Toxicological analysis of serious drug-related harm among electronic dance music festival attendees in New South Wales, Australia: A consecutive case series

Black, Eleanor; Govindasamy, Laksmi Sakura; Auld, Robin; McArdle, Kylie; Sharpe, Caroline; Dawson, Andrew; Vázquez, Santiago; Brett, Jonathan; Friend, Caren; Shaw, Vanessa; Tyner, Sophie E.; McDonald, Catherine; Koop, David; Tall, Gary; Welsby, Deb; Habig, Karel; Madeddu, Daniel; Cretikos, Michelle

doi:10.1016/j.drugalcdep.2020.108070

Cited by 14 publications

(12 citation statements)

References 45 publications

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“…Such a finding is consistent with other series that have examined this cluster. The toxicological analysis of a smaller New South Wales population taken during the 2018–2019 festival season has previously been reported by Black et al 20 . Similar to our data, the authors found MDMA to be the primary agent ingested, detected in 87.5% of individual samples.…”

Section: Discussionsupporting

confidence: 91%

Characteristics, presentation and outcomes of music festival patrons with stimulant drug‐induced serotonin toxicity

Miles

Austin

Eade

et al. 2021

Emerg Medicine Australasia

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Objective A large number of stimulant drug‐associated deaths at music festivals in Australia were reported during the southern hemisphere summer of 2018–2019. This led to the prehospital deployment of healthcare professional‐led critical care response teams. We aimed to describe the characteristics, clinical presentation, management and outcomes of music festival patrons with stimulant drug‐induced serotonin toxicity managed using this model during the study period. Methods We performed a retrospective observational study of patients presenting with stimulant drug‐induced serotonin toxicity and/or drug‐induced hyperthermia who presented between December 2017 and December 2019. Comprehensive follow‐up data were collected for those patients who required hospital admission. Data included demographics, clinical features, management and disposition, hospital outcomes and laboratory data, stratified by severity of presentation. Results Forty‐seven patients were included. Median age was 21.9 years (interquartile range 19.6–22.2). 3,4‐Methylenedioxymetamphetamine was the most frequently reported agent ingested (32/47). After stratification, 13 of 47 patients were classified as mild, 20 of 47 as moderate and 14 of 47 as severe. Median presenting temperature in this latter cohort was 41.1°C (40.5–42.0°C). All severely ill patients required intensive care unit admission, with a median hospital stay of 4.63 days (interquartile range 2.08–8.36). End‐organ complications were reported in 11 of 14 patients. No mortalities were reported. All patients (13/13) from the mild cohort and 15 of 20 patients from the moderate cohort were treated and discharged on‐site. Conclusions Severe illness was associated with a high incidence of end‐organ impairment. A high proportion of patients without severe disease were able to be successfully managed at the event without transport to hospital. No deaths are reported in this series.

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Section: Discussionsupporting

confidence: 91%

Characteristics, presentation and outcomes of music festival patrons with stimulant drug‐induced serotonin toxicity

Miles

Austin

Eade

et al. 2021

Emerg Medicine Australasia

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“…Higher-risk drug-related behaviours explored here included: double dropping (the concurrent use of two or more dosing units) [4]; higher-risk ethanol (consumption of eleven or more standard drinks (SD), defined as high risk by the Australian Institute of Health and Welfare [25]) alongside drug use [6]; larger quantity MDMA (consumption of four or more pills or capsules or 1 g or more of powder) [3] over the course of the event; mixing stimulants (MDMA/ ecstasy, cocaine, methamphetamine, lysergic acid diethylamide [LSD/acid], or magic mushrooms) [5], and; preloading (taking all or larger amounts of drugs and/or alcohol before an event) [26].…”

Section: Methodsmentioning

confidence: 99%

“…Such outcomes are often the result of a complex interaction between drug consumption, drug-related behaviours, cultural norms and a range of contextual factors such as ambient temperatures and onsite provision of peer-based harm reduction programs and medical services [3].…”

