The illicit secrets are in the sewage.

Just like how wastewater testing helps communities learn when COVID surges, cities and towns are able to see what drugs are spiking in real time from their wastewater.

Nantucket is the latest community to start testing its sewage for drugs—partnering with a Cambridge firm that analyzes sewage for cocaine, fentanyl, methamphetamine, and xylazine.

The wastewater data can help the town in its response to the opioid crisis, as the real-time data provides communities with early warning signs of alarming drug trends.

“It can help them tailor their educational messaging appropriately, letting the community know that a new drug is circulating,” Newsha Ghaeli, president and co-founder of Biobot Analytics, told the Herald.

“This can be very helpful for both residents and first responders, who want to know what they’re getting into,” she added. “If you know what drugs are circulating, then first responders can know what medical actions to take when they arrive on site.”

Biobot was constantly in the Boston-area news during the pandemic, as the Cambridge firm tracked COVID surges and drops in the wastewater. The COVID wastewater data helped predict virus spikes in real time.

Biobot, a spin-off from an MIT research project, was able to detect new, more contagious variants, as they looked at sewage samples from the Massachusetts Water Resources Authority’s Deer Island Treatment Plant.

“We have been working with Nantucket on COVID monitoring, and this is now piggybacking and building on that program,” Ghaeli said.

Beginning in July, the town of Nantucket will expand the COVID surveillance to also include testing for flu and RSV to help predict outbreaks and identify clusters early.

“In addition, with the ongoing opioid overdose crisis impacting communities across the country, Nantucket stakeholders focused on behavioral health are working to reduce the impact of opioids locally,” Nantucket Public Health Director Roque Miramontes said in a statement.

“Wastewater sampling will play a role in tracking substance use trends on Nantucket, supporting efforts to implement harm reduction strategies, and enhancing our ability to anticipate and respond to potential overdose events,” the director said.

The drug wastewater data can help with targeted education, Miramontes added.

“We are in the early stages of this initiative and look forward to working with community partners as we gain a better understanding of high-risk substance use on Nantucket,” the director said.

Biobot will be providing updated data once a week to Nantucket officials.

“The local public health department can see in real time what drugs are circulating, and the trends in consumption,” said Biobot’s Ghaeli.

Wastewater in recent years has helped serve as an effective early warning for new threats. Xylazine, known as “tranq,” was detected in wastewater at least one month before reported overdoses—helping communities launch public health interventions.

One of Biobot’s community success stories is the town of Cary, North Carolina. In Cary’s case, the town discovered that prescription opioids were the most commonly consumed substance across all sites surveyed.

As a result, the town increased its conversations about proper disposal and security of medications. Prior to the project, the town in 2017 disposed of 924 pounds of medication through take-back events. A year later, the amount increased more than 2.5 times to 2,511 pounds.

Ultimately, Cary reduced opioid overdoses by about 40%.

The town launched a public health campaign with social media posts, Facebook Live and Youtube videos, five large community events, and 35 community presentations.

As Cary’s website reads, “Getting the word out was critical to achieving our goals: starting a conversation about the opioid crisis in our community, and reducing barriers and stigma for those who might want to seek support.”

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