Many health behaviors are difficult to measure. Estimates of illegal drug use are subject to substantial self-report and sampling biases. Municipal wastewater samples are routinely collected for 24-hour periods at the point of inflow to treatment plants, providing insights into substance consumption upstream that is anonymous, near real time, and relatively inexpensive. Analytic chemistry can identify specific compounds at the level of parts per billion in wastewater with very good accuracy and precision. Findings from several large-scale sampling campaigns across the Northwest for prescription and illegal drugs of abuse will be shared. Approaches to dealing with measurement and analytical issues including measuring actual population in a municipality in a 24-hour period will be discussed. The possibilities and limits of this approach for other health behaviors will be discussed.