How synthetic cannabinoid user profiles and consumption patterns can affect wastewater-based epidemiology (2025)

Wastewater-based epidemiology needs the connection of drug abusers to sewers. However, social decline, even social recruitment of consumers, can limit their access to solid houses, piped water, and electricity. On the hand, this marginalization can limit their access to toilets, obscuring a population of critical interest for suitable interpretation and health policies. On the other hand, the part of consumers with the most intense consumption can distort the community evaluation. To elucidate those antagonist bias, the present study focused on the consumers of synthetic cannabinoid receptor agonists in the island of Mayotte because insularity favors community studies and because the endemic poverty helps to generalize the results, even by a "worst case" situation. One hundred twenty-three. consumers of SCRA valuably informed about their life standards, including their age, gender, consumption intensity, education level, and employment, and detailed their housing condition including access to tap water. The most important part of the consumers is the group smoking SCRA daily (49.6% of responding consumers). Inversely, there is no housing difference between groups of consumers gathered following their occasional, repeated, regular, or daily consumption. Even if SCRA consumers in Mayotte are ostracized, only a few numbers of them are homeless, highlighting how the support of relatives can ensure even the daily consumers have the access to facilities. This result strengthens wastewater-based epidemiology representativeness, regardless of consumption frequency. [Author's abstract]