Wastewater Based Epidemiology for the Surveillance of Illicit Drug and Substance of Abuse Use in Prison Settings: A Critical Review

Abstract

People held in prison suffer from drug use disorders, with important health and safety implications. In order to design strategies to reduce drug consumption and for the provision of services, reliable data is necessary. In this study, a review of published works that have applied wastewater-based epidemiology (WBE) in prison settings was performed in order to evaluate its utility. The study also explored future options for WBE in correctional settings. A search of MEDLINE was conducted using the following PubMed query terms: (“Wastewater” OR “Sewage”) AND (“Prisons” OR “Health Care Correctionals”) AND (“Abuse, substance” OR “illicit drugs”) since 2005 (first report of WBE applied to illicit drug consumption) to February 26, 2025. Then, it was complemented by a Google Scholar citation analysis. We found 8 studies, half of which have been conducted in Australia. Cocaine, cannabis, methamphetamine, and methadone have been the most widely monitored substances (5 studies). Different studies have also monitored various new psychoactive substances (NPS). So far, estimated consumption in prison settings has generally been lower than in the community, with the exception of cannabis and cocaine in French prisons. WBE has proven to be a valuable complementary tool to inform drug consumption in prison settings, as it can offer objective data. However, the number of publications is still limited. Studies focusing on gabapentinoids, synthetic cannabinoids, or enantiomeric profiling should be considered in future research. Additionally, the use of WBE to monitor the effectiveness of interventions offers a great potential as well.