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The misuse of fentanyl and more recently tramadol in the population has caused an opioid crisis in several countries and drawn much public attention worldwide. However, there is a gap of information on the potential misuse of fentanyl and tramadol in China. This study aims to fill this gap by analysing fentanyl and tramadol in wastewater of major cities across China to estimate their use. Wastewater samples were collected from 30 cities located across all seven geographic regions of China, from 2016 to 2019. Fentanyl was detected in only