OBJECTIVES: Illicit drug use presents a significant challenge to global health and public safety, requiring innovative and effective monitoring strategies. This study aimed to evaluate the current landscape of wastewater-based epidemiology (WBE) for monitoring illicit drugs in Europe, focusing on collaboration, current practices, and barriers, while identifying opportunities for improvement. STUDY DESIGN: Cross-sectional survey-based study. METHODS: Coordinated by the Sewage Analysis CORe Group Europe (SCORE) and the European Union Drugs Agency (EUDA), two surveys were conducted in 2023 targeting researchers and stakeholders using WBE for illicit drugs. Data were analysed to identify trends, gaps, and opportunities for improving WBE implementation. RESULTS: The findings indicate a robust research infrastructure and diverse analytical methods among European institutions. Two-thirds of the participating countries reported using WBE data to inform policy. However, challenges persist, particularly in securing funding and coordination, as well as generating national estimates from multiple locations and addressing specific local policy needs. CONCLUSIONS: WBE has proven to be a valuable tool for monitoring illicit drug trends and informing drug policies. To unlock its full potential, sustained funding, methodological standardization, and enhanced cooperation are essential. This study provides critical insights into the European WBE landscape, offering a roadmap for strengthening the integration of actionable WBE data into public health and policy frameworks.

Analytical Chemistry Service Laboratoire national de santé 1 Rue Louis Rech Dudelange Luxembourg

Aqua Enviro Sampling and Laboratory Services Suez Wakefield United Kingdom

Centre of Excellence in Water Based Early Warning Systems for Health Protection University of Bath Claverton Down BA2 7AY Bath United Kingdom

Croatian Institute of Public Health Zagreb Croatia

Cyprus National Addictions Authority Cyprus National Focal Point of EUDA 35 Iosif Hadjiosif and Andreas Avraamides 1st Floor 2028 Nicosia Cyprus

Czech National Monitoring Centre for Drugs and Addiction Office of the Government of the Czech Republic Prague Czech Republic

Department of Alcohol Tobacco and Drugs Norwegian Institute of Public Health P O Box 222 Skøyen 0213 Oslo Norway

Department of Aquatic Sciences and Assessment Swedish University of Agricultural Sciences SE 75007 Uppsala Sweden

Department of Drug Monitoring and Policy Trimbos Institute Utrecht the Netherlands

Department of Infection Control and Preparedness Norwegian Institute of Public Health Oslo Norway

Department of Living Conditions and Lifestyle The Public Health Agency of Sweden Folkhälsomyndigheten SE 17182 Solna Sweden

Department of Microbiology and Biomonitoring Faculty of Agriculture and Economics University of Agriculture in Kraków Adam Mickiewicz Ave 24 28 30 059 Krakow Poland

Department of Wildlife Fish and Environmental Studies Swedish University of Agricultural Sciences Umeå Sweden; Department of Zoology Stockholm University Stockholm Sweden; School of Biological Sciences Monash University Melbourne Australia

Dept of Environmental Engineering Faculty of Chemical and Food Technology Slovak University of Technology Bratislava Slovak Republic

Direction de la santé service d'épidémiologie et statistique rue de Bitbourg 20 Luxembourg Hamm 1273 Luxembourg

Drug Tobacco and Alcohol Control Department Šv Stepono str 27A LT 01312 Vilnius Lithuania

Eawag Swiss Federal Institute of Aquatic Science and Technology 8600 Dübendorf Switzerland

Ege University Institute on Drug Abuse Toxicology and Pharmaceutical Science Izmir Türkiye

Environmental and Public Health Analytical Chemistry Research Institute for Pesticides and Water University Jaume 1 E 12071 Castelló Spain

Environmental Institute Okružná 784 42 97241 Koš Slovak Republic

European Union Drugs Agency Lisbon Portugal

Forensic Chemistry Unit Finnish Institute for Health and Welfare Helsinki Finland

French Monitoring Centre for Drugs and Drug Addiction rue de Varenne 69 75007 Paris France

Gesundheit Österreich GmbH Austrian National Public Health Institute Vienna Austria

Institute of Clinical Pharmacology Faculty of Medicine Carl Gustav Carus Technische Universität Dresden Fetscherstrasse 74 01307 Dresden Germany

Institute of Forensic Sciences Department of Forensic Toxicology Ankara University Ankara Türkiye

Institute of Legal Medicine and Core Facility Metabolomics Medical University of Innsbruck Müllerstraße 44 Innsbruck 6020 Austria

Istanbul University Cerrahpaşa The Institute of Forensic Sciences and Legal Medicine Department of Science Istanbul Türkiye

Istituto di Ricerche Farmacologiche Mario Negri IRCCS Department of Environmental Health Sciences Via Mario Negri 2 20156 Milan Italy

Jožef Stefan Institute and International Postgraduate School Jamova 39 1000 Ljubljana Slovenia

KWR Water Research Institute Nieuwegein the Netherlands; Chemistry for Environment and Health Amsterdam Institute for Life and Environment Vrije Universiteit Amsterdam the Netherlands

KWR Water Research Institute Nieuwegein the Netherlands; Institute for Biodiversity and Ecosystem Dynamics University of Amsterdam the Netherlands

Laboratory of Analytical Chemistry Department of Chemistry National and Kapodistrian University of Athens Greece

METIS Sorbonne Université EPHE Université PSL CNRS Paris 75005 France

MRC Centre for Environment and Health Environmental Research Group School of Public Health Faculty of Medicine Imperial College London 86 Wood Lane London W12 0BZ United Kingdom

National Criminal Intelligence Service of the French Gendarmerie 95300 Pontoise France

National Institute of Public Health Ljubljana Slovenia

Nemzeti Drog Fókuszpont Budapest Hungary

Nireas International Water Research Centre University of Cyprus P O Box 20537 1678 Nicosia Cyprus

Technical Scientific and General Affairs Section Department for Anti Drug Policies Prime Minister's Office Rome Italy

Toxicological Center University of Antwerp Universiteitsplein 1 2610 Antwerp Belgium

University of Iceland Department of Pharmacology and Toxicology Hofsvallagata 53 107 Reykjavik Iceland; University of Iceland Faculty of Pharmaceutical Sciences Hofsvallagata 53 107 Reykjavik Iceland

Water Environmental and Food Chemistry Unit Jordi Girona 18 26 080834 Barcelona Spain

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