Conceived and designed the experiments: JK ARJG MB. Performed the experiments: JK. Analyzed the data: JK MB. Contributed reagents/materials/analysis tools: JK MB. Wrote the paper: JK ARJG MB.
The authors have declared that no competing interests exist.
The objective of this study was to describe a 12-year (1997–2008) observation of substance-related incidents occurring at rave parties in the Netherlands, including length of visits to first-aid stations, substances used, and severity of the incidents. During rave parties, specifically trained medical and paramedical personnel staffed first aid stations. Visitors were diagnosed and treated, and their data were recorded using standardized methods. During the 12-year period with 249 rave parties involving about 3,800,000 visitors, 27,897 people visited a first aid station, of whom 10,100 reported having a substance-related problem. The mean age of these people was 22.3+/−5.4 years; 52.4% of them were male. Most (66.7%) substance-related problems were associated with ecstasy or alcohol use or both. Among 10,100 substance-related cases, 515 required professional medical care, and 16 of these cases were life threatening. People with a substance-related problem stayed 20 min at the first aid station, which was significantly longer than the 5 min that those without a substance-related health problem stayed. These unique data from the Netherlands identify a variety of acute health problems related to the use of alcohol, amphetamines, cannabis, cocaine, ecstasy, and GHB. Although most problems were minor, people using GHB more often required professional medical care those using the other substances. We recommended adherence to harm and risk reduction policy, and the use of first aid stations with specially trained staff for both minor and serious incidents.
In the early 1990s, a new music culture called
In the Netherlands, rave parties are allowed only if strict regulations are met. One of these is that a first aid station is required to take care of rave party attendees with various health-related problems. Here we present an overview of substance-related visits to first aid stations at rave parties in the Netherlands between 1997 and 2008.
In 1997, 2001, 2005, and 2009, surveys of substance use in the general population in the Netherlands were conducted. Each of the substances covered in the present study were included in these surveys. During this period, lifetime prevalence of cannabis use generally increased (from 19.1% in 1997 to 25.7% in 2009), as did ecstasy use (from 2.3% to 6.2%) and cocaine use (from 2.6% in 1997, 2.1% in 2001, 3.4% in 2005, to 5.2% in 2009). For the first time in 2009, lifetime prevalence of γ-Hydroxybutyric acid (GHB) use was determined to be 1.3%, and the lifetime prevalence of alcohol use was 84%
This was a prospective observational study of rave-party attendees who presented themselves for help at first aid stations at rave parties during the period 1997–2008. All persons seeking first aid were registered, but only those with substance-related problems were included in this study. Health-related incidents are described, together with length of medical care, severity of the incidents, predictability of symptoms, and short-term risks. Specifically, the following information was collected with regard to rave party attendees who sought help at first aid stations: (1) Length of stay, (2) substances used alone or in combination, and (3) nature of the substance-related problems.
In an unpublished 1996 prospective pilot study of rave-party attendees, those seeking first aid were divided into two groups. The first was a self-care group. These people visited a first-aid station with only minor health-related problems and were not included in the study. The second group visited the first aid station seeking help or advice. For this group, a standard questionnaire was developed to ask about their health-related problems
In the present observational study, data were collected prospectively and anonymously. According to Dutch regulations, neither medical nor ethical approval was needed to conduct the study. The study was not supported financially in any way. The data were obtained from files maintained by Educare, a nonprofit organization that provides first-aid assistance at large-scale events. The Educare Board of Directors consented to our using the data for scientific purposes.
Upon entering the first aid station, the person was seen by a clerical officer, who determined whether medical assistance was necessary or self-care was sufficient. If aid was required, the person was referred to a member of the medical staff. This staff included qualified nurses, paramedics, and physicians, all of whom had received training in rave-related health risks, including the effects of psychoactive substances. They had also been trained to use the standardized questionnaire. An experienced co-worker was appointed to assist the staff in filling out the questionnaires, and this person coached all of the staff members in using the questionnaires. After the rave-party attendee had been discharged from the first aid station, the co-worker checked all of the data to verify their integrity.
