Stacey Forrester is a Vancouver-based harm-reduction advocate and nurse involved in projects on health and safety at live-music events and is focusing her studies at UBC on the intersection of community, gender, and health. Kimberly Girling is a UBC PhD candidate in neuroscience with a strong interest in global health and accessible medicine who has worked with the Student Biotechnology Network and who volunteers with the Canadian Drug Policy Coalition.

In 2015, the B.C. Coroners Service reported that drug-related deaths in the province had reached an all-time high. By the year’s end, that number, a 33-percent increase from the 364 deaths in 2014, represented 484 lives lost, and with an increase in the use of the potent opiate fentanyl, it was showing no signs of slowing down.

Tragically, it did not, and drug-related deaths are still on the rise. Just three months into 2016, another 200 people died, and B.C. now finds itself in the throes of a public-health emergency .

As a result, many initiatives have been developed to address these high-risk populations, with harm-reduction programs such as Toward the Heart and the long-established Insite aiming to increase access to safe spaces, education, and substance-use facilities for street-drug users.

Casual drug use at concerts, clubs, and festivals a concern

Programs like these and many others are immensely important and are helping to make positive changes in the lives of many drug users. However, the reality is that drug use extends beyond these stereotypes, and many people of all backgrounds also use drugs on a social basis: at music festivals, at concerts, or on the

occasional weekend at a club or with friends.

In the summer of 2014 alone, almost 100 people were hospitalized due to drug-related incidents at just two music festivals in Canada. Three of these people died.

The sad truth is that many of these deaths and incidents could have been prevented with better access to drug testing to prevent ingestion of adulterated or unknown substances, better legislation surrounding harm reduction, and better discussion and education about recreational drug use. Making assumptions about a homogenous drug-user population may leave a portion of those users vulnerable, particularly recreational users who may not have easy access to harm-reduction strategies or education.

Currently, a major barrier to making changes in harm-reduction strategies for this population is a lack of good data on use patterns and perspectives of young people regarding drugs.

Survey questioned 700 young people about drug use

To address this, in the fall of 2105 we created and launched the Canadian Survey on Substance Use and asked more than 700 young people across the country about their drug use: where, when, why, and what they are using. We did this in the hopes of collecting a set of data to help better direct safety

measures for this subpopulation and address the barriers that leave them at risk of preventable consequences.

We aimed to create information that stakeholders, agencies, insurance providers, security teams, and patrons might find useful to help maximize opportunities for event safety and to benefit harm-reduction organizers and educators looking to address gaps in young peoples’ knowledge of drug use.

We had Vancouver-based harm-reduction organization Karmik review the survey prior to launch and provide feedback on the questions. Once ready, it was disseminated exclusively online, with the assistance of the B.C. Centre for Addictions Research, Canadian Students for Sensible Drug Policy, the Canadian Working Group on Overdose, and social-media outlets.

The largest group represented within our participants were those between the ages of 25 to 30 with at least a bachelor’s-degree level of education and reporting a middle-range income. Almost 90 percent of survey takers reported having used, or are currently using, substances other than tobacco, alcohol,

or medicinal cannabis.

Almost half of the participants reported first using substances between the ages of 12 and 15, which is valuable information in conversations about when to introduce drug-related education to youth.

The three most common reasons selected, when asked what their motivations were in using illicit substances, were (one could select all that applied): to have fun/relax (89 percent), to enhance an experience (82 percent), and to learn about yourself/your mind/the world (64 percent).

One participant explained his motivation in more detail: “To have a different perspective and lens, to feel more connected with people and natural spaces.”

How much do people know about drugs?

People who took our survey indicated that they felt they had a strong baseline knowledge of what they were using, and almost half indicated that they “always” research the substance prior to using. People want be familiar with dosages, what to expect, and warning signs, and they told us they use

the Internet (94 percent) and friends as their primary sources of information.

As one person stated: “Knowing what to expect from a given substance, what constitutes an appropriate dose, and how to recognize potential dangers is prudent, to say the least.” Another said: “The recent fentanyl issues make me more cautious.”

Thirty-six percent of people surveyed reported having an “unexpected” response to a substance at some point in their lives. Some of the common things experienced were dizziness, vomiting, sweating, blurred vision, and rapid or irregular heartbeat, with some needing to utilize event medic services or being sent to the hospital.

Almost half (42 percent) of the people surveyed indicated they were “very aware” of the danger signs to look out for. The habits described in the hundreds of responses we received paint a picture of educated, inquisitive, cautious people who use drugs socially and thoughtfully, people who feel confident and informed about their choices, but are receptive and wanting access to more science-based, factual information.

What substances are people using and why?

