The real danger of drugs in the wastewater isn’t what you’d think
Drug use in America follows trends, something Straight Arrow has previously reported on. Now, a report from the Office of National Drug Control Policy shows how wastewater can detect some of those trends.
The report, called Wastewater Analytics: A Powerful Window into Shifting Drug Use Trends, studied wastewater samples from more than 100 counties, accounting for about 18% of the country. The ONDCP described the study as the largest wastewater drug-monitoring effort ever conducted in the U.S.
What did the report find?
Researchers found that wastewater samples from January to April showed a decline in fentanyl, cocaine and methamphetamine, both nationally and regionally. They also said there were variations at the state and local levels. Washington state, for example, had the highest concentrations of fentanyl, while Texas had the highest cocaine levels. Colorado and Nevada recorded the highest levels of methamphetamine.
The report also highlighted seven emerging substances researchers tracked: acetyl fentanyl, carfentanil, ketamine, medetomidine, para-fluorofentanyl, tianeptine and xylazine. All seven were found in every U.S. Census region in 2026.
Ketamine turned out to be the most widespread of the group, detected in 100% of the counties tested. Tianeptine — sometimes called “gas station heroin” — was the second most common, showing up in 77% of counties. Acetyl fentanyl was the least prevalent, found in just 17% of counties.
Medetomidine also stood out to researchers. It’s a potent synthetic drug typically used by veterinarians as a sedative and analgesic that has slowly worked its way into the illicit drug supply because of its sedative properties. It carries an added danger compared to opioids like heroin and fentanyl because it’s not an opioid. That means that standard overdose reversal drugs like Narcan don’t work on it.
The report also tracked longer-term trends. It found that fentanyl use peaked nationally in 2023 and has declined since. Cocaine peaked at the same time, dropped in early 2024, then trended upwards again in 2026 before falling once more. Methamphetamine levels, by contrast, have stayed roughly steady since 2023, according to the report.
How are drugs affecting the ecosystem?
Eventually, wastewater makes its way back into ecosystems. Treatment plants filter out many contaminants before that happens, but they aren’t designed to catch most pharmaceuticals. Common drugs like Advil still pass through largely intact and end up in local waterways.
Recent studies have detected drugs in the tissue of animals, some of which find their way to our dinner tables, that live in these waterways. Researchers who studied juvenile Chinook salmon and staghorn sculpin in Washington state’s Puget Sound found detectable levels of a multitude of chemicals, including prescription medications and even cocaine, according to a study published in 2016.
Jim Meador, the lead author on the study, told the Organic Consumers Association that the levels were higher than he had expected.
“We analyzed samples for 150 compounds and we had 61 percent of them detected in effluent,” Meador said. “So we know these are going into the estuaries.”
Meador said that fish tested in intended control waters — waters that were supposed to be clean — also had detectable levels of chemicals. He added, however, that he doubted the findings would translate into human health effects, since people don’t typically eat sculpin or juvenile chinook, and the levels in the water are likely too low to be biologically active in humans.
Another study in the Puget Sound found that mussels also showed signs of wastewater contamination. Every two years, scientists transplant uncontaminated mussels to various locations in the sound to study pollution levels. Researchers say that because mussels are filter feeders, they’re good indicators of pollution.
What they discovered in 2018 was that these mussels showed traces of drugs like cocaine and oxycodone. But the oxycodone was found at levels thousands of times below a therapeutic human dose, and researchers said the mussels likely don’t even metabolize the drug. The mussels also showed high levels of the chemotherapy drug Melphalan. Researchers said Melphalan is a potential carcinogen because of how it affects DNA.
Andy James, one of the researchers involved, said the drug was found at “levels where we might want to look at biological impacts.” The Puget Sound Institute reported that the quantity of Melphalan the mussels had ingested was, by weight, equivalent to a recommended human dosage. The oxycodone-tainted mussels, notably, were sampled from urbanized harbor areas that aren’t near commercial shellfish beds, which are not places people would typically harvest them.
How could this affect people?
While researchers are concerned about people eating contaminated fish or other aquatic wildlife, there’s a bigger concern that could impact people’s health.
Wastewater treatment plants sometimes don’t completely remove all traces of antibiotics and bacteria during their process. So when someone takes an antibiotic to treat an infection, traces of that drug — along with some bacteria in their body — can pass into wastewater and eventually into the ecosystem.
Once in local waterways, evolution takes its course. Bacteria that are resistant to antibiotics have an advantage over bacteria that aren’t, so resistant strains become more common in the water over time. Bacteria also have a unique way of passing their genes to even different species — something called horizontal gene transfer.
When people come into contact with waterways contaminated with these resistant bacteria, there’s a chance they could get infected.
The Centers for Disease Control and Prevention said coordinated, aggressive action is critical to prevent the spread of antibiotic-resistant bacteria.
Round out your reading
- From Obama to Trump to Biden: When networks said ‘no’ to presidential speeches.
- ‘The end of American science as we know it.’ White House funding plan sparks alarm.
- AI data centers are popping up everywhere. What exactly do they do?
- The Trump administration is accused of breaking a law built to target the KKK.
- One Republican senator is dead, another is still alive. Both are the center of conspiracy theories.
Ella Rae Greene, Editor In Chief