The number of visitors to each rave party (i.e., the number of tickets sold) was obtained from the organizers of the event. Serious health-related incidents were defined as those rated as
Descriptive statistics were used to understand the demographic characteristics of the sample and the nature of their substance-related visits to first-aid stations. To evaluate the statistical significance of the results, Person's
From 1997 to 2008, 3,793,500 visitors attended 249 rave parties. Most (70%) of the raves occurred at night. Many (
Across the 12 years, a total of 10,100 people (36.2% of those seeking first aid), representing 0.3% of all rave party visitors, experienced a substance-related incident. The incidents were medical (80%), traumatic (9%), psychological (4%), or miscellaneous (7%). The median overall length of stay at a first aid station was 10 minutes, but it was 20 minutes for substance-using visitors and 5 minutes for nonsubstance-using visitors—a difference that is statistically significant (
Year | Nr of FAA | Substance use% | Mean Age(SD) | Sex M % |
Sex F % |
General Stay at FAS |
Stay at FAS Substance-related |
Stay at FASNot substance-related |
|
2044 | 57.6 | 18.7 (2.8) | 62.0 | 37.4 | 12 (294) | 15 (294) | 7 (137) |
|
1566 | 41.4 | 20.0 (4.2) | 52.4 | 46.4 | 10 (389) | 18 (389) | 6 (184) |
|
1683 | 39.9 | 21.0 (4.5) | 56.3 | 43.2 | 10 (361) | 20 (197) | 8 (361) |
|
1843 | 36.4 | 22.2 (5.1) | 53.0 | 46.7 | 7 (359) | 15 (264) | 5 (359) |
|
3629 | 37.8 | 21.7 (4.8) | 50.3 | 49.1 | 5 (272) | 13 (272) | 4 (266) |
|
2971 | 37.3 | 22.0 (5.1) | 52.6 | 47.3 | 10 (294) | 15 (294) | 5 (248) |
|
3337 | 34.0 | 22.5 (5.2) | 51.8 | 47.9 | 10 (269) | 20 (269) | 6 (163) |
|
3818 | 30.5 | 23.5 (5.8) | 53.4 | 46.3 | 10 (323) | 20 (241) | 5 (323) |
|
2690 | 34.0 | 23.3 (5.7) | 50.1 | 48.8 | 10 (312) | 23 (312) | 6 (216) |
|
1249 | 28.1 | 23.4 (5.5) | 46.1 | 52.8 | 10 (364) | 25 (293) | 8 (364 |
|
1600 | 27.8 | 24.0 (6.5) | 48.1 | 51.6 | 10 (241) | 28 (212) | 8 (241) |
|
1467 | 30.1 | 24.0 (6.3) | 52.3 | 47.4 | 10 (554) | 30 (274) | 7 (554) |
|
27897 | |||||||
|
36.2 | 22.3 (5.4) | 52.4 | 47.0 | ||||
|
10 (554) | 20 (389) | 5 (554) |
*in minutes.
**
***missing data.
Most (
N = 10,100 | Alc | Amp | Can | Coc | GHB |
Ecs | Total |
|
|
|
|
|
|
|
|
|
2554(25.3%) | ||||||
|
- | 70 (0.7%) | 384 (3.8%) | 47 (0.5%) | 123 (1.2%) | 1129 (11.2%) | |
|
70 (0.7%) | - | 5 (0.0%) | 13 (0.1%) | 18 (0.2%) | 428 (4.2%) | |
|
384 (3.8%) | 5 (0.0%) | - | 8 (0.1%) | 61 (0.6%) | 6 (0.1%) | |
|
47 (0.5%) | 13 (0.1%) | 8 (0.1%) | - | 6 (0.1%) | 66 (0.7%) | |
|
123 (1.2%) | 18 (0.2%) | 61 (0.6%) | 6 (0.1%) | - | 190 (1.9%) | |
|
1129 (11.2%) | 428 (4.2%) | 6 (0.1%) | 66 (0.7%) | 190 (1.9%) | - |
Alc = alcohol. Amp = amphetamines. Can = cannabis. Coc = cocaine. Ecs = ecstasy.
