Meeting Newz January / February 2021

Presentations over summer Over the last couple of months St John has seen a broad range of clinical presentations secondary to recreational drug use at events, and many consistent with synthetic cathinones (the psychoactive substance commonly referred to as bath salts). Drug testing agency Knowyourstuff declared in December that this is likely to be the ‘summer of cathinones’ – and this certainly appears to have been the case. The most common clinical presentations that we have seen include agitated delirium (acute severe behavioural disturbance), anxiety, tachycardia (fast heart rate) and unconscious collapse. St John clinical director Dr Tony Smith says that while the safest thing to do is abstain from taking illegal recreational drugs, there will always be some people who take drugs and unwittingly put their lives at risk. “Often drugs contain unknown poisonous substances and/or an unknown concentration of a drug which can be extremely dangerous, meaning the person taking them is not aware they are risking their health and potentially their life.” Drug testing Until December 2020 drug testing at festivals was a legal grey area under the Misuse of Drugs Act 1975 and Psychoactive Substances Act 2013. The recent legislation changes to enable drug testing at concerts and festivals provides legal certainty to organisers, and therefore another tool in their kit to proactively support harm reduction. St John supports the testing of drugs at concerts and festivals as part of a broader harm reduction approach. Testing these substances will arm people with knowledge about drug composition and concentration before taking the drug, allowing them to make a more informed decision. Lives will be saved. St John is investigating the feasibility of providing drug testing services at events. Whilst discussions are still in their early stages, we intend to reach a decision and have an update by the end of February 2021. Recommendations to mitigate health risk: • Invest in a high level of qualified medical staff, and a sufficient ratio of clinical cover to spectator numbers (eg >1 per 1000 is a good guideline). If medical staff are overwhelmed with complex patients, it is difficult to make good and safe The presence of recreational drugs at events poses a significant health risk to event organisers that, if unmitigated, could have a significant impact on participant wellbeing and subsequently the event hosts’ brand/reputation. This update takes a quick look at what the St John Event Health Services team is currently seeing, and our recommendations to event organisers. clinical decisions. • Provide and support drug testing at the event, where available. • Provide a safe zone with an agency that has robust vulnerable people policies, and ensure your medical provider also has a dedicated presence on top of primary medical cover. • Have sufficient security on-site and dedicate a number to medical response/ locations to support safety in the management of agitated delirium. • Provide strong and clear public messaging to event participants on harm reduction pre and during the event. If you would like to discuss an upcoming event please feel free to reach out to me personally – simon.barnett@stjohn.org.nz. [ ST J OHN COLUMN By Simon Barnett Simon Barnett has 15 years’ experience as a frontline intensive care paramedic and is head of Event Health Services at St John Poisoning from recreational drugs [36] meeting newz [january february] 2021