Wastewater doesn’t lie — but the report does a neat little sleight of hand

A continuation from my previous blog.

Why Australia’s national wastewater data show nicotine hasn’t fallen, and why the ACIC’s wording hides the only question that matters

Australia’s National Wastewater Drug Monitoring Program (NWDMP) has been quietly collecting one of the best population-level records of substance use in the country since 2016. The latest collections (August and October 2024) cover roughly half to just over half the population and give us a fresh snapshot of nicotine and alcohol use across capital cities and regional Australia.

The headline is blunt and inconvenient for prohibitionists: total nicotine use is not falling. Regional Australia consistently records higher nicotine consumption than capital cities. The Northern Territory sits at the top of the national table, and over the life of the program, nicotine consumption has trended up, not down.

But there’s a second, subtler headline the report buries in the methods: ACIC has switched the language from tobacco to nicotine, and explains that it estimates nicotine from two metabolites, only cotinine and hydroxycotinine, and therefore “cannot distinguish” whether nicotine came from cigarettes, e-cigs or nicotine replacement therapies (NRT). That explanation is presented as a scientific limitation. It isn’t. It’s a choice. And that choice changes everything.

What the wastewater actually shows (and what it doesn’t)

Wastewater measurement is powerful because it captures population-level chemical signatures in an objective way. From those signatures, the NWDMP estimates consumption per thousand people for multiple substances, sampled across capital and regional sites.

From the August–October 2024 results, we know:

• Regional > capital for nicotine consumption in every reporting period since 2016. This pattern is robust, not a one-off blip.

• The Northern Territory exhibits the highest nicotine and alcohol loads nationally — in both capital and regional samples.

• Nicotine levels in Aug 2024 sit around the long-term average, but the longer trend is upward.

• Alcohol is broadly steady in the past two years and has trended downward over the longer term, a useful contrast to nicotine’s trajectory.

But critically, the dataset as presented only reports total nicotine. That is, it lumps together nicotine from combustible tobacco, e-liquids (vapes), and nicotine replacement therapies. The method uses cotinine and hydroxycotinine as markers, and the report states those markers don’t differentiate sources.

The kicker: they can separate sources — they just chose not to As per this study

Wangetal.Talanta2024 (1).pdf

Download PDF • 1.89MB

Here’s the political science wrapped in a chemistry lab coat.

ACIC separates chemically close opioids, heroin, fentanyl, and oxycodone in the same program. That demonstrates two things: (1) the program knows how to measure nuanced chemical differences, and (2) the choice of which substances to disaggregate is a programmatic one, not an inevitable technical barrier.

Analytical approaches exist (and have been used in research) to tease apart nicotine from tobacco combustion versus nicotine from e-liquids or pharmaceutical products. Tobacco leaves and combustion produce additional alkaloids, combustion by-products and tobacco-specific nitrosamines that aren’t present (or are present in different proportions) in vaping liquids or NRT. Those markers allow a source-resolved view.

So when ACIC writes that the method “cannot distinguish” sources, the reader should translate that as: the program is reporting total nicotine by design. And by relabeling the category from “tobacco” to “nicotine”, the report dilutes the underlying public health question: are we reducing the harms of smoking?

Why that dilution matters

Lumping everything into “nicotine” turns a health outcome (less smoking, fewer combusted cigarettes) into a neutral metric (amount of nicotine molecules in wastewater). That shift has three destructive consequences:

1. It hides success. If smokers switch to vaping or to medically supervised NRT, population harm falls dramatically even if total nicotine remains steady. Aggregate “nicotine” would not show that gain.

2. It misdirects policy debate. Policymakers and media can point to “nicotine is high” and claim the policy is working or failing, depending on their spin, without having to show whether the deadliest element, combustible tobacco, has actually fallen.

3. It justifies prohibition optics. By refusing to distinguish sources, the report can be wielded as evidence that “nicotine use is high” while concealing whether smoking (the main cause of tobacco death and disease) is up or down.

Suppose a program wants to be a genuine tool for public health policy. In that case, it should measure what matters: smoking, youth initiation of combustible tobacco, cessation rates, and illicit market dynamics, not just raw nicotine mass.

The regional story matters — and policy must match it

One of the clearest and most actionable findings of the NWDMP is the persistent gap between regional and capital consumption. Regional Australia is not a homogeneous, passive victim of policy; it has higher nicotine and alcohol use for reasons that deserve specific, local responses:

• Economic stress, unemployment or precarious work patterns.

• Cultural norms around smoking and alcohol.

• Reduced access to cessation services and regulated alternatives.

• Potentially different retail and illicit markets.

A national one-size-fits-all crackdown, particularly one that drives consumers to illicit supply chains, is likely to fail where local drivers of demand remain unaddressed.

Policy implications — what should happen next

The wastewater program gives us the data to ask useful questions. But the way those data is packaged determines what questions are even visible. Here’s what policymakers should do immediately:

1. Measure source-resolved nicotine. Add markers that distinguish tobacco combustion from vaping and NRT. It’s technically feasible and essential for honest evaluation.

2. Report smoking outcomes, not just nicotine mass. Pair wastewater with surveys and sales/cessation data to judge reductions in harmful tobacco use.

3. Move from prohibition to harm reduction. Regulated, quality-controlled adult access to vaping products, combined with stronger cessation support, will target smoking — without pretending that simply reducing nicotine molecules is the same thing.

4. Target regional strategies. Fund place-based cessation services, outreach and economic supports in areas where wastewater shows consistent excess consumption (NT and many regional catchments).

5. Be transparent about analytic choices. Any change in reporting taxonomy (tobacco → nicotine) must be flagged as a policy decision with a clear rationale, not buried in a methods paragraph.

Rebutting the predictable lines

If you hear: “Wastewater proves vaping increases nicotine,” reply: No, wastewater shows total nicotine. It doesn’t show the source.

If you hear: “You can’t separate sources,” reply: ACIC separates close-chemical opioids. The tool exists; the choice was not to use it for nicotine.

If you hear: “Crackdowns take time,” reply: The long-run trend is up, not down. If prohibition reduced smoking, we’d expect directional change; we don’t see it.

The Democratic Test

Public health measurement must inform democratic choices. When a national program converts a question about smoking harms into a single “nicotine” line, it erodes the information citizens and policymakers need to make sensible decisions. That’s not a neutral analytic decision; it’s an argument about which outcomes we regard as important.

Wastewater tells us the pipes: who’s consuming and where. It can also tell us whether a policy reduces the deadly practice of smoking. But only if we insist on the program measuring the right things. Until we demand source-resolved nicotine data and transparent reporting, policymakers will continue to hide behind neutral-sounding metrics while the health outcomes that actually matter, less smoking, fewer hospitalisations, fewer premature deaths, remain unmeasured and unresolved.

Call to action

If you care about reducing smoking and protecting public health:

• Demand ACIC publish source-resolved nicotine analyses (tobacco vs vaping vs NRT).

• Insist governments judge policy by smoking outcomes, not by aggregated nicotine mass.

• Push for regulated access to safer nicotine products and extra support for regional communities.

If the goal is health, we must measure health, not just molecules.