Hostname: page-component-7c8c6479df-5xszh Total loading time: 0 Render date: 2024-03-28T11:26:37.431Z Has data issue: false hasContentIssue false

Medical Emergencies Related to Ethanol and Illicit Drugs at an Annual, Nocturnal, Indoor, Electronic Dance Music Event

Published online by Cambridge University Press:  29 December 2017

Paul Calle*
Affiliation:
Ghent University, Ghent, Belgium Emergency Department, General Hospital Maria Middelares, Ghent, Belgium
Nora Sundahl
Affiliation:
Ghent University, Ghent, Belgium
Kristof Maudens
Affiliation:
Toxicological Centre, University of Antwerp, Antwerp, Belgium
Sarah MR Wille
Affiliation:
National Institute of Criminalistics and Criminology, Brussels, Belgium
Diederik Van Sassenbroeck
Affiliation:
Emergency Department, General Hospital Maria Middelares, Ghent, Belgium
Koen De Graeve
Affiliation:
Emergency Department, General Hospital Jan Palfijn, Ghent, Belgium
Stefan Gogaert
Affiliation:
Belgian Red Cross, Mechelen, Belgium
Peter De Paepe
Affiliation:
Ghent University, Ghent, Belgium Emergency Department, University Hospital, Ghent, Belgium
Dieter Devriese
Affiliation:
Emergency Department, General Hospital Saint Lucas, Ghent, Belgium
Geert Arno
Affiliation:
Federal Public Service Health, Food Chain Safety and Environment, Brussels, Belgium
Peter Blanckaert
Affiliation:
Belgian Early Warning System on Drugs, Scientific Institute of Public Health, Brussels, Belgium
*
Correspondence: Paul Calle, PhD General Hospital Maria Middelares Emergency Department Ghent, Belgium E-mail: paul.calle@ugent.be

Abstract

Introduction

Medical problems are frequently encountered during electronic dance music (EDM) events.

Problem

There are uncertainties about the frequencies and severity of intoxications with different types of recreational drugs: ethanol, “classical” illicit party drugs, and new psychoactive substances (NPS).

Methods

Statistical data on the medical problems encountered during two editions of an indoor electronic dance event with around 30,000 attendants were retrieved from the Belgian Red Cross (Mechelen, Belgium) database. Data on drug use were prospectively collected from the patient (or a bystander), the clinical presentation, and/or toxicological screening.

Results

In the on-site medical station, 487 patients were treated (265 in 2013 and 222 in 2014). The most frequent reasons were trauma (n=171), headache (n=36), gastro-intestinal problems (n=44), and intoxication (n=160). Sixty-nine patients were transferred to a hospital, including 53 with severe drug-related symptoms. Analysis of blood samples from 106 intoxicated patients detected ethanol in 91.5%, 3,4-methylenedioxymethamphetamine (MDMA) in 34.0%, cannabis in 30.2%, cocaine in 7.5%, amphetamine in 2.8%, and gamma-hydroxybutyric acid (GHB) in 0.9% of patients (alone or in combination). In only six of the MDMA-positive cases, MDMA was the sole substance found. In 2014, the neuroleptic drug clozapine was found in three cases and ketamine in one. Additional analyses for NPS were performed in 20 cases. Only in one agitated patient, the psychedelic phenethylamines 25B-NBOMe and 25C-NBOMe were found.

Conclusions

At this particular event, recreational drug abuse necessitated on-site medical treatment in one out of 350 attendants and a hospital transfer in one out of 1,000. Ethanol remains the most frequently abused (legal) drug, yet classical illicit recreational drugs are also frequently (co-) ingested. The most worrying observation was high-risk poly-drug use, especially among MDMA users. Regarding NPS, the number of cases was low and the clinical presentations were rather mild. It should be stressed that these observations only apply to this particular event and cannot be generalized to other EDM events.

CalleP, SundahlN, MaudensK, WilleSMR, Van SassenbroeckD, De GraeveK, GogaertS, De PaepeP, DevrieseD, ArnoG, BlanckaertP. Medical Emergencies Related to Ethanol and Illicit Drugs at an Annual, Nocturnal, Indoor, Electronic Dance Music Event. Prehosp Disaster Med. 2018;33(1):71–76.

Type
Original Research
Copyright
© World Association for Disaster and Emergency Medicine 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Conflicts of interest: none

