Toxicological analysis of serious drug-related harm among electronic dance music festival attendees in New South Wales, Australia: A consecutive case series.

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.

Analysis of presentations to on-site medical units during World Youth Day 2008.

World Youth Day 2008 was held in Sydney, Australia in July 2008. New South Wales (NSW) Health, the government health provider in Australia's most populous state, worked with partner agencies to provide medical services via on-site medical units at key event venues. A post-event review of medical records from the on-site medical units indicated 465 patient presentations, comprised largely of infectious respiratory symptoms and general health concerns of a primary care nature. Providing on-site health services is considered an important risk-mitigation action for many mass gatherings, especially those that generate a substantial temporary population of participants and take place over a number of days.

Pandemic (H1N1) 2009 influenza vaccine roll-out in NSW.

The roll-out of the pandemic (H1N1) 2009 influenza vaccine in NSW was significantly different to that envisaged for a pandemic vaccination program. Pre-pandemic planning had focused on the urgent roll-out of a vaccine through mass vaccination clinics in a time of high demand due to a virulent influenza virus. Instead the situation was less urgent, with the vaccine available only after the peak of incidence of infections in NSW. Consequently mass vaccination clinics were considered to be a less appropriate method of delivering the vaccine than a primary care focused delivery model. This paper describes the program, some of the controversies considered during its roll-out and factors to be considered in planning for future pandemics.