heroin 250 10 8 150 6 100 4 50 ACT NSW Capital NT Regional QLD All Site Average SA TAS Capital Average Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - 2 Aug 2016 Dec 2016 Apr 2017 Aug 2017 Dec 2017 - 0 Estimated Excretion 200 Estimated Consumption (Doses / 1000 People / Day) Estimated Alcohol Consumption Estimated Consumption (mg / 1000 People / Day) 12 ƒƒ No historical data to show trends across Australia ƒƒ Consumption highest in VIC VIC Regional Average 0 WA * No Data Figure 25: Change in heroin consumption in South Australia. 175 SA: Adelaide (average of 007, 013, 027 & 059) The 2016 bar represents the average of Feb, Apr and Jun 150 6 125 4 100 75 2 50 Estimated Heroin Consumption [Doses / 1000 People / Day] Estimated Heroin Consumption [mg / 1000 People / Day] 200 25 0 2013 2014 2015 2016 Aug Oct Dec Feb Apr Jun Aug Oct Dec 2016 2016 2016 2017 2017 2017 2017 2017 2017 0 4.2.4 NEW PSYCHOACTIVE SUBSTANCES (NPS) Methylone and mephedrone were only detected sporadically and at very low levels compared to other substances included in the report (December mephedrone and methylone results are shown in Table 3). 38 Australian Criminal Intelligence Commission National Wastewater Drug Monitoring Program—Report 4, March 2018 4.2.5 CAPITAL CITY AVERAGES For the purposes of determining representative population trends for the collective catchments included in the report over the total sampling period, the averaged capital city site populations were expressed as the total capital average consumption of illicit stimulants (Figure 26). A complication with this type of analysis was that fewer sites were sampled between August 2016 and December 2017, so the contributing population was smaller between these dates. Some approximations had to be made to account for the absence of some densely populated regions (e.g. October 2016 for capital city New South Wales and Queensland). For the total population included in the report, methylamphetamine appeared to show a steady decline from October 2016 to June 2017, with an increase from August 2017. With additional data from future collections, the significance of any trend will become more apparent. MDMA levels declined overall over the year on year reporting period, but since detected levels are very low, the result may not be significant. Cocaine consumption has shown an overall increase since August 2016. In terms of legal substances with abuse potential, nicotine consumption remained largely unchanged over the reporting period (Figure 27). In contrast, the two pharmaceutical opioids included in the study showed an overall decline in capital city areas since August 2016. In regional areas, fentanyl remained steady for the year on year period, but showed a decline from August 2016 to April 2017. In the case of alcohol, marginal changes were evident. All regional sites 1200 40 600 20 0 300 300 Oct 16 Dec 16 Feb 17 Apr 17 Jun 17 Aug 17 Oct 17 Dec 2017 Weighted average consumption of MDMA Weighted Weighted average average consumption consumption of of MDMA MDMA All capital sites All All capital capital sites sites 3.0 3.0 250 3.0 2.5 200200 200 2.0 2.0 2.0 150150 150 1.5 1.5 1.5 100100 100 1.0 1.0 1.0 50 50 50 0.5 0.5 0.5 Feb 17 Feb 17 Feb 17 Apr Apr 17 17 Apr 17 0.0 0.0 0.0 Aug 17 17 2017 17 Oct 17 Dec 2017 Jun 17 Aug Aug 17 Oct Oct 17DecDec 2017 Jun Jun 17 17 Estimated MDMA consumption [Doses / 1000 People / Day] All regional sites All All regional regional sites sites 2.5 Capital data estimated 2.5 Capital data Capital data estimated estimated for QLD, NSW for for QLD, QLD, NSW NSW 250250 0 Estimated EstimatedMDMA MDMAconsumption consumption [Doses [Doses//1000 1000People People//Day] Day] [mg [mg//1000 1000People People//Day] Day] Aug 16 0 0 0 Aug Oct Dec Aug 16 Oct 16 Dec 16 16 Aug 1616 Oct 1616 Dec 16 39 60 All capital sites Capital data estimated for QLD, NSW 300 Estimated MDMA consumption [mg / 1000 People / Day] Estimated Estimated MDMA MDMA consumption consumption Weighted average consumption of methylamphetamine 1800 Estimated methylamphetamine consumption [Doses / 1000 People / Day] Estimated methylamphetamine consumption [mg / 1000 People / Day] Figure 26: The population-weighted average of all sites for methylamphetamine, MDMA and cocaine. Australian Criminal Intelligence Commission National Wastewater Drug Monitoring Program—Report 4, March 2018 Figure 26 (continued): The population-weighted average of all sites for methylamphetamine, MDMA and cocaine. Weighted average consumption of cocaine 9 All capital sites 800 All regional sites 8 700 Capital data estimated