Understanding treatment of pain during SARS-CoV-2 pandemic in a two-year intercity longitudinal study using wastewater-based epidemiology

Problem: SARS-CoV-2 pandemic had a significant impact on the society, economy, and health of people around the world with consequences that need to be better understood for future pandemic preparedness.  

 

The study: Four towns and cities in our CWBE Living Lab with a total population of > 1 million people covering an area of 2000 km2 in South West England were monitored for twenty-four months to provides insights into the usage of pharmaceuticals for pain treatment management throughout SARS-CoV-2 pandemic.  

 

Conclusions: Different patterns in pain pharma usage were observed, with small towns having higher usage than big cities for majority of pain killers studied. This is likely due to demographics of these cities with smaller cities having older populations. Per capita consumption of non-steroidal anti-inflammatory drugs (NSAIDs) increased compared to pre-pandemic usage in line with SARS-CoV-2 infections (ibuprofen and acetaminophen), while body pain drugs (diclofenac and naproxen) decreased in line with restrictions and closure of sports facilities. Changes in population normalised daily intake (PNDI) of pain killers were particularly apparent during the 1st and 3rd national lockdown. Comparison of PNDIs with prescriptions highlighted differences related to medication availability (OTC drugs) and patients’ nonadherence (prescribed drugs). In addition, several instances of direct disposal events across the catchments were observed which raises an issue of lack of pharma compliance and general understanding of potential environmental impacts from pharma usage. 

 

Paper (s): Ceolotto, N, K Jagadeesan, LK Xu, R Standerwick, M Robertson, R Barden, J Barnett, and B Kasprzyk-Hordern. 2024. “Understanding treatment of pain during SARS-CoV-2 pandemic in a two-year intercity longitudinal study using wastewater-based epidemiology.”  JOURNAL OF HAZARDOUS MATERIALS 471. doi: 10.1016/j.jhazmat.2024.134121 

 

Our pre-pandemic work on community-wide pain management is captured here: Kannan, A., N. Sims, A. J. Hold, K. Jagadeesan, R. Standerwick, R. Barden, and B. Kasprzyk-Hordern. 2023. “The burden of city’s pain treatment – A longitudinal one year study of two cities via wastewater-based epidemiology.”  Water Res 229:119391. doi: 10.1016/j.watres.2022.119391. 

Partners: Wessex Water 

Funders: EPSRC Impact Acceleration Account (EP/R51164X/1, ENTRUST IAA), Wessex Water Innovative Pathways Control Project and GCRF EWS-C19 project (EP/V028499/1).