The Poison Is Invisible But Flowing: Türkiye's Drug Crisis in the Sewers

Altınbaş University School of Health Services Vocational School Anesthesia Program Chair Lecturer Merve Zıvalı, in her assessment written for January 17 Drug Abuse Prevention Day, emphasized that drug use should be monitored not only through criminal records and individual statements, but also through scientific methods such as wastewater-based epidemiology. According to Zıvalı, the most honest and objective data on drugs is hidden in the wastewater that silently flows beneath cities.

Stating that individual confessions or court records regarding drug use reflect only the visible side of the truth, Zıvalı emphasized that wastewater analyses provide a much more reliable picture on a societal scale. Explaining that traces of illegal substances metabolized in the human body mix into the sewage system, Zıvalı stated that this method clearly reveals which substances are used, at what concentrations, and during which periods.

Widespread worldwide, limited in Türkiye 

Noting that wastewater-based epidemiology has long been an integral part of public health and safety policies in Europe, Australia, and Latin America, Zıvalı said that in Türkiye, this method has only been discussed in a limited number of academic studies to date. 

Global picture: Historic increase in synthetic substances  

Referring to the latest reports from the United Nations Office on Drugs and Crime (UNODC), Zıvalı stated that the global drug market has reached historic highs, particularly for methamphetamine, amphetamine derivatives, and synthetic opioids. Zıvalı stated that these substances are rapidly replacing traditional drugs due to their low cost, ease of production, and high potential for addiction. He emphasized that “New Psychoactive Substances” (NPS) are advancing ahead of legal regulations, exposing societies to more deadly risks without their awareness.

Türkiye's mirror: What do wastewater samples reveal?  

Drawing attention to the results of the most comprehensive wastewater-based drug analysis conducted in 11 major cities in Türkiye in 2019, Zıvalı stated that the findings seriously challenged established public perceptions. According to the study, Gaziantep ranked first in methamphetamine use, Kayseri ranked second, and Adana saw a more than threefold increase in a few years. The same analysis found that MDMA use showed sharp increases on weekends, particularly in Mersin, Diyarbakır, and Adana, while cocaine use rose significantly in Diyarbakır, Mersin, and Gaziantep.

Although there has been no new national wastewater monitoring study since 2019, Zıvalı stated that arrest, clinical referral, and mortality data strongly support the increase in methamphetamine and synthetic stimulant use in Türkiye. 

Drugs are becoming localized  

Zıvalı stated that official security data also confirms this transformation, noting that the amount of methamphetamine seized has increased tenfold in recent years, and that drug production has begun to be carried out in neighborhood warehouses and local laboratories rather than across borders. He emphasized that this situation has transformed the drug problem from an “imported” security issue into a domestic and structural crisis.

Children and adolescents at risk  

Referring to a toxicological study conducted at Ege University on 4,524 children and adolescents aged 0-18, Zıvalı stated that alcohol or substance use was detected in 13.2% of cases, with the highest risk group being those aged 15-18. Another noteworthy finding was that one in five users were girls. 

Treatment, not punishment, should be the priority  

Zıvalı stated that studies have shown that prison sentences are not effective in reducing substance use, emphasizing that access to treatment and rehabilitation services significantly reduces recidivism rates. Pointing out that the capacity of AMATEM and ÇEMATEM centers in Türkiye is limited, Zıvalı said that scientific literature clearly shows that family-based interventions reduce substance use among young people by 30–60 percent.

Call for a comprehensive fight 

Stating that the fight against drugs should be conducted not only with a security reflex but also with a comprehensive public policy that includes early warning, prevention, treatment, and social rehabilitation, Zıvalı said that wastewater-based epidemiology could be one of the cornerstones of early warning systems.

Underlining that the drug crisis is no longer just a security issue but a multidimensional social problem threatening public health, family structure, and economic future, Zıvalı stated, “This issue is measured not by numbers but by the cost of a lost generation.”