Abstract：
This paper explores Wastewater-Based Epidemiology (WBE) as a tool enabling understanding of city\'s pain treatment in an intercity longitudinal study. An intensive 13-month monitoring programme was undertaken in two adjacent urban areas in South-West England: a small commuter town Keynsham and the city of Bath (>180 samples collected). The study has shown a great potential of using triangulated WBE and National health Service (NHS) prescription data in understanding pain treatment in two contrasting communities with strong apparent seasonal patterns of short pain medications vs chronic pain treatment as well as the type of treatment used (e.g. oral vs topical). Community-wide usage of Non-Steroidal Anti-inflammatory Drugs (NSAIDs) and paracetamol in the intercity study is population size and season driven with the highest usage recorded in winter months. This contrasts with other pain pharmaceuticals, especially those used for chronic pain, where no/limited seasonal usage was recorded. Unmetabolized NSAIDs are, to a large extent, directly disposed of into the sewerage system bypassing metabolism due to their topical application. This is particularly apparent in winter months with naproxen showing the highest seasonal variability. Pharma/met (ratio of pharmaceutical and its metabolite concentration) analysis allows for tracking topical (non-metabolic) application/down-the-drain disposal of pharmaceuticals with frequent instances of direct disposal of NSAIDs into the sewerage system observed. Normalisation of pharma markers to population size shows comparable estimates of pharma usage in the two cities confirming population as the main driver of pharma loads in wastewater. Variable application patterns of pain pharmaceuticals make back-calculation of intake more convoluted. Intake calculated using percentage excretion of parent NSAIDs will likely lead to overestimation, as it is assumed that NSAIDs are subject to extensive metabolism (this is not the case for topical applications). Intake calculated using percentage excretion of metabolites (or parent compound) as consumption markers leads to underestimation of NSAIDs usage due to contributions from topical application not being accounted for. Prescription data indicates cumulative internal and topical usage, but the data ignores large proportion of over-the-counter usage. Therefore, we have proposed a combined approach allowing for estimation of total usage including, and differentiating between, topical application and oral administration.
摘要：
本文探讨了基于废水的流行病学（WBE）作为一种工具，可以在城际纵向研究中了解城市的疼痛治疗。在英格兰西南部的两个相邻城市地区进行了为期13个月的密集监测方案:一个通勤小镇Keynsham和巴斯市(收集了>180个样本)。该研究表明，使用三角测量的WBE和国家卫生服务（NHS）处方数据在理解两个截然不同的社区中的疼痛治疗方面具有巨大的潜力，这些社区具有明显的季节性短期止痛药与慢性疼痛治疗以及所使用的治疗类型（例如口服与局部）。在城际研究中，非甾体类抗炎药（NSAIDs）和扑热息痛的社区使用是人口规模和季节驱动的，冬季记录的使用量最高。这与其他止痛药形成对比，尤其是那些用于慢性疼痛的，其中没有/有限的季节性使用记录。未代谢的NSAIDs是，在很大程度上,由于其局部应用，直接处理到污水处理系统中，绕过新陈代谢。这在冬季月份尤其明显，萘普生表现出最高的季节性变化。Pharma/met（药物及其代谢物浓度的比率）分析允许跟踪药物的局部（非代谢）应用/下泄处置，并观察到经常将NSAID直接处置到污水处理系统中。药物标记与人口规模的标准化显示了这两个城市对药物使用的可比估计，证实人口是废水中药物负荷的主要驱动因素。疼痛药物的可变应用模式使摄入量的反向计算更加复杂。使用亲本NSAIDs排泄百分比计算的摄入量可能会导致高估，因为假定NSAID会经历广泛的代谢（局部应用并非如此）。使用代谢物(或母体化合物)的排泄百分比作为消耗标记物计算的摄入量导致对NSAIDs使用的低估,这是由于局部应用的贡献未被考虑。处方数据表明累积的内部和局部使用，但数据忽略了大部分的非处方使用。因此,我们提出了一种组合方法，允许估计总使用量，包括，和区分，局部应用和口服给药。