for QLD, NSW 7 600 6 500 5 400 4 300 3 200 2 100 1 0 Aug 16 Oct 16 Dec 16 Feb 17 Apr 17 Jun 17 Aug 17 Oct 17 Dec 2017 Estimated cocaine consumption [Doses / 1000 People / Day] Estimated cocaine consumption [mg / 1000 People / Day] 900 0 As Queensland and New South Wales capital city sites were not sampled in October 2016, their average consumption in August and December 2016 was used to provide the overall October estimate. Regional areas were only sampled every second collection period. Figure 27: The population-weighted average of all sites for nicotine, alcohol, oxycodone, fentanyl and heroin. Weighted average consumption of nicotine All capital sites All regional sites 2800 Capital data estimated for QLD, NSW 2400 2000 800 800 400 400 Aug 16 Oct 16 Dec 16 Feb 17 Apr 17 Jun 17 Aug 17 Oct 17 Dec 2017 0 Weighted average consumption of alcohol All capital sites All regional sites 2100 Capital data estimated for QLD, NSW 1800 1500 1200 900 600 300 Aug 16 Oct 16 Dec 16 Feb 17 Apr 17 Jun 17 Aug 17 Oct 17 Dec 2017 Estimated alcohol consumption [Standard Drinks / 1000 People / Day] Estimated alcohol consumption [Litres / 1000 People / Day] 2000 1200 1200 30 28 26 24 22 20 18 16 14 12 10 8 6 4 2 0 2400 1600 1600 0 2800 Estimated nicotine consumption [Cigarettes / 1000 People / Day] Estimated nicotine consumption [mg / 1000 People / Day] 3200 0 40 Australian Criminal Intelligence Commission National Wastewater Drug Monitoring Program—Report 4, March 2018 Figure 27 (continued): The population-weighted average of all sites for nicotine, alcohol, oxycodone, fentanyl and heroin. Weighted average consumption of oxycodone All capital sites All regional sites 250 Capital data estimated for QLD, NSW 8 150 6 100 4 50 2 Aug 16 Oct 16 Apr 17 Jun 17 Aug 17 Oct 17 Dec 2017 0 All capital sites 2.5 Capital data estimated for QLD, NSW 2.0 14 12 10 8 1.5 6 1.0 4 0.5 2 Aug 16 Oct 16 Dec 16 Feb 17 Apr 17 Jun 17 Aug 17 Oct 17 Dec 2017 Weighted average consumption of heroin All capital sites 0 7.5 6.0 100 4.5 75 3.0 50 1.5 25 0 Aug 17 Oct 17 Dec 2017 0.0 As Queensland and New South Wales capital city sites were not sampled in October 2016, their average consumption in August and December 2016 was used to provide the overall October estimate. Regional areas were only sampled every second collection period. 41 Estimated heroin consumption [Doses / 1000 People / Day] All regional sites 125 Estimated fentanyl consumption [Doses / 1000 People / Day] Estimated fentanyl consumption [mg / 1000 People / Day] Feb 17 All regional sites 150 Estimated heroin consumption [mg / 1000 People / Day] Dec 16 Weighted average consumption of fentanyl 3.0 0.0 12 10 200 0 14 Estimated oxycodone consumption [Doses / 1000 People / Day] Estimated oxycodone consumption [mg / 1000 People / Day] 300 Australian Criminal Intelligence Commission National Wastewater Drug Monitoring Program—Report 4, March 2018 4.3. DRUG PROFILE FOR EACH STATE AND TERRITORY In order to compare the scale of use of different types of drugs within the same region (for example, within a state or territory), drug consumption was reported as the number of doses consumed. When the amount of drug measured in wastewater was normalised for population size and average dose consumed (conversion factors listed in the first National Wastewater Drug Monitoring Program report and in Appendix 1), alcohol and nicotine remained consistently the highest consumed drugs in all states and territories. For example, the national average consumption of nicotine and alcohol per 1,000 people per day were 1,480 cigarettes per 1,000 people (Figure 5) and 1,370 standard drinks per day per 1,000 (Figure 6), whereas for methylamphetamine, the national average consumption was closer to 40 doses per 1,000 people per day (Figure 7). In agreement with previous reports, methylamphetamine consumption remained the highest amongst the measured illicit drugs and opioids in this report, across all regions of Australia (Figure 28 and Figure 29). This trend was consistent for both capital cities and regional sites. Based on the consumption profiles of other drugs detected in this study (cocaine, MDMA, oxycodone and fentanyl), no other consistent patterns of usage within the different states and territories were observed. Oxycodone and fentanyl use were very similar within almost all states and territories, with small differences between the proportions in capital cities vs. regional areas. Figure 28: Profile of average drug consumption by state or territory, for ACT, NSW, NT and QLD. Consumption is shown as the number of doses per 1,000 