Welcome to the Australian Festival Association’s (AFA) online harm reduction training portal. The AFA has worked in conjunction with the Alcohol and Drug Foundation (ADF), Australian Red Cross Save-A-Mate (SAM) program and Harm Reduction Victoria’s DanceWize program to develop this training. The content here draws on a range of other services and resources from around the world and within Australia too.

This text-heavy version of the training is temporary because we wanted to make this content available before Summer started, and a more user-friendly version with audio and visuals will be launched in 2020.

This training is designed for those who participate in the Australian music event and festival setting, either as event organisers, other staff and contractors, as well as patrons. By the end of this training participants will be able to:

  • Understand the influence of ‘Drug, set and setting’ on a drug experience, including how these factors in combination influence the likelihood of a drug-related health disturbance.
  • Name the main types of drugs and their general effects
  • Apply early detection, prevention, and general care measures to reduce the likelihood and severity of drug-related harm in event settings.

Your knowledge will be quizzed at the end of the training, and once you have achieved a result higher than 75%, you will have passed. You will have more than one opportunity to complete the quiz. Depending on existing knowledge, this training can take between 10-20 minutes.

Privacy statement: to complete the quiz and receive a certificate of completion, you will be asked to provide your name and email. Your personal information will be kept confidential according to law. Only staff at AFA will have access to this information and it will be kept in a secure database behind a password-protected firewall. The quiz results will help us understand the knowledge gaps among the people who have completed the training and to improve industry best practice standards. This information may be reported on in aggregate, and we will not report on any individual cases.

1) Drug, set and setting

A drug experience, and any potential drug-related health disturbance, is due to a combination of factors. ‘Drug, set and setting’ are the three key factors that determine the experience/wellbeing of the person. Next, these factors will be explained. ‘Drug’ Defined

A drug is ANY substance – solid, liquid or gas which, when taken into the body affects us…

Physically (body)
Mentally (brain)

And excludes food, water and oxygen.

A drug may be legally regulated, like alcohol, nicotine or medications, or it may be illicit. The potential that a drug may cause someone harm is not necessarily determined by its legal status.

Drugs acquired from an illegal market are not produced to pharmaceutical or commercial standards, which means they carry different kinds of risk. Drugs from an illegal market may or may not be what they are claimed to be. Drugs from an illegal market may be adulterated, that is, mixed or ‘cut’ with other drugs. These considerations may be for intentional or unintentional reasons.

‘Poly drug’ combination refers to the use of more than 1 drug. A person may experience a polydrug combination either intentionally or unintentionally. A common example of unintentional polydrug use is when a person on medication has alcohol. Some polydrug combinations are more high risk than others and all polydrug use is generally more high risk than using a single drug. All drug use involves some degree of risk.

1A) Drugs defined

When we say, consider ‘Drug, set and setting, ‘Drug’ refers to factors within the taken drug(s).

Examples are:

  • Chosen drug (type, duration etc)
  • Poly-use
  • Frequency of use
  • Amount used
  • Legality of use
  • Production quality of drug
  • How it is used (swallow, snort, smoke etc )

1B) ‘Set’ defined

‘Set’ was originally defined to mean a person’s ‘mindset’. ‘Set’ has come to be understood as a person’s entire physical and psychological set.

When we say, consider ‘Drug, set and setting, ‘Set’ is all factors within a person. These may be permanent or temporary factors. Examples are:

  • Physiology of person                      
  • General health of person
  • State of being                    
  • Hydration/hunger
  • Cultural background
  • Lived experiences
  • Experience with drug
  • Knowledge of drug
  • Motivation for use

1C ‘Setting’ defined

When we say, consider ‘Drug, set and setting, ‘Setting’ refers to external factors that can affect a person. Examples of ‘setting’ are:

  • Location of the experience
  • Intensity of stimuli
  • Control over stimuli
  • Social group person is with
  • Temperature (think hot Aussie summers)
  • Humidity
  • Affinity with location
  • Community attitudes and knowledge
  • Presence of law enforcement, security, authority figures

In this training, we are focusing on music events and festivals as the setting. So, it’s important to remember that these are generally places where people, often young people, go to celebrate music, art and friendship. Keep this in mind, as these patrons are generally seeking a pleasurable experience, may be drug naïve (never used alcohol or other drugs before) and, if they have used alcohol or other drugs before, it is unlikely that they have health concerns or use problematically that this stage in their life. If drug-related harm occurs, it more likely to be due to acute risks, like having ‘too much’, a high risk ‘combo’, or it wasn’t what someone was expecting.

