On a brisk January morning, Richard Thi goes with the flow, working as a stationary engineer at the San Francisco Public Utilities Commission’s Oceanside Wastewater Facility.
“This serves the west side of San Francisco. All of their house drains, including storm water whenever it rains," he explains.
In a quart-sized container, he pulls small samples from the 50 million gallons of wastewater that goes through the treatment plant on any non-rainy day.
"I grew up in the city, so it means a lot for me to, you know, give back in a way," he told Scripps News.
This water is now a tool in the fight against drugs. San Francisco is one of 70 communities across the country in a National Institute on Drug Abuse program. They send wastewater samples to Biobot, a commercial lab in Cambridge, Massachusetts.
Scientists analyze the samples for different drugs — opioids, methamphetamines, cocaine, even the overdose-reversal drug naloxone.
"It's a really powerful tool that we haven't had when other epidemics, like the fentanyl epidemic, started to take a hold on the U.S.," Kaitlyn Hess Jimenez, senior group lead for analytical chemistry with Biobot, said.
Wastewater surveillance gained notoriety during the pandemic, as humans shed biological clues in their stools. The Centers for Disease Control and Prevention contracted with Biobot to track COVID, spotting new case surges early on.
The data is accurate, anonymous, and in real time.
“We're able to identify these really low concentrations for the whole community,” Hess Jimenez said. “You can apply that to list any drug. And that's where we can go from there. [Health officials] will be able to identify when xylazine crops up in their community before it ends up in an overdose report or a hospitalization."
This means health officials can get a clearer picture faster. Historically, public health departments rely on data like ER visits or 911 calls on overdoses or overdose deaths. Those numbers can lag.
“We can get the sample into our lab, test it, and generate the data within 4 or 5 business days,” Ethan Gauvin, Biobot director of government affairs, said.
Before the 70 cities, Biobot tested for six months in Cary, North Carolina, which has a population of 170,000. They’d get sent samples and give Cary public health officials monthly reports, which showed, for example, “Narcan consumption exceeded overdoses 25-to-1, suggesting that 25 times more people were overdosing than what was reported through emergency services,” according to a Biobot press release.
Overdose deaths caused by counterfeit pills growing in the US
In 41.4% of cases where fake pills were found, the only substance responsible for the deaths was fentanyl, the CDC reports.
“They [had] assumed it was illicit substances that were making their way from the larger cities into their community. Things like heroin. When we started to test, we actually found that the majority of the substance use, vast majority, was actually being driven by legal prescription painkillers, opioids,” Gauvin said, resulting in the Cary public health department having to "rethink their whole approach."
“Instead of needle exchange units, they invested in medicine take-back programs, working with local partners, churches, law enforcement. In that short period that they worked with the pilot, they actually reduced their overdoses 40% over the previous year," said Gauvin.
Dr. Jeffrey Hom, director of population behavioral health for San Francisco’s Public Health Department, says they’re still in the early data collection phases.
“But it really is sort of showing us; it's validating, certainly, what our office of the chief medical examiner has found. We do know that individuals are using fentanyl, they're using methamphetamine, they're using cocaine in the city,” he said.
More than 800 people diedfrom an accidental overdose in 2023 in San Francisco, 52 in December alone.
"It was the highest number of record overdose deaths; the majority of those deaths do involve fentanyl," said Hom.
Hom says the department gave out over 100,000 doses of Narcan last year. Their strategy for 2024 is to increase access to other drug use disorder medications, noting that the majority of cases they see are in individuals who have used multiple drugs.
“How are things changing? If there's a new drug that may have been introduced, do more in-depth testing that could really allow it to do, you know, more early interventions, maybe an alert if needed? Those are sorts of ways in which I think, down the line, you know, this data could really be useful," said Hom.