people per day to allow comparison of drugs of different types within the same region (state or territory). Australian Capital Territory (ACT) 80.0 Capital Average Regional Average (None) National Capital Average National Regional Average 60.0 50.0 40.0 30.0 20.0 Methylamphetamine Cocaine MDMA Oxycodone Fentanyl Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- 0.0 Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- 10.0 Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Estimated Consumption (Doses / 1000 People / Day) 70.0 Heroin 42 0.0 43 Methylamphetamine Cocaine MDMA 70.0 60.0 Oxycodone Fentanyl Fentanyl Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Oxycodone Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Fentanyl Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- 60.0 Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- 70.0 Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Oxycodone Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- 60.0 Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- 70.0 Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- MDMA Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- 80.0 MDMA Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Cocaine Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- 80.0 Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Cocaine Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Estimated Consumption (Doses / 1000 People / Day) 80.0 Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Methylamphetamine Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Methylamphetamine Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- 0.0 Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Estimated Consumption (Doses / 1000 People / Day) 0.0 Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Estimated Consumption (Doses / 1000 People / Day) Australian Criminal Intelligence Commission National Wastewater Drug Monitoring Program—Report 4, March 2018 Figure 28 (continued): Profile of average drug consumption by state or territory, for ACT, NSW, NT and QLD. New South Wales (NSW) Capital Average Regional Average National Capital Average National Regional Average 50.0 40.0 30.0 20.0 10.0 Heroin Northern Territory (NT) Capital Average Regional Average National Capital Average National Regional Average 50.0 40.0 30.0 20.0 10.0 Heroin Queensland (QLD) Capital Average Regional Average National Capital Average National Regional Average 50.0 40.0 30.0 20.0 10.0 Heroin 0.0 Methylamphetamine Cocaine MDMA 60.0 Oxycodone Fentanyl Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- 70.0 Fentanyl Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Oxycodone Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- 80.0 Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- 90.0 Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- MDMA Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- 80.0 Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Cocaine Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Estimated Consumption (Doses / 1000 People / Day) 100.0 Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Methylamphetamine Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- 0.0 Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Estimated Consumption (Doses / 1000 People / Day) Australian Criminal Intelligence Commission National Wastewater Drug Monitoring Program—Report 4, March 2018 Figure 29: Profile of average drug consumption by state or territory, for SA, TAS, VIC and WA. Consumption is shown as the number of doses per 1,000 people per day to allow comparison of drugs of different types within the same region (state or territory). South Australia (SA) Capital Average Regional Average National Capital Average National Regional Average 70.0 60.0 50.0 40.0 30.0 20.0 10.0 Heroin Tasmania (TAS) Capital Average Regional Average National Capital Average National Regional Average 50.0 40.0 30.0 20.0 10.0 Heroin 44 0.0 45 Methylamphetamine Cocaine MDMA 60.0 Oxycodone Fentanyl Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- 70.0 Fentanyl Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Oxycodone Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- 60.0 Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- 70.0 Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- MDMA Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- 80.0 Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Cocaine Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Estimated Consumption (Doses / 1000 People / Day) 80.0 Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Methylamphetamine Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- 0.0 Aug 2016Dec 2016Apr 2017Aug 2017Dec 2017- Estimated Consumption (Doses / 1000 People / Day) Australian Criminal Intelligence Commission National Wastewater Drug Monitoring Program—Report 4, March 2018 Figure 29 (continued): Profile of average drug consumption by state or territory, for SA, TAS, VIC and WA. Victoria (VIC) Capital Average Regional Average National Capital Average National Regional Average 50.0 40.0 30.0 20.0 10.0 Heroin Western Australia (WA) Capital Average Regional Average National Capital Average National Regional Average 50.0 40.0 30.0 20.0 10.0 Heroin Australian Criminal Intelligence Commission National Wastewater Drug Monitoring Program—Report 4, March 2018 5: ACKNOWLEDGMENTS The project team sincerely thank the numerous WWTP operators involved in sample collection and WWTP management agencies for providing flow volumes and other site information. The cooperation of the plants and management agencies is critical to the ongoing success of this project. The University of South Australia would like to thank our funding partners, the Drug and Alcohol Services South Australia (DASSA), for their permission to use historical and current data from South Australia as well as the Western Australia Police Force for permission to use data from Western Australia. We would also like to acknowledge the efforts of other team members at the University of South Australia, including Lynn Nguyen for assistance with logistics and analytical methods. The University of Queensland thanks Geoff Eaglesham for his contributions to the analytical work for this study. We also thank the members of the Emerging Environmental Health Risks research group at QAEHS (incorporating the former Entox) for assistance with preparing and shipping over 1,000 sampling bottles to the various plants, and those members, past and present, who helped establish this field at the university. We also would like to acknowledge the wider wastewater-based epidemiology field which includes addiction specialists, analytical chemists, environmental engineers, forensic scientists, pharmacologists, policy advisers and sewer engineers for their ongoing contributions to knowledge, willingness to share both methodology and data, critical review and for advancing wastewater analysis research. 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DOI: 10.1289/ehp.11022 48 Australian Criminal Intelligence Commission National Wastewater Drug Monitoring Program—Report 4, March 2018 7: APPENDICES APPENDIX 1: DRUG-SPECIFIC PARAMETERS FOR ANALYTICAL REPORTING AND USAGE CALCULATIONS Analyte levels of detection, levels of reporting, highest detection, excretion factors and standard doses from the literature. Level of reporting Level of detection (LOD) [ng/L] Excretion Factor Standard dose pure drug (mg) (LOR) [ng/L] Amphetamine 12 16 0.394a 30b Cocaine 17 50 0.075b 100b Cotinine 33 100 0.3c 1.25c Norfentanyl 0.1 0.1 0.3d 0.2d JWH-018 1 14 n.a. n.a. JWH-073 10 20 n.a. n.a. MDA * 1 4 n.a. n.a.# MDMA 1.5 2 0.225b 100b Mephedrone 0.4 0.8 n.a. n.a Methylamphetamine 33 100 0.39g 30b 0.01 0.1 n.a. n.a. Hydroxycotinine 17 50 0.44c 1.25c Noroxycodone 0.1 1 0.22f 20d Ethyl sulphate 167 500 0.00012e 10ge Benzoylecgonine 33 100 0.35g 100b 6-monoacetylmorphine 0.5 1.0 0.013h 20i Analyte Methylone n.a. = data not available; a = (Khan and Nicell 2012) ; b = (Zuccato et al. 2008); c = (Castiglioni et al. 2015); d = (Rossi 2016), e = (Ryu et al. 2016); f = (Lalovic et al. 2006); g = (Lai et al., 2011); h = (Boerner et al., 1975); i =(Sullivan et al. 2006) * Data is not available in the scientific literature for the proportion of MDA that is eliminated after MDA consumption. However, data is available detailing the proportion of MDA eliminated after MDMA consumption. Therefore, our MDA estimate of mg excreted per day per 1 000 people is the amount of MDA excreted from the population after considering the metabolic fraction excreted from MDMA. # 49 It is likely that the dose for MDA is similar to that of MDMA, of 100 mg. 5 1 3 4 3 2 3 NSW NT QLD SA TAS VIC WA 55.9% % of Australian population         6.5  – – – – – – – – – R 27.8% 6.5 3 2 – 4 – – – – C         3 3 – 5 8 – 3 – R 1.3 50.9% 11.9 10.6 3 2 – 4 2 – 3 1 C         –  – – – – – – – – R 47.4% 11.1 11.1 3 2 – 4 3 – 3 1 C *Feb-17 3 2 – 5 8 – 2 – R 1.2 52.4% 12.3 11.1 3 2 – 4 3 – 3 1 C Apr-17         –  – – – – – – – – R 47.4% 11.1 11.1 3 2 – 4 3 – 3 1 C *Jun-17 Report 3         3 6 3 5 7 1 7 – R 1.7 56.3% 13.2 11.5 3 2 3 4 3 1 5 1 C Aug-17  – – – – – – – – – R 47.9% 11.2 11.2 3 2 3 4 3 – 3 1 C *Oct-17 3 4 2 5 6 – 5 – R 1.5 54.3% 12.7 11.2 3 2 3 4 3 1 3 1 C Dec-17 Report 4 * Every second time point aims to sample from only capital city sites. Census 2016 population used (23,401,892) for population percentage estimates. Estimates have been rounded to the nearest 0.1 million. Note: catchment populations have been refined, and so population totals and percentages may have changed accordingly. 