2. Why is it important to recognise the influence of ‘Drug, set and setting’ and not just learn about drugs?

Recognising that a drug experience, and any potential drug-related health disturbance, is due to a combination of factors means assumptions are not made too soon and a person’s situation is not under or over-estimated. For example:

  • Certain health conditions may present like common signs of intoxication, even when a person has not used a drug.
  • What looks like intoxication on a single drug may actually be a poly-drug combination, for example, a person may use prescription medication for anxiety and, if they mix this with alcohol, they are more at risk of a depressant overdose than if they only had 1 drug.

The ‘Drug, set, and setting’ framework or educational tool that encourages you to change your perspective so you don’t miss important signs that someone needs support or assume too soon that you understand the kind of support someone may need. This change in perspective can reduce stigmatising attitudes, for example, toward a person for using a certain drug or being too intoxicated. Even if you disapprove of drug use or it scares you, when we tolerate stigmatising attitudes, like ‘Just Say No’, we can create barriers that undermine health and wellbeing. For example,  people hesitant to seek help if they feel judged. Stigma is a factor relating to a setting that increases the likelihood of drug-related harm.

3. Types of Drugs

The simplest way to categorise types of drugs is demonstrated by this triangle diagram, but due to changes in the international drug market in the 21st century, this is too simple to reasonably explain the types of drugs that are commonly being used.

In this basic alcohol and other drug harm reduction training we will discuss the 6 main categories of drugs. There are more advanced ways to categorise drugs, such as the ADF’s Drug Wheel (https://adf.org.au/insights/drug-wheel/) and Youthrise’s Universe of Drugs (http://youthrise.org/resources-library/the-universe-of-drugs/)

3A) Type of drug: stimulant  

‘Stimulant’ defined: any drug that excites any bodily function, but more specifically those that stimulate the brain and central nervous system.
Examples of this drug include caffeine, steroids, amphetamine-like ‘speed’ & ‘ice’ & medications like dexamphetamine, cocaine.

Signs of stimulant use/intoxication:

  • Euphoria (very happy)
  • Alert & increased energy (talkative and moving quickly)
  • Sweaty & red skin
  • Jaw clenching & teeth grinding
  • Dilated (big) pupils
  • Decreased appetite
  • Increased muscle tension
  • Raised blood pressure, heart rate, and breathing rate.

3B) Type of drug: psychedelic

‘Psychedelic’ defined: a drug that alters a person's cognitive processes and sense of self. The effects of psychedelics on the central nervous system are reasonably neutral, but a person’s experience may be significantly influenced by factors relating to set and setting.
Examples of this drug include LSD, Magic Mushrooms, DMT. Note.

Signs of psychedelic use:

  • Euphoria (very happy)
  • Introversion, extroversion or possibly no outward change
  • Reports of creative or unusual thoughts
  • Reports of sensory enhancement
  • Increased awareness of bodily sensations
  • Paranoia (rare eg. thinking you are under threat)
  • Hallucinations (seeing, hearing, smelling, feeling things that aren’t there)
  • Delusions (thoughts of grandeur or that you are in a different reality)

3C) Type of drug: depressant

‘Depressant’ defined: Any drug that slows bodily function, but more specifically those that depress the brain and central nervous system. This should not be confused with the mental health state of depression.

Examples of this drug include alcohol, GHB, benzodiazepine medication (eg. ‘Xanax’ or ‘Valium’), opioids (Note, this is a kind of depressant drug derived from the opium poppy that has an analgesic or pain-relief effect. Examples of this drug include heroin and medications like Codeine, Tramadol and Oxycontin).

 Signs of Depressant use:

  • Euphoria (very happy)
  • Slurred or slow speech
  • Poor coordinator or concentration
  • Drowsiness/nodding off
  • Clammy & pale skin
  • Pinned (small) pupils
  • Decreased muscle tension
  • Lowered blood pressure, body temperature and breathing rate

3D) Type of drug: empathogens

‘Empathogens’ defined: A kind of drug that stimulates a sense of empathy and social connectedness.

The most well-known example is MDMA / ‘ecstasy’. MDMA use may present like the effects of a stimulant combined with mild psychedelic effects.

