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How Dallas Could Fight the Fentanyl Epidemic With Wastewater Analysis

As Dallas and the state of Texas ramp up their fentanyl monitoring and interventions, wastewater may be able to play a key role.
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Courtesy: iStock

As Dallas ramps up its assault on the opioid epidemic, the state could analyze its wastewater to track opioid use in the city and measure the impact of interventions and the spread of the drug, just as it did with COVID-19.

The nationwide epidemic hit close to home in a heartbreaking string of overdoses among middle school students in North Texas, leading to a focused response from law enforcement. The synthetic opioid is up to 50 times more potent than heroin, and the equivalent of 15 grains of table salt can be lethal.

The state and the newly-launched fentanyl data dashboard tell the story of the drug’s invasion of Texas and how it is being taken seriously. Fentanyl overdose deaths grew from 30 in 2006 to more than 2,100 last year, an increase of more than 7,000 percent. In 2006, fentanyl accounted for just 3.21 percent of opioid deaths. In 2023, the dashboard says fentanyl accounts for over three-fourths of opioid deaths.

The City of Dallas has launched an opioid overdose response team focused on response and education rather than punishment. City manager T.C. Broadnax recorded a podcast episode with city council members about what the city is doing to combat the crisis, including an opioid strike force. The city is working on OD mapping and providing data to public health authorities and local communities. The strike force partners with Dallas ISD, the city, first responders, DART, and other stakeholders to measure the problem and intervene.

According to state data, Dallas County suffered 199 fentanyl deaths last year, Tarrant County had 170, and Collin County had 64 (Harris County led the way with a disproportionately high 502 deaths last year). The crisis impacts nearly every community, but the extent to which it is present may be hidden because different groups use the drug differently, potentially hiding its growth in specific communities. “This is an epidemic that is touching all populations,” Bazaldua said on Broadnax’s “Keeping it REAL” podcast earlier this year. “The fentanyl crisis in schools without youth is different than what we are seeing with our adults who are recreational drug users. There is a need for a comprehensive approach and robust discussion.”

Dallas is no stranger to using wastewater analysis as a public health measure. The city conducted COVID-19 testing during the pandemic to get a real-time estimate of the virus’ spread through the city. The same can be done with fentanyl or other substances. Measuring overdoses or deaths can give an idea about deadly abuse, but those figures depend on victims contacting the health system. Measuring wastewater can accurately measure the usage rate of a substance in a city, region, or neighborhood and doesn’t depend on reporting.

“Wastewater is a data asset flowing beneath our feet every day, all the time. And every time we’re using the restroom or flushing the toilet, we’re contributing to that communal data asset,” says Biobot CEO and co-founder Mariana Matus. Biobot is a Massachusetts-based wastewater epidemiology company that works in every state and measures hundreds of sites. “We can measure infectious diseases before they expand and become pandemics. We can understand drug use and be able to understand the opioid epidemic in real time on a local level.”

Biobot works with municipalities, the CDC, and governments to analyze wastewater and communicate findings. The information can guide resources and policies to target problems in specific areas. It also provides real-time usage rate data that can be used to measure consumption or see the impact of an intervention. If a neighborhood known for high fentanyl use is targeted with educational and law enforcement interventions, wastewater can be used to measure their impact without depending on overdose or death counts.

When wastewater data in Marin County, California, found the presence of a previously unused animal tranquilizer, the county was able to post a health advisory to the public and tell providers to be on the lookout for the symptoms of the substance and be prepared to treat it. The data was used to verify anecdotal stories about the tranquilizer’s presence in the community. If fentanyl is unknowingly being added to other drugs, the wastewater data would be able to measure that increase better than those identifying the cause of the death, which could be connected to another drug.

Biobot, which exploded during the pandemic from 5 to over 100 employees as wastewater became an essential tool in fighting the spread of COVID-19, doesn’t do much work in Texas yet. But the state is flush with funds that need to be used to fight the opioid epidemic from the global settlement, totaling $3 billion from Allergan, CVS, Walmart, and Walgreens. Wastewater analysis could be an effective tool to guide spending.

“An impactful use of wastewater data could help them better diagnose what type of substance use is happening in their location and evaluate if the programs they are running are making a difference,” Matus says.

Author

Will Maddox

Will Maddox

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Will is the senior writer for D CEO magazine and the editor of D CEO Healthcare. He's written about healthcare…

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