*GHB was monitored after the year 2000.
**Magic mushrooms (
The most common substance-related health problem was a general feeling of being unwell/fainting, which was associated with the use of all substances. Additional minor health-related problems were associated with the different substances. Using amphetamines was associated with having cramps (OR = 6.9); cocaine, with having a high body temperature (>37.5°C) (OR = 29.5) or palpitations (OR = 6.5); and GHB, with altered consciousness (OR = 32.7) (
Alc |
|
Amp |
|
Can |
|
Coc |
|
GHB |
|
Ecs |
|
|
N = 2296 |
|
N = 331 |
|
N = 190 |
|
N = 44 |
|
N = 252 |
|
N = 3308 |
|
|
|
4.7 | 3.3 | 5.3 | 0.0 | 56.0 |
|
3.8 |
|
||||
|
2.6 |
|
0.9 | 0.5 | 0.0 | 22.2 |
|
1.2 |
|
|||
|
0.3 | 0.3 | 1.6 | 4.5 |
|
0.8 | 0.8 | |||||
|
1.2 |
|
19.0 |
|
0.5 | 4.5 | 2.0 | 5.3 |
|
|||
|
0.3 |
|
6.0 |
|
0.0 | 2.3 | 0.8 | 2.0 |
|
|||
|
15.6 |
|
12.3 | 27.9 |
|
11.4 | 6.0 | 18.0 |
|
|||
|
34.8 | 40.4 |
|
37.4 | 34.1 | 34.5 | 52.8 |
|
||||
|
22.8 |
|
21.4 |
|
31.6 |
|
9.1 | 14.3 | 25.4 |
|
||
|
1.2 |
|
7.5 |
|
3.7 | 13.6 |
|
0.0 | 2.5 |
|
||
|
3.5 | 6.3 |
|
1.6 | 4.5 | 0.8 | 3.1 |
|
||||
|
16.8 |
|
6.9 | 15.8 |
|
6.8 | 17.5 | 10.9 |
Alc = alcohol. Amp = amphetamines. Can = cannabis. Coc = cocaine. Ecs = ecstasy.
More than one symptom can occur in combination with each substance.
Reference category for the logistic regression analysis is not reporting use of each of the substances.
95% CI = 95% confidence interval (lower-upper).
ORs are available only for variables included in the forward stepwise model.
Alc+Ecs |
|
Amp+Ecs |
|
Alc+Can |
|
GHB+Ecs |
|
Alc+GHB |
|
|
N = 1129 | N = 428 | N = 384 | N = 190 | N = 123 | ||||||
|
8.1 |
|
5.1 | 7.8 |
|
52.1 |
|
56.9 |
|
|
|
7.1 | 10.3 | 2.6 | 1.6 | 0.8 | |||||
|
3.1 | 0.2 | 3.4 | 21.1 |
|
20.3 | ||||
|
1.2 | 2.1 |
|
0.3 | 2.1 | 3.3 | ||||
|
3.0 | 14.3 |
|
1.0 | 3.7 | 0.0 | ||||
|
1.7 | 8.9 |
|
0.5 | 0.5 | 0.0 | ||||
|
5.4 |
|
0.9 | 2.6 | 7.9 | 8.9 |
|
|||
|
16.1 | 13.3 | 25.7 |
|
3.7 |
|
6.5 | |||
|
57.2 |
|
65.2 |
|
48.8 |
|
43.7 | 35.0 | ||
|
24.1 |
|
22.9 |
|
41.3 |
|
11.1 | 13.0 | ||
|
3.5 |
|
6.5 |
|
1.3 | 0.5 | 1.6 | |||
|
2.2 | 5.8 |
|
2.1 | 0.5 | 2.4 | ||||
|
13.4 | 9.1 | 30.9 |
|
13.2 | 21.1 |
Alc = alcohol. Amp = amphetamines. Can = cannabis. Coc = cocaine. Ecs = ecstasy.
