Toxicological analysis of serious drug-related harm among electronic dance music festival attendees in New South Wales, Australia: A consecutive case series. (1st August 2020)

• Record Type: Journal Article
• Authors: Black, Eleanor; Govindasamy, Laksmi; Auld, Robin; McArdle, Kylie; Sharpe, Caroline; Dawson, Andrew; Vazquez, Santiago; Brett, Jonathan; Friend, Caren; Shaw, Vanessa; Tyner, Sophie; McDonald, Catherine; Koop, David; Tall, Gary; Welsby, Deb; Habig, Karel; Madeddu, Daniel; Cretikos, Michelle
• Is Part Of: Drug and alcohol dependence. Volume 213(2020)
• Publication Date: 2020-08-01
• Subjects: MDMA -- Ecstasy -- Music festivals -- Fatalities -- Toxicity -- Harm reduction; Drug abuse -- Periodicals; Alcoholism -- Periodicals; 616.86
• DOI: 10.1016/j.drugalcdep.2020.108070
• Languages: English
• ISSNs: 0376-8716

Abstract

Highlights: A recent increase in serious drug-related harm has occurred at New South Wales music festivals. A rapid public health response included toxicological analysis of critically ill cases. MDMA toxicity appears to have been a major factor in these cases. Harm reduction strategies targeted to the music festival setting are required. Abstract: Background: A substantial increase in drug-related harm was observed during the 2018−2019 music festival season in New South Wales, Australia, including the deaths of five young people. As part of a rapid public health response, the New South Wales Ministry of Health referred samples from patients with suspected severe drug-related illness for forensic toxicological testing to identify the type and concentration of substances associated with the presentations. Methods: Cases were identified through a variety of active and passive surveillance systems, and selected consecutively based on indicators of clinical severity. Comprehensive toxicology testing of blood and urine samples was expedited for all cases. Demographic and clinical characteristics were collated, together with quantitative toxicology results. Results were analysed using descriptive statistics. Results: Forty cases from eleven different music festivals were included. The majority of cases (80.0%) were aged 25 years and under. There were five fatalities, and 62.5% of cases were admitted to intensive care units. MDMA was the most frequent substance, detected in 87.5% of cases. In 82.9% of cases with MDMA, blood concentrations were above thresholds that have been associated with toxicity. Multiple substances were detected in 60.0% of cases. Novel psychoactive substances were not detected. Conclusions: Our findings strongly suggest that MDMA-related toxicity was a major factor in the severity of the clinical presentations among these cases. Other substances may have enhanced MDMA toxicity but appear unlikely to have caused severe toxicity in isolation. These findings have important implications for harm reduction strategies targeted to music festival settings.