Novel harm reduction measures at music festivals in Australia: Pilot implementation of the Emerging Drugs Network of Australia-Victoria toxicosurveillance methodology

Introduction: Harm reduction strategies at music festivals seek to create a safer environment for patrons. The Emerging Drugs Network of Australia-Victoria (EDNAV) project is a state-wide toxicosurveillance network that derives drug intelligence from a sample of patients presenting to hospital with illicit drug-related toxicity. This publication describes the preliminary outcomes of conducting toxicosurveillance for critically unwell festival patrons within on-site medical facilities.

Methods: Blood samples were collected from patrons who presented with severe illicit drug-related toxicity across three festivals (2022/2023). Blood samples were analysed via liquid chromatography-tandem mass spectrometry for over 700 pharmaceutical and illicit drugs.

Results: There were 1603 individual medical encounters across the festivals, 228 of which were illicit drug related. A blood sample was collected for 24 patients, with a median age of 22 years (range 18-39 years). A median of two drugs (range 1-5 drugs) were reported and four drugs (range 0-8 drugs) were analytically confirmed per patient. The most frequently reported exposures were congruent with analytical results, 3,4-methylenedioxymethamphetamine (reported n = 17, detected n = 20), ketamine (reported n = 9, detected n = 13) and cocaine (reported n = 9, detected n = 12). An unreported illicit drug and/or new psychoactive substance (NPS) was detected in 18 patients, including methylamphetamine (n = 10), a cathinone (n = 7), benzodiazepine-type NPS (n = 6), N-ethylamphetamine (n = 1), 3-hydroxyphencyclidine (n = 1) and/or 4-hydroxy-N-methyl-N-isopropyltryptamine (n = 1).

Discussion and conclusions: EDNAV toxicosurveillance serves as an additional tool within a multi-faceted approach to harm reduction at festivals. Continued data collection will allow for the characterisation of high-risk drug use patterns to provide evidence-based messaging to festival patrons and key stakeholders.