Eleanor Black1, Laksmi Govindasamy2, Robin Auld3, Kylie McArdle4, Caroline Sharpe5, Andrew Dawson4, Santiago Vazquez6, Jonathan Brett4, Caren Friend7, Vanessa Shaw6, Sophie Tyner5, Catherine McDonald6, David Koop8, Gary Tall9, Deb Welsby3, Karel Habig9, Daniel Madeddu10, Michelle Cretikos3. 1. Clinical Quality and Safety, Centre for Population Health, New South Wales Ministry of Health, St Leonards 2065, NSW, Australia. Electronic address: eleanor.black@health.nsw.gov.au. 2. New South Wales Public Health Officer Training Program, Centre for Epidemiology and Evidence, NSW Ministry of Health, St Leonards 2065, NSW, Australia. 3. Clinical Quality and Safety, Centre for Population Health, New South Wales Ministry of Health, St Leonards 2065, NSW, Australia. 4. New South Wales Poisons Information Centre, The Children's Hospital at Westmead, 2145, NSW, Australia. 5. Office of the Chief Health Officer, New South Wales Ministry of Health, St Leonards 2065, NSW, Australia. 6. Forensic and Analytical Science Service, New South Wales Health Pathology, Lidcombe 2141, NSW, Australia. 7. Western Sydney Local Health District, New South Wales Health, Sydney NSW, Australia. 8. New South Wales Health Emergency Management Unit, NSW Ambulance, Rozelle 2039, NSW, Australia. 9. Aeromedical and Medical Retrieval Services, NSW Ambulance, 2039, Rozelle NSW, Australia. 10. Alcohol and Other Drugs, Centre for Population Health, New South Wales Ministry of Health, St Leonards 2065, NSW, Australia.
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.
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 MDMAtoxicity but appear unlikely to have caused severe toxicity in isolation. These findings have important implications for harm reduction strategies targeted to music festival settings.
Authors: Robert Page; Amy Healey; Krista J Siefried; Mary Ellen Harrod; Erica Franklin; Amy Peacock; Monica J Barratt; Jonathan Brett Journal: Drug Alcohol Rev Date: 2022-05-23