Signs of Empathogen use:

  • Stimulant signs + Psychedelic signs

All stimulants increase the body temperature. What’s unique about an empathogen like MDMA compared to stimulants is it works with the brain chemical ‘serotonin’. With MDMA there’s an increased risk of over-heating from serotonin syndrome, which can result in an overdose and cause death. Early signs include uncontrolled movements like uncontrolled movements, like, shaking feet (clonus), shaking/wobbly eyes (ocular clonus), or ‘gurning’/repetitive chewing (bruxism). Muscles may become tense, especially around wrists and ankles. It’s worth visiting 1st aid to get your temperature checked if any of these signs start happening. People may show these signs and still report they are having a great time, but be starting to overheat. Once you are in a temperature that is 30 degrees Celsius of higher (indoors or outside), the risk of over-heating can increase rapidly.

There have been cases of hypernatremia associated with MDMA use, which can result in an overdose and cause death (drowning from drinking too much water and loss of body salts). A harm reduction tip is to drink up to 500mls of fluids per hour, but not more. Eat regularly to maintain your body’s salt levels, but if eating is difficult put electrolytes in the fluids you’re drinking.

https://i.ytimg.com/vi/pRwXP2zIWVQ/hqdefault.jpg

3E) Type of drug: dissociative

‘Dissociative’ defined A kind of drug that distorts a person’s perception, particularly of the relationship between their mind and body. The effects may present like a depressant combined with a psychedelic

Examples include nitrous oxide / ‘nangs’ and ketamine.

Signs of Dissociative use:

  • Depressant signs + Psychedelic signs

For example, ketamine is regularly described as a ‘depressant’ because a person may outwardly appear to be slowed down or nonresponsive, but internally their blood pressure and heart rate make be unaffected or slightly increased. Pupils may be normal or even dilated. People in this state may also be aware of what’s going on around them, but unable to move (referred to as a k-hole).

3F) Type of drug: cannabinoids

‘Cannabinoid’ defined: the effects of cannabis may present or be experienced as being more like a depressant, stimulant, or psychedelic depending on the strand of the plant, which varies in terms of their cannabinoid make-up. When people smoke or vaporise the cannabis the onset of effects is very quick and over sooner. When consumed orally it takes longer to take effect, lasts longer, and could be a more psychedelic-like experience.

The most well-known examples of cannabinoids are THC and CBD. THC produces the experience people most commonly associate with cannabis. CDB is understood to reduce the experience of anxiety

Signs of Cannabinoid use:

  • Depressant signs + Psychedelic signs + Stimulant signs

THC and CBD have different boiling temperatures, which is something to consider when comparing smoking to vaporising. With smoking the plant matter combusts, both THC and CBD are consumable. With Vaporising, THC can be consumed from about ~150 degrees Celsius. For CBD it’s ~180 degree Celsius. So if someone vaporised cannabis at <180 they may not be consuming the CBD content, has an anti-anxiety effect.

4) Know the Signs (what others can see) and symptoms (what a person is experiencing)

The signs of intoxication or overdose vary depending on the type of drug consumed, the factors internal to a person (Set) and environmental factors (setting). The way an overdose looks also varies from person to person, for example, a person experiencing a depressant overdose has lowered consciousness or even be unconscious, but a person experiencing a stimulant overdose may be highly active and then become unconscious. The setting can change the prevailing risk of overdose too. For example, the risk of a stimulant overdose increases in hot weather and for depressant overdoses the risk increases in cooler weather.

4A) What is an overdose?

An overdose is the use of any drug in an amount or way which causes negative reactions in the user which are mental or physical. Overdoses can sometimes cause death, but more commonly they may be experienced without any kind of intervention. Drug-related harm is broader than just an overdose.

4B) Overdose and polydrug combinations

  • It’s challenging to predict the effects of polydrug combinations.
  • The effect of different drugs last different lengths of time and how someone presents over the course of a polydrug experience will change to reflect that.
  • The effects of one type of drug may override the effects of another type of drug. For example, the effects of depressants generally override the effects of both stimulants and psychedelics.
  • Having more than one drug of the same type, like two depressants, can have a compounding effect and increase the risk of overdose.
  • If mixing different types of drugs or more than one drug of the same type, there is a generally increased risk of overdose. For example, if you mix a depressant and a stimulant you may think these two types of drugs level each other out (for example alcohol & MDMA or alcohol & cocaine or GHB & speed), but a person who does this is often putting their heart under strain, which can cause acute and longer-term risk, meaning they may seem OK until they are not OK.
  • Check out the risk ratings of respective drug combinations here: https://wiki.tripsit.me/images/3/3a/Combo_2.png

4C) What are the signs and symptoms of a mild health disturbance?

