As clubs and other venues reopen, David Lynch examines a new document on drug trends and health responses in the night-time economy.

Drug-checking “enables health professionals to engage with hard-to-reach populations”, according to a recent report from the HSE National Social Inclusion Office. The Report of the Emerging Drug Trends and Drug Checking Working Group concludes that there is “no tailored service for young people who use drugs in nightlife settings, as in other countries”. One of its key recommendations is for a pilot drug-checking service for music festivals.

“Health and social responses in nightlife settings and drug-checking provision provide an opportunity for professionals to engage with populations of young people that don’t currently present to traditional service s tructures, including those who may have never received previous healthcare interventions for their substance use,” according to the report.

The Irish drug landscape has “been changing for some time”, the report states, and “many new user groups now exist from a range of social demographics”. Drug-checking and monitoring has the “potential to reduce drug-related harm” by identifying “when extra risky substances are in circulation”, the HSE National Clinical LeadAddiction Services Dr Eamon Keenan said.

Dangerous Substances

Speaking at the report launch, Dr Keenan added that “Dutch examples have shown the value of real-time alerts in preventing drug-related deaths when dangerous substances emerge on the market”.

The report recommends a so-called ‘backof-house’ limited pilot drug-checking project at music festivals, in which drug samples can be anonymously dropped into an amnesty bin and then be tested by medical experts. For the moment, the report does not recommend a more large-scale ‘front of house’ system, in which people can openly hand over drugs to be tested, citing some possible legal difficulties.

It found that there are barriers to piloting an on-site ‘front-of-house’ service at this time in Ireland, with more work needed to be done with the Department of Justice. “The working group reviewed a ‘back-of house’ approach, with consideration for placing an ‘amnesty bin’ within a drug service at a festival which could inform attendees of the contents of drugs through communication structures on-site,” according to the report.

“While not directly engaging with people who use drugs, a ‘back-of-house’ approach can provide valuable insight on drug contents to inform drug alert mechanisms.” The report states if the ‘back-of-house’ pilot system proves positive, “this may then support the development of a full ‘front-of-house’ approach for festival settings”. The report also makes some specific recommendations for emergency medicine at music festivals and similar events.

It states “emergency critical medical care requires further expert discussion to consider the management and preparedness for critical illness, toxidromes and hyperpyrexia at events, as well as improved data collection”. In this regard, the report notes that there will be the formation of a national committee chaired by HSE’s emergency management division. It is expected that this committee will develop standardised reporting templates for festival medical care providers and drug services at events to capture necessary data for health services.

The report reviews drug use and health responses among people who use drugs in nightlife spaces. “For some time, the topic of substance use in the context of nightlife settings has received little attention in research, policy and practice,” said Dr Keenan.

The report recognises that an emerging stimulant and polydrug culture among new user groups is currently a major issue of concern across Europe and here in Ireland. “The proliferation of stimulant drugs in Ireland is occurring during a period when increased purity and potency of substances is a cause of concern for health services,” said Dr Keenan. “We have identified a need to improve research and develop new services in response to these trends.

The current situation is particularly relevant as nightlife resumes throughout Europe. Nightlife outreach and drug analysis are recognised ways in which we can engage with young, hard-toreach populations.” The HSE said it recognised that there is limited information on the composition of substances consumed in Ireland, with identification mainly being utilised for law enforcement purposes that does not inform health communications, interventions and warnings.

Full report available at: https://www.hse.ie/eng/services/publications/report-of-the-emerging-drug-trends-and-drug-checking-workinggroup-2021.pdf.