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Drug-taking at festivals: how to reduce harm and protect health and wellbeing

Festival drug-related deaths are a growing public health concern. There are health risks associated with the use of party drugs such as cocaine, MDMA, and ecstasy, particularly for frequent users. The dynamic nature of the EU drug market can increase risks for all user groups, with new drugs continuing to emerge and traditional substances such as MDMA and cocaine rising significantly in purity.

Drug-checking services enable the drug user to have their drugs chemically analysed, as well as providing information on the content of the samples. Advice, and in some cases, counselling or brief interventions, may also be provided. The Trinity College Dublin Neurobehavioural Addiction Group, led by Professor Jo-Hanna Ivers and in collaboration with the National Clinical Lead of the Addiction Services (Dr Eamon Keenan), sought to comprehensively explore the evidence for drug-checking services as a harm reduction intervention. To do this, they undertook a series of interlinked studies. Firstly, a systematised review of the literature (currently in-press) aimed to review the current literature on drug-checking regarding the advantages and disadvantages, how it might work best, as well as the legal framework.

Professor Iver’s team also ran a national survey examining drug use, harm-reduction practices and attitudes toward the utilisation of drug safety testing services in an Irish cohort of festival-goers. A total of 1,193 Irish festival goers were surveyed using an anonymous online questionnaire. Alcohol, MDMA powder/crystals, ecstasy pills and cocaine were the highest reported drugs used by Irish festival attendees. Almost 9 in 10 study participants reported polysubstance use, in other words they tended to take multiple different drugs at the same time. The use of drugs was also associated with further potentially risky behaviour. Four in 10 reported having had sex following the use of a drug at a festival; and of those, two thirds said that the sex was unprotected. Overwhelmingly, participants reported a willingness to engage with drug-checking services.

In parallel to the research pieces, a report was prepared for the Minister of State for Public Health, Wellbeing and National Drugs Strategy by the Health Services Executive National Social Inclusion Office, entitled ‘Report of the Emerging Drug Trends and Drug Checking Working Group 2021’. This report, published in September 2021, was authored by Dr Keenan, Nicki Killeen and the Emerging Drugs Trends and Drug Checking Working Group, of which Professor Ivers was a senior member. This comprehensive report identified that there is currently no tailored service for young people who use drugs in nightlife settings as exists in some other countries. Health and social responses in nightlife settings and drug-checking provision provide an opportunity for professionals to engage with populations of young people that do not currently present to traditional service structures, including those who may have never received previous healthcare interventions for their substance use. The report stated that there is an increased demand for drug-checking services within the night-time economy, and especially at festivals, however, there are also barriers to an onsite ‘front of house’ service at present.

The Working Group suggested:

It is possible that a ‘back of house’ approach could be used instead, that is, using an amnesty bin within a drug service that could also inform festival goers of the content of the drugs, via communication structures outside. This might provide valuable insight into drug contents to inform drug alert mechanisms. If this ‘back-of-house’ approached worked, we might then be able to move to a full front-of-house approach at festivals. The overall aim is to protect health and wellbeing, and to minimise the harms caused by the use and misuse of drugs.”

The working group and the research team presented their findings at the Ministerial level in the Department of Health, which provided vital evidence to underpin new approaches to harm reduction for a hard-to-reach population. This research is an excellent example of the effective partnership of academics, policymakers and clinicians to produce evidence, affect policy change, and secure necessary resources to implement the evidence into practice in real-time.

Speaking about the overall impact of research, Professor Ivers said:

This work will directly impact public health policy towards drug use at festivals and in the broader ‘night-time economy’ and will result in funding for services in 2022. This investment in resources will produce significant health benefits for a cohort of people who do not access traditional treatment services, and is ground-breaking for Ireland

The National Survey can be accessed here: https://link.springer.com/article/10.1007/s11845-021-02765-2

The full Ministerial Report can be accessed here: https://www.hse.ie/eng/services/publications/report-of-the-emerging-drug-trends-and-drug-checking-working-group-2021.pdf