If you can recognise the early signs and symptoms that someone is at risk of an overdose or drug-related harm and encourage self-care and harm reduction strategies you can reduce the likelihood and severity of that harm.

Most of the mentioned health disturbances below are common at music events and festivals and may be early warning signs that may be experienced from any kind of drug use or factors relating to the person (set) and environment (setting):

Headache

One of the most common health disturbance at events. A headache can be a symptom of dehydration, which occurs after inadequate fluid and salts intake over a period of 72 hours. People should be having up to 500mls per hour and eating regularly for salt intake. Alcohol also plays a part in dehydration as for each glass of alcohol the body excretes one-and-half glasses of fluid.

Malaise

Malaise is described as “a general feeling of discomfort, illness, or unease whose exact cause is

difficult to identify”. Sometimes it is a combination of multiple vaguely described factors and something just doesn’t feel or seem right.

Nausea / Vomiting

Some drugs are taken orally and can give a strong reaction to the body. Some drugs have a direct effect on parts of the brain related to the digestion system. Someone can just be nauseous for personal health-related reasons. Stimuli can be too overwhelming within the experience someone is having, or a combination of the above. Vomiting contributes to the risk of dehydration.

Dizziness

This can be a difficult concept because not everyone means the same thing using the word ‘dizziness’. It is important to understand what the person means by ‘dizziness’. Dizziness is caused by changes in the vestibular and the brain. These two are closely related.

Drowsiness

Many drugs can cause a decrease in consciousness without the person being unconscious. In this case, people don’t react or react less to stimuli, such as a person speaking to them. A person might only react to a strong stimulus i.e. speaking loud or applying pain.

Temperature deviation

Depressants can lead to a decreased body temperature by a combination of the drug, an individual’s decreased activity and the surrounding temperature. GHB can cause excessive sweating, so you’re wet and more at risk of getting cold, which is an extra cause for hypothermia.  Some stimulants increase the body temperature and suppress the person’s own ability to feel how hot/cold they really are. Stimulants can also cause sweating and are linked to both hyperthermia and hypothermia.

Anxiety

Music events and festivals can be an overwhelming setting for anyone at times. If someone uses a drug they may have an expectation towards the affects and if the experience is not in line with these expectations the person can become anxious.

Challenging experience

An event can be very overwhelming. Presence of strong stimuli such as loud music, moving lights, a large number of people attending the event, weather conditions, social/group dynamics, and the duration of the event (setting); combined with the use of a drug and/or possible internal factors such as previous unprocessed psychological distress (drug and set), can lead to a breaking point where coping with the experience becomes challenging. This could of course also happen without the presence of a drug. The examples of challenging experiences listed below may be light disturbances or more deemed more critical depending on how the individual is responding to their experience:

  • A person is having an unexpected drug experience or more challenging than anticipated drug experience
  • A person is having an emotional experience because of a relationship breakdown on-site
  • Sense of overwhelm
  • Lost or confused

These can occur from any kind of drug use or factors relating to set or setting.

4D) Text the Effects

Want to know more? Text the Effects is a drug information service via SMS. It provides information about the effects of drugs in a confidential and accessible way, any location, any time. Simply text the name of the drug you want to know about to 0439 tell me (0439 835 563).

5) Harm Reduction Strategies

General harm reduction measures are designed to lessen the negative social and/or physical consequences associated with various human behaviours, both legal and illegal, including alcohol and other drug use. Here are some tips to share among people considering drug use:

5A) Drug

  • Consider the source
  • Sample only a small amount
  • Tell someone what you intend to take/have taken
  • Don’t share drug equipment
  • If you choose to redose, make sure you have researched that substance (never redose within 2 hours)
  • Learn about the different risks regarding polydrug combinations

5B) Set

  • Practice self-care
  • Ask yourself what is your motivation for use?
  • Eat regularly to maintain electrolytes (have smoothies or soup if solids are too much)
  • Drink water (up to 500mls per hour)
  • Rest often on stimulants and let your body cool down
  • Don’t rest unsupervised on depressants, go to medical if staying awake is difficult or if you have to leave someone to get help put them in the recovery position (shown in a diagram later).
  • Know your limits, as less is often more.
  • Don’t be afraid to get help, you can ask any event crew member to help you get to medical and you don’t have to explain why.