13.1 1.6 1 5 4 4 9 1 5 – R Total Population (millions) 11.5 1 ACT Population (millions) C & R C State/Territory Dec-16 Aug-16 *Oct-16 Report 2 Report 1 Number of sites assessed in each state for Report 4, and total populations assessed. C = capital city wastewater treatment plant, R = regional wastewater treatment plant. APPENDIX 2: NUMBER OF SITES ASSESSED IN EACH REPORT Australian Criminal Intelligence Commission National Wastewater Drug Monitoring Program—Report 4, March 2018 50 51 Capital/Regional Capital Capital Capital Capital Capital Capital Regional Regional Regional Regional Regional Regional Regional Capital Regional Capital Capital Capital Regional Regional Regional Regional Regional Regional Regional Regional Regional Capital Capital Capital Site Code ACT: 009 NSW: 003 NSW: 006 NSW: 008 NSW: 021 NSW: 071 NSW: 016 NSW: 025 NSW: 040 NSW: 051 NSW: 068 NSW: 081 NSW: 115 NT: 010 NT: 078 QLD: 002 QLD: 005 QLD: 011 QLD: 012 QLD: 020 QLD: 024 QLD: 028 QLD: 029 QLD: 033 QLD: 039 QLD: 053 QLD: 077 SA: 007 SA: 013 SA: 027 7 7 7 6 7 7 5 7 7 7 1 7 7 7 7 7 5 7 7 7 7 7 7 7 7 5 5 5 # Samples Aug 16 7 7 7 # Samples Oct 16 7 7 7 7 7 4 7 6 7 7 7 7 7 7 7 3 7 7 7 7 # Samples Dec 16 Sampling details of each wastewater treatment plant. 7 4 7 7 6 7 6 7 7 7 # Samples Feb 17 APPENDIX 3: FURTHER INFORMATION ON WWTPS 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 5 7 7 7 7 # Samples Apr 17 7 7 7 7 7 7 7 7 7 7 # Samples Jun 17 7 7 7 7 7 7 5 7 7 7 7 7 7 7 7 7 6 6 7 7 7 7 7 7 7 7 7 7 # Samples Aug 17 7 7 7 7 7 6 7 7 7 7 # Samples Oct 17 7 7 7 7 0 0 7 7 0 0 7 7 7 7 0 7 7 7 6 0 0 0 7 7 7 5 7 7 7 7 # Samples Dec 17 >150,000 >150,000 >150,000 >150,000 30,000 to 150,000 >150,000 30,000 to 150,000 >150,000 <30,000 <30,000 >150,000 <30,000 30,000 to 150,000 30,000 to 150,000 <30,000 >150,000 >150,000 >150,000 >150,000 <30,000 30,000 to 150,000 30,000 to 150,000 30,000 to 150,000 30,000 to 150,000 <30,000 <30,000 <30,000 >150,000 >150,000 30,000 to 150,000 Population Category Australian Criminal Intelligence Commission National Wastewater Drug Monitoring Program—Report 4, March 2018 7 7 7 4 4 4 4 4 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 63 236 107 9 37 16 9 15 16 0 22 0 Total samples in Report 2; Oct & Dec 2016 & Feb 2017: 406 329 # Samples Feb 17 Capital 5 Regional 5 Regional 5 Regional 5 Regional 5 Regional Capital 7 Capital 7 Capital 7 Regional 7 Regional 7 Regional 7 Regional 7 Capital 7 Capital 7 Regional 7 Regional 7 Regional 7 Regional 7 Regional 6 Regional Capital 7 Capital 7 Capital 7 Regional 7 Regional 0 Regional Regional Total Days 329 Total Sites 51 Total Capital 22 Total Regional 29  Total samples in Report 1; August 2016: # Samples Dec 16 SA: 059 SA: 017 SA: 022 SA: 063 SA: 076 SA: 119 TAS: 004 TAS: 019 TAS: 041 TAS: 018 TAS: 038 TAS: 048 TAS: 058 VIC: 001 VIC: 067 VIC: 037 VIC: 046 VIC: 061 VIC: 062 VIC: 066 VIC: 114 WA: 101 WA: 103 WA: 104 WA: 102 WA: 118 WA: 120 WA: 129         # Samples Oct 16 Capital/Regional Site Code # Samples Aug 16 Sampling details of each wastewater treatment plant (continued). # Samples Jun 17 # Samples Aug 17 690 7 7 7 4 4 4 4 5 4 4 4 4 4 5 5 4 5 5 5 7 7 7 7 7 7 7 7 7 7 5 7 7 5 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 236 112 342 36 16 54 16 16 22 20 0 32 Total samples in Report 3; Apr & Jun & Aug 2017: # Samples Apr 17 # Samples Dec 17 Population Category 414 1,839 7 6 30,000 to 150,000 4 <30,000 4 <30,000 4 <30,000 4 <30,000 4 <30,000 5 5 30,000 to 150,000 5 5 30,000 to 150,000 5 5 30,000 to 150,000 7 30,000 to 150,000 0 <30,000 5 <30,000 0 <30,000 7 7 >150,000 7 7 >150,000 7 >150,000 0 30,000 to 150,000 7 30,000 to 150,000 0 30,000 to 150,000 7 30,000 to 150,000 7 30,000 to 150,000 7 7 >150,000 7 7 >150,000 7 7 >150,000 7 30,000 to 150,000 0 <30,000 7 30,000 to 150,000 7 <30,000 126 288 19 45 19 20 Grand total 0 25 number of samples Total samples in Report analysed for Report 4; Oct & Dec 2017: 1, 2, 3 & 4: # Samples Oct 17 Australian Criminal Intelligence Commission National Wastewater Drug Monitoring Program—Report 4, March 2018 52 Australian Criminal Intelligence Commission National Wastewater