References

1. Van Havere, T, Vanderplasschen, W, Lammertyn, J, Broekaert, E, Bellis, M. Drug use and nightlife: more than just dance music. Subst Abuse Treat Prev Policy. 2011;6:18-29.Google Scholar
2. Palamar, JJ, Thomas, MG, Ompad, DC. Illicit drug use among rave attendees in a nationally representative sample of US high school seniors. Drug Alcohol Depend. 2015;152:24-31.Google Scholar
3. Novel Psychoactive Treatment UK Network NEPTUNE. Guidance on the clinical management of acute and chronic harms of club drugs and novel psychoactive substances. 2015. http://neptune-clinical-guidance.co.uk/. Accessed February 24, 2017.Google Scholar
4. Nelson, ME, Bryant, SM, Aks, SE. Emerging drugs of abuse. Emerg Med Clin North Am. 2014;32(1):1-28.Google Scholar
5. Krul, J, Blankers, M, Girbes, AR. Substance-related health problems during rave parties in the Netherlands. PLoSONE. 2011;6(12):e29620.Google Scholar
6. Van Sassenbroeck, DK, Calle, PA, Rousseau, FM, et al. Medical problems related to recreational drug use at nocturnal dance parties. Eur J Emerg Med. 2003;10(4):302-308.Google Scholar
7. Ridpath, A, Driver, CR, Nolan, ML, et al. Illnesses and deaths among persons attending an electronic dance-music festival – New York City, 2013. MMWR Morb Mortal Wkly Rep. 2014;63(50):1195-1198.Google Scholar
8. Lund, A, Turris, SA. Mass-gathering medicine: risks and patient presentations at a 2-day electronic dance music event. Prehosp Disaster Med. 2015;30(3):271-278.CrossRefGoogle Scholar
9. European Drug Report – Trends and Developments 2016. European Monitoring Centre for Drugs and Drug Addiction publication. EMCDDA Europol, Lisbon; May 2016. http://www.emcdda.europa.eu/publications/eu-drug-markets/2016/strategic-overview. Accessed February 24, 2017.Google Scholar
10. Hondebrink, L, Nugteren-van Lonkhuyzen, JJ, Van Der Gouwe, D. Monitoring new psychoactive substances (NPS) in The Netherlands: data from the drug market and the poisons information center. Drug Alcohol Depend. 2015;147:109-115.Google Scholar
11. Helander, A, Bäckberg, M, Hultén, P, Al-Saffar, Y, Beck, O. Detection of new psychoactive substance use among emergency room patients: results from the Swedish STRIDA project. Forensic Sci Int. 2014;243:23-29.Google Scholar
12. Blanckaert, P, van Amsterdam, J, Brunt, T, et al. 4-methyl-amphetamine: a health threat for recreational amphetamine users. J Psychopharmacol.. 2013;27(9):817-822.Google Scholar
13. Walterscheid, JP, Phillips, GT, Lopez, AE, Gonsoulin, ML, Chen, HH, Sanchez, LA. Pathological findings in 2 cases of fatal 25I-NBOMe toxicity. Am J Forensic Med Pathol. 2014;35(1):20-25.Google Scholar
14. World Health Organization (WHO). Global status report on alcohol and health 2014. http://www.who.int/substance_abuse/publications/global_alcohol_report/en/. Published 2014. Accessed February 24, 2017.Google Scholar
15. Gogaert, S, Vande Veegaete, A, Scholliers, A, Vandekerckhove, P. MedTRIS (Medical Triage and Registration Informatics System): a web-based client server system for the registration of patients being treated in first aid posts at public events and mass gatherings. Prehosp Disaster Med. 2016;31(5):557-562.Google Scholar
16. del Mar Ramirez Fernandez, M, De Boeck, G, Wood, M, Lopez-Rivadulla, M, Samyn, N. Simultaneous analysis of THC and its metabolites in blood using liquid chromatography-tandem mass spectrometry. J Chromatogr B. 2008;875(2):465-470.Google Scholar
17. del Mar Ramirez Fernandez, M, Wille, SMR, Kummer, N, Di Fazio, V, Ruyssinckx, E, Samyn, N. Quantitative Analysis of 26 opioids, cocaine, and their metabolites in human blood by ultra-performance liquid chromatography–tandem mass spectrometry. Ther Drug Monit. 2013;35(4):510-521.Google Scholar
18. Elliott, SP. Gamma hydroxybutyric acid (GHB) concentrations in humans and factors affecting endogenous production. Forensic Sci Int. 2003;133(1-2):9-16.Google Scholar
19. del Mar Ramirez Fernandez, M, Samyn, N. Ultra-performance liquid chromatography-tandem mass spectrometry method for the analysis of amphetamines in plasma. J Anal Toxicol. 2011;35(8):577-582.Google Scholar
20. Kinyua, J, Negreira, N, Ibáñez, M, et al. A data-independent acquisition workflow for qualitative screening of new psychoactive substances in biological samples. Anal Bioanal Chem. 2015;407(29):8773-8785.Google Scholar
21. Calle, S, Patteet, L, Maudens, K, et al. Did the Walking Dead appear at a dance event? Paper presented at: MEMC-GREAT 2015 Joint Congresses, September 5-9, 2015; Rome, Italy. https://issuu.com/aaeminfo/docs/poster_abstracts_-_tuesday T209. Accessed February 24, 2017.Google Scholar
22. Ganguly, S, Friedman, MS. Raves and saves: massive music festivals call for advanced emergency care. http://epmonthly.com/article/raves-and-saves-the-need-for-advanced-emergency-management-at-mass-gatherings/. Accessed February 24, 2017.Google Scholar
23. Ferguson, GM. Dayglow incident sheds light on growing EMS problems of dance parties. http://www.jems.com/articles/2011/12/dayglow-incident-sheds-light-growing-ems.html. Accessed February 24, 2017.Google Scholar
24. Wood, DM, Beaumont, PO, May, D, Dargan, PI. Recreational drug use presentations during a large outdoor festival event: reduction in hospital emergency department transfer where medical physicians are present. J Substance Use. 2010;15(6):434-441.Google Scholar
25. Chapple, J. 17 deaths and 100+ overdoses: a year in live EDM. http://www.iq-mag.net/2016/05/17-deaths-100-overdoses-year-edm/#.WBBsXYVOKM8. Accessed February 24, 2017.Google Scholar
26. Heyerdahl, F, Hovda, KE, Giraudon, I, et al. Current European data collection on emergency department presentations with acute recreational drug toxicity: gaps and national variations. Clin Toxicol.. 2014;52(10):1005-1012.CrossRefGoogle ScholarPubMed
27. Ritter, A. Six reasons Australia should pilot ‘pill testing’ party drugs. http://theconversation.com/six-reasons-australia-should-pilot-pill-testing-party-drugs-34073. Accessed February 24, 2017.Google Scholar
28. Krul, J, Girbes, AR. γ-hydroxybutyrate: experience of 9 years of γ-hydroxybutyrate (GHB)-related incidents during rave parties in The Netherlands. Clin Toxicol.. 2011;49(4):311-315.Google Scholar