Monitoring of changes in illicit drugs, alcohol, and nicotine consumption during Ramadan by wastewater analysis

Abstract Illicit drug use is a global problem and represents social, economic, and health burden on society. Wastewater-based epidemiology is an approach based on calculating the consumption of substances in the target population by analyzing the concentrations of human metabolic excretion products of licit and illicit substances in wastewater. The relationship between Ramadan and the consumption of illicit drugs, alcohol, and nicotine (cocaine, benzoylecgonine, amphetamine-like stimulants (amphetamine, methamphetamine, extacy (3,4-Methyl​enedioxy​methamphetamine)), opiates (morphine and heroine); marijuana (THC-COOH); ethyl sulfate and cotinine) was discussed based on the wastewater analysis results. This study aims to estimate the changes in the consumption of illicit drugs, alcohol, and nicotine in Adana Province during Ramadan as compared to normal periods using wastewater-based epidemiology. An overall decrease was observed fort he Ramadan Period, most strongly for ecstasy (29%) followed by heroin (19%). For cocaine, the variation was slightest (8.6%). For ecstasy, heroin, nicotine, and alcohol the differences were statistically significant but not for cocaine, amphetamine, methamphetamine, and marijuana. The study presented firstly data about the number of illicit drug, alcohol and nicotine users during and after Ramadan.