Drug Monitoring Program—Report 4, March 2018 APPENDIX 4: POPULATION ESTIMATION: PERCENTAGE OVERCOUNT OR UNDERCOUNT BY SITE Percentage undercount, overcount and total overcount or undercount for all site population estimates. Site number 53 State Capital or Potential regional undercount (%) Potential Total undercount overcount (%) + overcount (%) 001 VIC Capital 2.11 1.97 4.08 002 QLD Capital 1.03 1.23 2.26 003 NSW Capital 0.61 0.57 1.18 004 TAS Capital 3.15 1.79 4.94 005 QLD Capital 1.17 1.12 2.29 006 NSW Capital 1.00 1.21 2.21 007 SA Capital 0.92 0.81 1.73 008 NSW Capital 1.71 1.90 3.61 009 ACT Capital 0.01 0.09 0.10 010 NT Capital 0.99 0.23 1.22 011 QLD Capital 2.28 2.72 5.00 012 QLD Regional 0.38 0.09 0.47 013 SA Capital 0.86 1.38 2.24 016 NSW Regional 1.91 1.75 3.66 017 SA Regional 2.65 0.69 3.34 018 TAS Regional 2.64 4.42 7.06 019 TAS Capital 0.74 0.44 1.18 020 QLD Regional 5.88 5.07 10.95 021 NSW Capital 2.32 2.55 4.87 022 SA Regional 2.67 2.17 4.84 024 QLD Regional 0.89 0.69 1.58 025 NSW Regional 1.52 1.29 2.81 027 SA Capital 4.45 5.05 9.50 028 QLD Regional 0.82 1.10 1.92 029 QLD Regional 0.59 0.99 1.58 033 QLD Regional 1.96 1.76 3.72 037 VIC Regional 0.80 0.92 1.72 038 TAS Regional 1.86 2.46 4.32 039 QLD Regional 0.07 0.29 0.36 040 NSW Regional 1.07 1.00 2.07 041 TAS Capital 1.31 2.41 3.72 046 VIC Regional 3.21 2.58 5.79 Australian Criminal Intelligence Commission National Wastewater Drug Monitoring Program—Report 4, March 2018 Percentage undercount, overcount and total overcount or undercount for all site population estimates (continued). Site number State Capital or Potential regional undercount (%) Potential Total undercount overcount (%) + overcount (%) 048 TAS Regional 1.77 0.63 2.40 051 NSW Regional 0.41 0.14 0.55 053 QLD Regional 2.30 1.77 4.07 058 TAS Regional 2.74 1.63 4.37 059 SA Capital 0.69 0.67 1.36 061 VIC Regional 2.06 2.79 4.85 062 VIC Regional 7.25 6.94 14.19 063 SA Regional 0.87 0.44 1.31 066 VIC Regional 0.54 0.59 1.13 067 VIC Capital 0.99 0.96 1.95 068 NSW Regional 0.10 0.09 0.19 071 NSW Capital 0.22 0.22 0.44 076 SA Regional 2.86 3.07 5.93 077 QLD Regional 8.50 5.28 13.78 078 NT Regional 1.08 2.41 3.49 081 NSW Regional 0.37 1.59 1.96 085 NT Capital 0.23 0.86 1.09 101 WA Capital 0.71 0.74 1.45 102 WA Regional 1.35 0.19 1.54 103 WA Capital 1.13 1.03 2.16 104 WA Capital 0.27 0.23 0.50 114 VIC Regional 3.12 2.31 5.43 115 NSW Regional 2.52 3.13 5.65 118 WA Regional No catchment map available No catchment map available No catchment map available 119 SA Regional 0.44 1.59 2.03 120 WA Regional No catchment map available No catchment map available No catchment map available 129 WA Regional 17.49 0.82 18.31 Average (%): 1.99 1.63 3.62 54 Australian Criminal Intelligence Commission National Wastewater Drug Monitoring Program—Report 4, March 2018 APPENDIX 5: POPULATION ESTIMATION METHODOLOGY: PERCENTAGE OVERCOUNT OR UNDERCOUNT BY SITE The refined catchment population estimate uses the area of a mesh block within the catchment to estimate the proportion of the population within the catchment (where a mesh block is the smallest population unit of the 2016 Australian Census). However, when the population within the mesh blocks are not distributed equally this can decrease the precision of the estimate. The potential overcount and undercount estimates are a measure of precision of the refined population estimate. Some uncertainty is caused by the potential unequal population distribution for the mesh blocks that intersect the catchment boundary. A diagram outlining these terms is shown in the below figure, as well as the formulas used to calculate the overcount and undercount estimates. As can be seen in the figure, the population distribution across this particular mesh block is unequal when comparing the green and yellow areas. On average, the wastewater catchments used in this study had a 4 per cent combined population overcount or undercount estimate. This demonstrates that, in the vast majority of cases, the associated precision can be assumed to be very high for the Census-generated population estimates for the usual residence population. It should be noted that day-to-day population differences within a catchment due to seasonal tourism or commuting cannot be elucidated by this population estimate. However, for the capital city areas commuting is less likely to affect population estimates as multiple catchments per city are assessed concurrently (and include the CBD), so movement from one catchment to another would be captured. 