Section: Introductionmentioning

confidence: 99%

“…Behaviours related to drug use that are proposed to put people at higher risk of harm at festivals include double dropping 3,4-methylenedioxymethamphetamine (MDMA) (taking two or more dosing units at once), consuming higher quantities of ethanol alongside drug use, consuming higher quantities of MDMA, mixing stimulants and preloading with drugs prior to entering the festival [3][4][5][6]. Double dropping carries increased risks of MDMA-related toxicity given the unknown and variable dose of MDMA found in recreational samples [7][8][9], while prior studies have found that excessive consumption of alcohol has been the predominant cause of presentation for emergency medical treatment at festivals [6].…”

Section: Introductionmentioning

confidence: 99%

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Correlates of higher‐risk drug‐related behaviours at music festivals in New South Wales, Australia

Healey

Siefried

Harrod³

et al. 2021

Drug and Alcohol Review

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Introduction. There are few contemporary data on illicit drug use at music festivals. We describe drug use patterns and prevalence of specific higher-risk drug-related behaviours, and their associations with festivalgoer characteristics. Methods. We approached attendees at six major music festivals in New South Wales, Australia, from November 2019 to March 2020. Participants self-completed an anonymous survey on prior and intended drug use and associated higher-risk behaviours; double dropping; higher-volume ethanol alongside drug use; higher quantity 3,4-methylenedioxymethamphetamine (MDMA); mixing stimulants; and preloading. Logistic regression and UpSet analyses were performed to identify festivalgoer characteristics and the intersection of high-risk behaviours, respectively. Results. Of 1229 participants, 372 (30.3%) used or planned to use drugs at the festival. In multivariable analyses, men and those purchasing drugs both inside and outside the venue had greater odds of engaging in higher-risk behaviours. Of those using MDMA, 47.9% reported double dropping. People using drugs for the first time had 3.3 (95% confidence interval 1.2-8.7) greater odds of higher-volume ethanol alongside drug use. People reporting that police/police dog presence influenced their decision to take drugs had 2.2 (95% confidence interval 1.4-3.6) greater odds of preloading. In UpSet analysis, preloading was the most common intersection (17% of those using drugs). Discussions and Conclusions. Engagement in the five higher-risk drug behaviours was common, particularly amongst males and those using drugs for the first time, while police/police dog presence appeared to influence higher-risk behaviours amongst festival attendees. This information can be used to inform harm reduction advice, public health and law enforcement strategies.

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“…15 Access to state-of-the-art analytical instrumentation and expertise provided by ChemCentre WA enabled identification of the specific drugs causing harm, their quantitative levels and associated clinical effects across more than 600 ED patients. Similar approaches with varying methodology have also been successfully implemented in South Australia (South Australian Drug Early Warning System -Admission Blood Psychoactive Substance Testing), 16 New South Wales (Prescription, Recreational and Illicit Substance Evaluation -PRISE) 17 and Victoria (Emerging Drugs Network of Australia VIC).…”

Section: Introductionmentioning

confidence: 99%

The Emerging Drugs Network of Australia: A toxicosurveillance system of illicit and emerging drugs in the emergency department

Smith

Soderstrom

Dawson

et al. 2021

Emerg Medicine Australasia

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Objective: The unprecedented rise in synthetic drugs, many containing unknown toxic agents, has made timely analytical diagnosis more difficult, and has reduced the confidence of clinicians providing ED management to this population of patients. This has also impacted the quality of evidence informing harm reduction responses. The Emerging Drugs Network of Australia (EDNA) brings together emergency

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Toxicological analysis of serious drug-related harm among electronic dance music festival attendees in New South Wales, Australia: A consecutive case series

Cited by 14 publications

References 45 publications

Characteristics, presentation and outcomes of music festival patrons with stimulant drug‐induced serotonin toxicity

Characteristics, presentation and outcomes of music festival patrons with stimulant drug‐induced serotonin toxicity

Correlates of higher‐risk drug‐related behaviours at music festivals in New South Wales, Australia

The Emerging Drugs Network of Australia: A toxicosurveillance system of illicit and emerging drugs in the emergency department

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