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This study is the first to apply wastewater-based epidemiology (WBE) to assess drug consumption patterns across 15 wastewater treatment plants in six major Tunisian cities. Daily 24-hr composite samples were collected for seven consecutive days per site between November and December 2021. Samples were analyzed using liquid chromatography\u2013tandem mass spectrometry to quantify 11 drugs and their metabolites. Results revealed marked regional differences in drug use: Sfax and Nabeul exhibited the highest amphetamine levels, while cannabis (\u0394-9-tetrahydrocannabinol (THC)) was the most consumed drug across all cities. Methamphetamine use remained low, and cocaine consumption showed localized peaks in Tunis and Ariana. To assess the pandemic\u2019s impact, 2021 data were compared with pre-COVID-19 levels from 2019. Postpandemic trends indicated increased MDMA consumption, particularly during weekends, coinciding with resumed nightlife. A qualitative screening for 32 NPS identified 26 compounds, with synthetic cannabinoids and cathinones most prevalent, and occasional detections of fentanyl analogues, reflecting evolving patterns in recreational drug use. These trends were influenced by socioeconomic and demographic differences across regions. This study highlights the value of WBE as an effective rapid surveillance tool for public health surveillance and underscores the lasting effects of COVID-19 on drug consumption behaviors in Tunisia.<\/jats:p>","DOI":"10.1093\/inteam\/vjag040","type":"journal-article","created":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T07:02:06Z","timestamp":1773212526000},"source":"Crossref","is-referenced-by-count":0,"title":["Spatio-temporal surveillance of drugs of abuse and novel psychoactive substances in Tunisian wastewater: A multicity study on consumption patterns and the impact of COVID-19"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9997-0626","authenticated-orcid":false,"given":"Bilel","family":"Moslah","sequence":"first","affiliation":[{"name":"Laboratory of Toxicology, Research Laboratory of Toxicology and Environment LR12SP07, Center Mahmoud Yaccoub for Urgent Medical Assistance , Tunis,","place":["Tunisia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1958-0769","authenticated-orcid":false,"given":"Omar","family":"Smaoui","sequence":"additional","affiliation":[{"name":"Laboratory of Toxicology, Research Laboratory of Toxicology and Environment LR12SP07, Center Mahmoud Yaccoub for Urgent Medical Assistance , Tunis,","place":["Tunisia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"N\u00e9fau","sequence":"additional","affiliation":[{"name":"European Union Drugs Agency (EUDA) Early Warning, Alert, Laboratory Network Sector, Substance Use, Harms and Responses Unit. , Lisbon,","place":["Portugal"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dorra","family":"Amira","sequence":"additional","affiliation":[{"name":"Laboratory of Toxicology, Research Laboratory of Toxicology and Environment LR12SP07, Center Mahmoud Yaccoub for Urgent Medical Assistance , Tunis,","place":["Tunisia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abderrazek","family":"Hedhili","sequence":"additional","affiliation":[{"name":"Laboratory of Toxicology, Research Laboratory of Toxicology and Environment LR12SP07, Center Mahmoud Yaccoub for Urgent Medical Assistance , Tunis,","place":["Tunisia"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2026,3,10]]},"reference":[{"key":"2026043010424438300_vjag040-B1","doi-asserted-by":"publisher","first-page":"792","DOI":"10.1016\/j.scitotenv.2017.12.269","article-title":"Wastewater-based epidemiology and enantiomeric profiling for drugs of abuse in South African wastewaters","volume":"625","author":"Archer","year":"2018","journal-title":"Science of the Total Environment"},{"key":"2026043010424438300_vjag040-B2","doi-asserted-by":"publisher","first-page":"85920","DOI":"10.1007\/s11356-023-28495-9","article-title":"Method development, validation, 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