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Mapping Community Opioid Exposure Through Wastewater-Based Epidemiology as a Means to Engage Pharmacies in Harm Reduction Efforts


Map A shows the outline of an anonymized city. Inside the city outline are the outlines of 10 catchments, as well as red crosses indicating the location of anonymized pharmacies. Map B shows the same city and catchment outlines, with pie charts in each catchment outline. These pie charts show the average MME of the 7 prescription opioids monitored in this study for each catchment. Panel C shows 7 chloropleth maps of the same city and catchment outlines. Each map shows data for 1 of the prescription opioids, and the catchments are colored in according to their binned detection rates (darker colors indicate higher detection rate). The maps are organized from most frequently detected opioid (codeine) to least (hydromorphone).

Map. Wastewater-based monitoring of opioid exposure from a pilot study conducted in North Carolina, June–November 2018. Opioid exposure was determined by measuring the concentration of opioid metabolites in sewage using LC-MS/MS. Mapping exposure within cities highlights priority substances and areas for tailoring harm reduction efforts. Map A shows anonymized outline of the municipality, sampling locations, and pharmacies. Map B shows relative average exposure to prescription opioids, highlighting priority substances in each location. Map C shows detection rates for each opioid, showing geographic patterns of opioid use and identifying municipality-wide priorities. All geographical data are anonymized, are for illustrative purposes only, and have no relation to the original location of the study. Abbreviation: LC-MS, liquid chromatography–mass spectrometry; MME, morphine milligram equivalents; MS, mass spectrometry.

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Page last reviewed: August 20, 2020