55 Australian Criminal Intelligence Commission National Wastewater Drug Monitoring Program—Report 4, March 2018 Percentage overcount and undercount estimates surrounding the mesh block (Census) population estimate and the formulas used to calculate the overcount and undercount estimates. Note: the boundaries displayed are for instructional purposes only and do not relate to a real catchment. Mesh block populations within boundary + mesh block populations outside boundary Percent x 100 Undercount = Mesh block populations within boundary Percent Undercount = Mesh block populations within boundary Mesh block populations with area fully within boundary (excluding yellow) x 100 56 57 Methylamphetamine Methylamphetamine Cocaine Cocaine MDMA MDMA MDA MDA Oxycodone Oxycodone Fentanyl Fentanyl Heroin Heroin Alcohol Alcohol Nicotine Nicotine Mephedrone Mephedrone Methylone Methylone Capital Regional Capital Regional Capital Regional Capital Regional Capital Regional Capital Regional Capital Regional Capital Regional Capital Regional Capital Regional Capital Regional 100 100 100 100 2 45 41 100 100 100 96 Aug 2016 100 100 97 45 100 95 19 - 100 100 97 100 100 97 Oct 2016 100 100 100 100 100 3 47 14 100 100 100 94 28 - 100 100 99 100 100 100 100 100 3 79 9 100 100 100 99 7 1 97 100 100 100 Drug detections % (above LOD) Report 1-4 Dec 2016 Feb 2017 Apr 2017 Jun 2017 100 100 100 100 100 100 96 96 97 96 52 53 100 100 100 96 96 100 Aug 2017 100 100 90 53 100 98 98 86 100 100 100 100 83 37 100 100 100 100 1 28 22 46 1 100 92 100 100 100 92 100 90 Oct 2017 100 Dec 2017 100 100 95 56 100 100 100 95 100 100 100 100 84 59 100 100 100 100 24 12 59 22 The proportion of samples that each drug was detected above LOD for Report 1-4. Note: regional sites are only sampled every second period. APPENDIX 6: PERCENTAGE OF SAMPLES ABOVE LOD (%) FOR EACH DRUG AND PERIOD ASSESSED Australian Criminal Intelligence Commission National Wastewater Drug Monitoring Program—Report 4, March 2018 CONCLUSIONS Australian Criminal Intelligence Commission National Wastewater Drug Monitoring Program—Report 4, March 2018 CONCLUSIONS For the fourth report of the National Wastewater Drug Monitoring Program, wastewater analysis was conducted in October and December 2017. The program has identified variations in patterns of drug consumption, both over time and within and between jurisdictions. Consistent with previous reports, findings show that, of the substances monitored, nicotine and alcohol are the most consumed drugs in Australia. Methylamphetamine remains the most consumed illicit drug of those tested in Australia, with estimated consumption significantly exceeding that of other monitored illicit drugs. METHYLAMPHETAMINE The population-weighted average consumption of methylamphetamine for both capital city and regional sites increased from August 2017 to December 2017. The regional average consumption of methylamphetamine exceeded capital city average consumption. South Australia had the highest estimated average capital city consumption of methylamphetamine in December 2017, with Western Australia having the highest estimated average regional consumption. AMPHETAMINE Amphetamine is a metabolite of methylamphetamine consumption. While the program measured amphetamine consumption, measured consumption was not reported separately as levels measured were consistent with observed levels related to methylamphetamine consumption. COCAINE The population-weighted average consumption of cocaine for both capital city and regional sites increased from August 2017 to December 2017. The capital city average consumption of cocaine was almost double the regional average. New South Wales had the highest estimated average capital city and regional consumption of cocaine in December 2017. 3,4-METHYLENEDIOXYMETHYLAMPHETAMINE (MDMA) The population-weighted average consumption of MDMA in capital city sites remained relatively stable in December 2017, while there was an increase in regional sites compared to August 2017. Regional average consumption was very similar to capital city average consumption. The Northern Territory had the highest estimated average capital city consumption of MDMA in December 2017, with New South Wales and Queensland having the highest estimated average regional consumption. 