More than one symptom can occur in combination with the two combined substances.
Reference category for the logistic regression analysis is not reporting the use of each combination of the substances.
95% CI = 95% confidence interval (lower-upper).
ORs are available only for variables included in the forward stepwise model.
The number of rave-party visitors who sought first aid fluctuated during the 12 years of the study. Between 1997 and 2000, 7,136 people (1.0% of the visitors) needed first aid. Between 2001 and 2004, the number rose to 13,755 (0.8% of the visitors). From 2005 to 2008, 7,006 visitors sought first aid. Across the 12 years, a total of 515 cases were considered serious (i.e., professional medical care was required; Category 1 and 2 of the Severity Index
Substance | Period | Nr of FAVs | Risk FAVs | Nr of SI | RR SI (CI) | Risk SI |
|
1997–2000 | 401 | 0.06 | 6 | 1.9 (0.8–4.4) | 0.02 |
2001–2004 | 1281 | 0.09 | 18 | 2.3 (1.3–3.8) | 0.01 | |
2005–2008 | 616 | 0.09 | 8 | 2.4 (1.1–5.2) | 0.01 | |
|
1997–2000 | 46 | 0.01 | 1 | 2.7 (0.4–19.4) | 0.02 |
2001–2004 | 110 | 0.01 | 0 | 0 (0.0–0.0) | 0 | |
2005–2008 | 34 | 0.01 | 0 | 0 (0.0–0.0) | 0 | |
|
1997–2000 | 12 | 0 | 0 | 0 (0.0–0.0) | 0 |
2001–2004 | 23 | 0 | 3 | 21 (7.1–62.2) | 0.13 | |
2005–2008 | 9 | 0 | 0 | 0 (0.0–0.0) | 0 | |
|
1997–2000 | 1487 | 0.21 | 15 | 1.3 (0.7–2.3) | 0.01 |
2001–2004 | 1405 | 0.1 | 10 | 1.1 (0.6–2.2) | 0.01 | |
2005–2008 | 418 | 0.06 | 6 | 2.6 (1.1–6.3) | 0.01 | |
|
1997–2000 | 12 | 0 | 2 | 20.8 (5.6–77.1) | 0.17 |
2001–2004 | 136 | 0.01 | 27 | 31.9 (20.8–48.9) | 0.2 | |
2005–2008 | 104 | 0.02 | 28 | 48.9 (29.9–80.0) | 0.27 | |
|
1997–2000 | 216 | 0.03 | 4 | 2.3 (0.8–6.5) | 0.02 |
2001–2004 | 84 | 0.01 | 5 | 9.6 (3.9–23.3) | 0.06 | |
2005–2008 | 32 | 0.01 | 0 | 0 (0.0–0.0) | 0 | |
|
1997–2000 | 3988 | 0.56 | 32 | 1 | 0.01 |
2001–2004 | 9008 | 0.66 | 56 | 1 | 0.01 | |
2005–2008 | 4907 | 0.7 | 27 | 1 | 0.01 |
For each substance, the risk of visiting a first aid station was calculated by dividing the number of first aid visits (FAVs) related to that substance by the number of FAVs for that cohort.
