By R. Santamarina  D. Caldicott , J. Fitzgerald , J.L. Schumann 

Background : Illicit drug use is overrepresented in music festival attendees compared with the general population. Drug use often involves a wide range of substances with the potential to cause drug toxicity. Law enforcement-centred strategies intended to deter drug use and supply at these mass gatherings have been implemented throughout Australia. However, many have been criticised for their lack of effectiveness, with evidence suggesting that they can inadvertently increase the risk of drug harm. Drug deaths are often multifactorial, providing added challenges in the development of prevention strategies. This study aimed to determine the frequency of deaths involving alcohol and other drugs at music festivals in Australia and to identify potential risk factors that may inform future harm reduction strategies.

Methods : A descriptive case series study was conducted using the National Coronial Information System (NCIS) to investigate drug-related deaths at music festivals throughout Australia between 1 July 2000 (Queensland from 1 January 2001) and 31 December 2019, using a list of keywords comprising music festival names and terms.

Results : There were 64 deaths, of which most involved males (73.4%) aged in their mid-20s (range 15-50 years). Drug toxicity was the most common primary cause of death (46.9%) followed by external injuries (37.5%). The drug most commonly detected or reported as being used was MDMA (65.6%), followed by alcohol (46.9%) and cannabis (17.2%), with most cases reporting the use of two or more drugs (including alcohol) and 36% reporting a history of drug misuse in the coroner's findings. Most deaths were unintentional, with less than a fifth of cases (17.2%) involving intentional self-harm. Clinical intervention was involved in 64.1% of cases and most festivals occurred in inner city locations (59.4%).

Conclusions : The findings suggest that drug-related deaths at music festivals in Australia typically involve young people using multiple illicit substances in combination with alcohol. Most are unintentional and could potentially be prevented through the implementation of a range of harm reduction strategies, including mobile medical care, drug checking services, and increased consumer education and awareness.

International Journal of Drug Policy Volume 123, January 2024, 104274

By Kunal Madan  , Samantha Schmidt  , Raeiti Fouladi Chami  , Raymond Ho , Justin C. Lewis  , Dorie E. Apollonio

Background: As of June 2023, a majority of states had legalized the sale of cannabis, which past research has found to be associated with increased exposures. In 2018, a change in federal policy increased access to cannabidiol (CBD) and derived psychoactive cannabis products, but there has been limited study of reported exposures following this change. Methods: This observational retrospective study analyzed exposures involving synthetic cannabinoid receptor agonists (SCRAs) and derived cannabis products, including CBD, reported to the California Poison Control System (CPCS) from 2010 to 2022. We focused primarily on potential shifts in reported exposures before and after the implementation of the 2018 Farm Bill, which removed products derived from hemp from the Controlled Substances Act. We reviewed and hand-coded individual call records to assess reported exposures over time and their characteristics, and conducted interrupted time series analysis to assess whether exposure counts changed after policy interventions. Results: Reported CBD exposures significantly increased following the federal reclassification of hemp products. Exposure reports were most common among young children and for edibles. Exposure reports provided limited information about derived psychoactive cannabis products. Conclusions: Our findings suggest a need for improved data collection regarding derived psychoactive cannabis products, as well as potential public health value in modifying packaging regulations and in providing additional guidance to parents to help prevent CBD exposures.

International Journal of Drug Policy Volume 124, February 2024, 104313

By ENACT

Iboga, a plant native to Central Africa, has been used for centuries in religious rituals and traditional medicine. In recent years, it has gained notoriety for its potential to treat substance use disorders. However, its increasing commercialisation and global trade are having a negative impact on the plant and the communities that rely on it. Ibogaine, the psychoactive alkaloid found in iboga root, can cause a variety of effects, including stimulation, aphrodisia, trance, and hallucinations. At high doses, it can be toxic. Despite the risks, iboga is being used in unregulated therapeutic clinics around the world to treat addiction. The online market for iboga is thriving, and consumers often seek out Gabonese iboga due to its sacred properties. This has led to overharvesting and deforestation in Gabon, harming local communities and the environment. Criminal networks are involved in the illicit harvesting, trafficking and sale of iboga. These networks are composed mostly of nationals from Gabon and Cameroon with connections to Europe and North America. Iboga is sold online in a variety of formats, including root bark, root powder, capsules, and, less commonly, ibogaine powder or iboga seed.

Lyon, France, INTERPOL, 2023. 31p.