When asked where they are using drugs, music festivals and concerts (78 percent) was selected as one of the primary sites of drug use, alongside parties (77 percent) and with friends (89 percent). This is important. Festival season is about to begin in B.C., with dozens of large single- and multi-day music gatherings happening over the next four months.

Drug-related hospitalizations and, more tragically, deaths do happen at festivals in B.C. and across Canada. These are realities that are usually preventable. We need to be realistic and expect that some of those festivalgoers are going to be indulging recreationally. What do they need to help keep themselves and each other safe?

Asked if they had a preference between using drugs or alcohol, drugs were preferred by a slightly higher margin (35 percent) than alcohol (22 percent), informing us that entertainment events need to be prepared to prevent and handle harms coming from both. When asked if the legal status of a substance factored into their choices, 51 percent answered “not at all” and 22 percent stated “a little”.

Banning drug use and outside alcohol is standard at most live-music events, but to pretend that prohibition policies are an effective enough safety measure ignores the first basic principle of harm reduction: pragmatism.

What is being done? What can we do?

Shambhala Music Festival in B.C.’s Kootenay region has established a “gold standard” for music-festival harm reduction. Working with the area health authority and with full support from the local RCMP, ANKORS (a Nelson-based group) offers a full gamut of safer-substance-use education and intervention, including on-site substance-testing (pills and powders) carried out by trained volunteers.

However, this model has not been easy for other communities to replicate. Across Canada, and elsewhere in North America, events intending to include testing, sanctuary space, or even just a table with harm-reduction information have been forced to make the choice between having the event shut down, losing their liability insurance, or removing the offending harm-reduction measure in question.

This is concerning, given that: only 53 percent of survey respondents reported feeling “fairly confident” that what they are buying is the substance they want; 21 percent would like to test before using but don’t know where or how to go about that; and 95.5 percent indicated that they would testbefore using if the resources were available.

Police won’t talk about fest tests; young people wary about self-testing

Setting up substance-testing facilities, or offering ticketholders test kits, is a legal issue because, unlike simply offering information, substance-testing requires the explicit acknowledgement that patrons are in possession of narcotics at the event. This acknowledgement weighs heavy on hosts and insurance providers and is one that, even in our fentanyl crisis, is not always supported by the RCMP, police, local government, or the community. This makes it hard to balance patron safety in communities where support for harm reduction is inconsistent, limited, or nonexistent.

We contacted multiple police departments for a discussion on this aspect of harm reduction: one was refused and the others went unanswered. This isn’t to say that individual users cannot purchase a kit and test their substances on their own, as 19 percent of respondents report having done. However, as pointed out in the survey, many people reported feeling apprehensive about purchasing these test kits online without knowing the legal implications. One participant stated: “Would like to but feel nervous about having test kits shipped to my home.”

It is important to acknowledge that testing is not a catch-all solution, as there is no test yet that can detect fentanyl, and with powerful designer drugs like W-18 (reportedly up to 100 times stronger than fentanyl) surfacing on a regular basis, test kits cannot be relied on to keep up with the production of new and deadly analogues. It also doesn’t mitigate the risks of polysubstance use or other medical risks at concerts and festivals, such as how heat and dehydration further complicate substance use.

No government guidelines for managing festival drug use

So where does this leave us? Herein lies the problem. To date, there are no established provincial or federal guidelines to provide consistent direction on how to prevent and manage drug- and alcohol-related incidents at entertainment events.

Therefore, it is important that harm-reduction measures are as comprehensive as possible and even creative in their delivery to this demographic, including accurate information about drugs, including polysubstance use as well as other aspects of self-care and safety.

Hope for future?

The Canadian Centre on Substance Abuse (no affiliation with our survey) and UBC’s Mass Gathering Medicine Interest Group—recognizing the dangers swimming in the trenches between reality, theory, and the law—hosted a stakeholder meeting that created some recommendations for large-scale events.

Bass Coast Music Festival in Merritt has a robust, fact based harm-reduction componentto its events, which, like Shambhala, use trained volunteers and outreach to promote safety, community, and informed choice. Harm-reduction group Karmik brings representatives, workshops, and information to both large festivals and smaller-scale local events.

The strengths of these and similar harm-reduction programs, despite a challenging political climate, come from their use of a peer-based approach. This was clear as we were poring over people’s detailed responses to our survey. We continue to be encouraged by people’s reflections on the importance of learning and the ongoing responsibility to look after themselves and each other.

While we wait for government and law enforcement to step up with a realistic plan to help minimize the harms to people who use substances in our communities, we are left to fill in the gaps by ourselves, with ourselves. This sentiment is best reflected in a final comment from a survey participant: “Knowledge is power. Informed communities are better at helping each other, protecting each other.”

The data collected and shared in this survey belong to the authors.