5C) Setting

  • Never use alone
  • Stay with your drinks (keep your eyes on them)
  • Dress for the weather
  • Stay with your mates/have a meeting spot
  • Look out for the wellbeing of others too, ask people if they’re OK if something doesn’t seem right.
  • Familiarise yourself with the services on-site
  • Plan a safe way home/charge your phone

6) How to Help

6A) What to do in the event of an emergency?

There are many types of emergencies. All alcohol and other drug emergencies are health emergencies. A person may be unconscious, they may be highly active or uncontrollably upset. Respond to the situation without making assumptions and remember these key points:

  • Remain Calm – there are a number of support services around you. Take a moment to assess the situation before you react.
  • Stay safe – check for danger and only offer assistance if it is safe to do so.
  • Send for help—notify the nearest staff member with a radio, like a security guard or bar supervisor, and they will call for on-site help

6B) Consent and an emergency

If you are unsure whether a situation is an emergency, ask – Trust your gut. If someone doesn’t seem right, then ask them. If you are unsatisfied with their response, reassure them that they are not in any trouble and that you would like them to get checked by medical.
A conscious person can refuse help, but you can still call for first aid to check in with them or monitor the person. Having a supportive and non-judgmental attitude is important for this communication process.

If unconscious or unable to formally consent, consent is assumed and necessary first aid can be given

For bar and security staff, remember your legal responsibilities – Always abide by the Responsible Service of Alcohol (RSA) laws of your state.

Get a 1st Aid certificate so you know more about responding to emergencies.

6C) DRSABCD – If trained apply 1st aid

If you are not 1st aid trained yet, it’s easy to learn to move an unconscious person into the recovery position

6D) Privacy
In a first aid situation, steps should be taken to maintain a person’s privacy by

  • Keeping crowds away and this may include friends if they are highly distressed
  • Covering up exposed body parts
  • Avoid talking about the incident unless with medical or necessary services

6E) Respectful behaviours

When handling patrons who are intoxicated or otherwise need first aid or emergency support, it is important to:
Treat everyone with respect. Do not touch anyone without their permission (unless unconscious). Be aware that people have the right to refuse assistance.

6F) Show sensitivity and reassure a person that you are there to help. Do this by;

  • Identifying yourself
  • Speak in a calm and positive manner
  • Bend or squat to the person's level (do not loom over them)
  • Use the patron's name if you know it
  • Keep the focus on positive support such as (“help is on its way” or “I am not going to leave you”)
  • This approach can have positive and reassuring effects to both the patron and bystanders.

7) TOPIC – Consent and respect

Above we introduced ‘consent’ during an emergency, where conscious people can refuse assistance, but if someone is unconscious you do not need consent to apply first aid. When it comes to interactions between conscious people, seeking, gaining and maintaining consent is essential. 

If someone discloses a sexual assault to you, whether you believe they are under the influence of alcohol and other drugs or not:

DO’T

ASSESS FOR SAFETY AND FIND QUIET

RESPECT SOMEONE’S STORY

LET THEM KNOW YOU’RE LISTENING BY NODDING YOUR HEAD OR SAYING ‘MMM’

BE PATIENT AND CALM

PROVIDE FACTUAL INFORMATION

BE HONEST ABOUT WHAT YOU CAN AND CANNOT DO

KEEP IT SIMPLE

ACKNOWLEDGE - I CAN IMAGINE THIS IS DIFFICULT FOR YOU

REMEMBER YOU ARE PART OF A WIDER RESPONSE

DON’T

PRESSURE SOMEONE

INTERRUPT

JUDGE

TELL THEM SOMEONE ELSE’S STORY

TALK ABOUT YOUR EXPERIENCES

GIVE FALSE PROMISES

GO INTO SOLUTION MODE

TAKE AWAY THE STRENGTH OF THE PERSON

COMMENCE COUNSELLING

Victim and Survivor – VAS – Validate, Acknowledge, Support

If someone does not want to make a report that is their choice. You can write down and give them the phone number 1800 RESPECT so they can connect with services later if they choose. If you tell them the number they may not remember it due to the experience of trauma.