59 Australian Criminal Intelligence Commission National Wastewater Drug Monitoring Program—Report 4, March 2018 3,4-METHYLENEDIOXYAMPHETAMINE (MDA) MDA is a metabolite of MDMA. As the proportion of MDA derived from MDMA is known, it has been possible from Report 3 to estimate MDA consumption rather that its presence solely as a metabolite of MDMA use. Regional average consumption of MDA exceeded capital city average consumption. Site 12 in Queensland is of particular concern given the very high consumption levels reported in December 2017. Tasmania had the highest estimated average capital city consumption of MDA in December 2017, with New South Wales and Queensland having the highest estimated average regional consumption. HEROIN Population-weighted averages for heroin consumption for both capital city and regional sites decreased from August 2017 to December 2017. Capital city average consumption of heroin is more than double regional average consumption. The Australian Capital Territory and Victoria had the highest estimated average capital city consumption of heroin in December 2017, with New South Wales having the highest estimated average regional consumption. MEPHEDRONE Consistent with previous reporting periods, mephedrone was mostly detected below the level at which it could be reliably quantified. The number of detections of mephedrone more than doubled between August and December 2017. Mephedrone was detected 23 times at six sites in December 2017, compared to 11 times at seven sites in August 2017. In December 2017, mephedrone was detected in New South Wales and Queensland, with detections in August 2017 located in Queensland, Victoria and Western Australia. METHYLONE Consistent with previous reporting periods, methylone was mostly detected below the level at which it could be reliably quantified. The number of national detections of methylone decreased from 90 in August 2017 to 65 in December 2017. Methylone was detected at 17 sites in December 2017, a decrease from the 22 sites in August 2017. In December 2017, methylone was detected in all states and territories with the exception of Western Australia, with detections of methylone in August 2017 located in all states and territories with the exception of the Australian Capital Territory and South Australia. OXYCODONE The population-weighted average consumption of oxycodone in regional sites remained relatively stable in December 2017 compared to August 2017, with an increase in capital city consumption. Regional average consumption of oxycodone was almost double the capital city average. Tasmania had the highest estimated average capital city consumption of oxycodone in December 2017, with Victoria having the highest estimated average regional consumption. 60 Australian Criminal Intelligence Commission National Wastewater Drug Monitoring Program—Report 4, March 2018 FENTANYL The population-weighted average consumption of fentanyl remained relatively stable in both capital city and regional sites in December 2017 compared to August 2017. Regional average consumption of fentanyl was almost double the capital city average. Tasmania had the highest estimated average capital city consumption of fentanyl in December 2017, with Queensland having the highest estimated average regional consumption. NICOTINE1 Nicotine remains one of the most consumed drugs in Australia. The population-weighted average consumption of nicotine decreased between August 2017 and December 2017. The regional average consumption of nicotine exceeded capital city average consumption. The Northern Territory and Tasmania had the highest estimated average capital city consumption of nicotine in December 2017, with Tasmania having the highest estimated average regional consumption. ALCOHOL Alcohol remains one of the most consumed drugs in Australia. The population-weighted average alcohol consumption in both capital city and regional sites increased between August 2017 and December 2017. No significant differences in alcohol consumption were observed between capital city sites and regional sites. The Northern Territory had the highest estimated average capital city consumption of alcohol in December 2017, with Tasmania having the highest estimated average regional consumption. NEXT REPORT The fifth report of the National Wastewater Drug Monitoring Program is scheduled to be publicly released in the third quarter of 2018. The next report will incorporate the latest Sewage Analysis CORe group Europe (SCORE) data to provide insight into Australia’s drug consumption in comparison with that of other countries participating in the SCORE program. 1 61 For accuracy, estimates have been changed from tobacco in Report 1 and 2 to nicotine in this report due to the inability to distinguish between nicotine intake from tobacco or electric cigarettes and nicotine replacement therapies such as patches and gum. Commonwealth of Australia 2018