Drug Checking at Music Festivals

"Illicit drug use at music festivals has been the subject of Australian public and media attention following the drug-related deaths of six young Australians across two festival seasons in 2019 and 2020 (Lee, 2019), and a further young Australian at a festival in February 2023 (Australian Associated Press, 2023). Internationally, studies show higher rates of drug use among music festival attendees compared to the general population (Day et al., 2018; Fox et al., 2018; Hughes et al., 2019; Hughes et al., 2017; Measham and Simmons, 2022). A substantial proportion of the health risks associated with illicit drug use relate to the lack of regulated drug supply caused by prohibition; for example, there is risk of variable purity, whereby the substance is stronger than anticipated (Day et al., 2018; Hughes et al., 2017), or risk of unexpected substances (e.g., fentanyl) being ingested at unknown doses or causing harm via interaction effects due to adulteration (Atherton et al., 2019; Karamouzian et al., 2018; Maghsoudi et al., 2022).

"Methods used to characterise drug use at music festivals include drug checking, in situ surveys and wastewater analysis. Drug checking services conduct chemical analyses of substances of concern submitted directly by the public and return the results to the service user through a tailored intervention that aims to reduce drug-related harms (Barratt and Measham, 2022). A secondary benefit of these services is their ability to generate unique and timely information about drug markets that can be disseminated rapidly via text message or social media alerts (Barratt and Ezard, 2016; Brien et al., 2023; Sample, 2015; Measham, 2019). Next, a handful of studies have used in situ patron surveys to investigate patterns of drug use at music festivals (e.g., (Day et al., 2018; Barratt et al., 2018; Southey et al., 2020)); while valuable, surveys are limited in their ability to accurately capture the full range of substances used due to sampling constraints and reliance on self-report (Lancaster et al., 2019; Zuccato et al., 2005; Tscharke et al., 2015; Gjerde et al., 2019). In contrast, other studies have analysed wastewater samples collected from festival-based sewage sources, essentially conducting an anonymised urine test on the whole festival (Bijlsma et al., 2020; Lai et al., 2013; Bade et al., 2020; Mackulak et al., 2019). While wastewater analysis cannot provide insight into individuals' experiences of substance use (e.g., amount used per person, motivations for use), it provides an objective, non-intrusive method of measuring substance use without raising major ethical issues (Gjerde et al., 2019; Lai et al., 2013; Mackulak et al., 2019; Mackulak et al., 2015), thus overcoming many of the limitations of survey data in these settings. A novel approach combines survey and wastewater data to compare substances that participants believe that they are using (via surveys) versus the drugs they are actually using (via wastewater analysis). We are aware of only one study internationally using this method among festival attendees; Brett and colleagues (2022) reported the detection of cathinones in wastewater at music festivals in New South Wales, Australia, yet no survey respondents reported intentional cathinone use, showing the value of this complementary approach (Brett et al., 2022). Using similar methodology to Brett et al. (Brett et al., 2022), and within the context of the imminent implementation of drug checking services in Queensland, this study aims to characterise the differences between drugs that participants self-report using or intending to use in surveys versus the drugs detected in wastewater at a Queensland-based music festival across two consecutive years (2021 and 2022)."