Identifying Greek Drug Consumption Using LC–MS/MS

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Researchers from the National and Kapodistrian University of Athens have used liquid chromatography with tandem mass spectrometry (LC–MS/MS) to understand changes in licit and illicit drug consumption patterns following the major socioeconomic changes Greece has experienced (1).

Heavily affected by the ongoing economic crisis, which began in 2008, the Greek population has been directly affected in terms of increased unemployment rates, substantial per-capita income decreases, and significant increases in poverty. The economic situation has also affected Greek healthcare with some studies suggesting a change in the use of legal pharmaceuticals since 2012 (2,3). Greek drug expenditure was earmarked for over 2 billion euros worth of cuts between 2010 and 2014 (2). The same studies also suggested an increment in the use of illicit drugs, however, there are no extensive studies using chemical data to support these hypotheses so far.

To gain figures on the use of legal pharmaceuticals and illegal drugs, surveys are traditionally integrated with medical records and drug production data. While useful, this method does not give accurate estimates of use rates and the prevalence of drug use, and has many limitations such as the inclusion of substantial time lags that negatively impact the reliability, validity, and utility of such data (4).  

Recently, an approach based on data obtained from influent wastewater has been proposed (5). Sewage systems rapidly collect and pool parent compounds and metabolites excreted after drug use, and can be used to provide data on the amount and type of drugs used by a population (5). The study aimed to use LC–MS/MS and sewage-based epidemiology to quantify the effects of the Greek economic crisis on drug use and identify trends in use patterns during the years 2010–2014, looking for potential correlations between social parameters.

Results indicated, indirectly, an increase of mental illnesses in the studied 3.7 million population because of an observed significant increase in psychiatric drug use during the years of socioeconomic change. Antidepressants and benzodiazepines were highly correlated with socioeconomic indicators with both drugs experiencing a sharp increase in use. Overall use of antibiotics and nonsteroidal anti-inflammatory drug (NSAIDs) had decreased, likely because of the aforementioned cuts in public health spending. Mefenamic acid, a mild to moderate painkiller, had a 28-fold reduction. Researchers also identified a twofold increase in the use of methamphetamine, which they attributed to the cheap street drug “sisa”, a major health concern in Greece at the moment. Illicit drug use in general increased with strong links to the socioeconomic changes the country has undergone. Notable increases were MDMA with a fivefold increase and methadone with a sevenfold increase. An increase in cannabis use was not detected caused by analytical discrepancies and difficulties in the determination of THCA, the active component of cannabis. The conclusions were in line with the arguments of other studies, which highlighted the largely ignored social costs of economic austerity and the harmful consequences these have on the people of Greece, according to the authors. - L.B.

References

1. N.S.Thomaidis et al., Enviro. Sci. Technol.50, 10065–10072 (2016).
2. A. Kentikelenis et al., Lancet 383(9918), 748−753 (2014).
3. D. Stuckler and S. Basu, The Body Economic: Why Austerity Kills (Basic Books, New York, USA, 2013).
4. A.L. van Nuijs et al., Sci. Total Environ.409(19), 3564−3577 (2011).
5. C.G. Daughton, in Pharmaceuticals and Care Products in the Environment (American Chemical Society, Washington DC, USA, 2001), pp. 348−363.