CI = 95% confidence interval. Confidence interval for relative risk (RR) of a serious incident (SI) was calculated using Morris and Gardner's
The category
Substances | Period | Nr of FAAs | Risk FAS | Nr of SI | RR SI (CI) | Risk SI |
|
1997–2000 | 54 | 0.01 | 1 | 2.3 (0.3–16.6) | 0.02 |
2001–2004 | 227 | 0.02 | 6 | 4.3 (1.9–9.8) | 0.03 | |
2005–2008 | 99 | 0.01 | 4 | 7.3 (2.6–20.6) | 0.04 | |
|
1997–2000 | 2 | 0 | 0 | 0 (0.0–0.0) | 0 |
2001–2004 | 66 | 0.01 | 17 | 41.4 (25.5–67.3) | 0.26 | |
2005–2008 | 54 | 0.01 | 15 | 50.5 (28.5–89.4) | 0.28 | |
|
1997–2000 | 10 | 0 | 3 | 37.4 (13.6–102.4) | 0.3 |
2001–2004 | 113 | 0.01 | 31 | 44.1 (29.7–65.7) | 0.27 | |
2005–2008 | 65 | 0.01 | 16 | 44.7 (25.4–78.9) | 0.25 | |
|
1997–2000 | 340 | 0.05 | 5 | 1.1 (0.7–4.7) | 0.02 |
2001–2004 | 63 | 0.01 | 1 | 0.8 (0.4–18.2) | 0.02 | |
2005–2008 | 22 | 0 | 1 | 2 (1.2–58.2) | 0.05 | |
|
1997–2000 | 3988 | 0.56 | 32 | 1 | 0.01 |
2001–2004 | 9008 | 0.66 | 56 | 1 | 0.01 | |
2005–2008 | 4907 | 0.7 | 27 | 1 | 0.01 |
For each combination of substances, the risk of visiting a first aid station was calculated by dividing the number of first aid visits (FAVs) rrelated to that combination by the number of FAVs for that cohort.
CI = 95% confidence interval. Confidence interval for relative risk (RR) of a serious incident (SI) was calculated using Morris and Gardner's
The category
Approximately one-third of all rave-party visitors who sought first aid reported having a substance-related problem. Visitors with substance-related problems stayed longer at first aid stations than those without a substance-use problem. Altogether, 515 of 10,100 substance-related incidents were classified as serious, and 16 of these were life-threatening. Most substance-related incidents were associated with ecstasy or alcohol use or both. It is noteworthy, however, that in the Netherlands alcohol use is relatively common, but ecstasy use is not. It is possible that the willingness of rave-party visitors to present themselves at a first aid station with health-related complaints was related to the drug that they used. For example, ecstasy users'
Unlike what most other recent studies from various countries have found
In the current research, no evidence was found for life-threatening, acute effects of GHB. Nevertheless, professional medical care is often required after GHB use and the syndrome that can occur (altered consciousness, vomiting, and subnormal body temperature) can be dangerous. Health education should focus on these secondary effects in addition to the primary effects.
Questions remain about whether the relatively low rate of severe incidents that occurred was related to the open nature and legal status of rave parties in the Netherlands. It would, therefore, be important to replicate this study in other countries. To our knowledge, there is no other published research on substance-related incidents that occur during large-scale events. It would be worthwhile for future research to focus on the causes of these incidents
There were limitations of the current study that should be acknowledged. For example, long-term effects on substance use or drug addiction were not addressed. Although the study sample was large, it included only self-referrals, which might not be representative of all health-related incidents at rave parties. It is possible that many people who experienced negative effects did not present themselves at a first aid station. In fact, Wijngaart et al. and de Bruin et al. reported that some rave party visitors sought help from friends, security personnel, or food-service staff
Only a small proportion of rave-party visitors (0.3%) reported substance-related health problems. The problems that were reported at first aid stations were usually related to ecstasy or alcohol use. Substance users who sought first aid stayed four times as long at a first aid station as nonsubstance users. A total of 515 of the substance-related incidents could be regarded as serious; this amounts to 0.01% of all party visitors, 1.8% of all visitors who sought first aid, and 5.1% of all substance users who sought first aid. Sixteen cases were classified as life threatening. Visitors who used GHB, with or without alcohol or ecstasy, and those who used cocaine were highest on relative risk of having a serious incident. Finally, it should be notes that although lifetime prevalence of GHB use is low, this substance causes many problems.
The writers would like to thank all staff members of Educare for their dedication, accuracy, loyalty and contribution to this study. Special thanks to Ludger van Dijk for the statistic support and Attie van der Meulen, Loes Greiner and Marga Witter for always being there.