Since 1990 I have been studying drug use and drug cultures in the Netherlands. In 1995 I started to study drug use and risky behaviour at raves. At that time I was working at the CVO-Addiction Research Centre in Utrecht. The study was subsidised by the ministry of Health (VWS). Due to ours and similar studies conducted by others, guidelines have been developed for big raves – parties of 3,000 to 30,000 people in the Netherlands. With these guidelines the government hopes to minimise health risks on raves as much as possible.

Situation

In this paper I would like to share some ideas that crossed my mind these last few years. I want to start with an experience I had last weekend when I attended a small party (about 300 people) in Utrecht city.

Utrecht (6^th November 1999): "Entering the club was like entering a sauna. It must have been around 40ºC. People were sweating and one could hardly breathe. Since I had paid the (considerable) entrance fee, I decided to stay and I tried to find my way down to the cloakroom. I had to wait a few minutes because the cloakroom attendant was smoking a marihuana-cigarette. It was very crowded everywhere, so I figured it would be a good idea to have a seat in the chill-out which was upstairs. It was even hotter in there. I noticed that many people were under the influence of ecstasy, speed, coke and marihuana. In the chill one could buy mushroom-tea. Buying a cool drink, however, seemed to be more problematic. It took me at least fifteen minutes to get to the bar. The only place one could easily enter were the toilets. Dancing for more than ten minutes was quite impossible because of the heat. So again I tried to find my way to the chill by small stairs. The only security man present was standing at the door all night. A (first-)aid post was lacking. People who did not feel well could go outside, but were not sure that they could get in again because of a row outside. Besides, it was quite cold outside, so it did not seem to be a good idea anyway."

In our study (van de Wijngaart i.e., 1998) the circumstances in this club would have been classified as risky. It is remarkable that we hardly ever came across places like the one I just described when we did our study of big raves (3,000 people and more). The described situation, however, is not an exception; there are lots of places like this. Every weekend there are many smaller and bigger parties that are not very well organised. Nonetheless, the number of accidents appears to be small.

Furthermore, the organisers of big raves try to get round the guidelines by denying that the parties they organise are raves, saying "It’s not a house party; it’s not a rave". Following the guidelines would be quite expensive for them and some of the rules seem to be magnified.

Questions

 

1. Is it really necessary to establish all these safety rules and have professional aid helpers present at all places where people might use drugs?
2. Why isn’t the number of accidents higher in places where they don’t follow the safety rules?

Study

Before answering the questions, I will present some of the results of our study on victims at raves (de Bruin, Maalsté and van de Wijngaart, 1999). In this study we have tried to find out when people seek help at a (first-)aid post and for what kind of problem. The methods we used were:

• observations at (first-)aid posts of 23 big raves (CVO, 1996-1997);
• 1121 interviews with party-goers at ten big raves (CVO, 1996);
• 28 in-depth interviews with party-goers who didn’t feel well at a rave (CVO, 1996);
• interviews with (first-)aid helpers and other key-figures (CVO, 1997);
• analysis of registrations of pill-tests at raves (Safe House Campaign, 1992-1997);
• analysis of registrations of pill-tests at offices (DIMS, 1993-1997);
• analysis of visitors to the (first-)aid post at 42 big raves (Educare, 1996-1997).

By combining the registrations of pill-testing, the registrations of visitors at (first-)aid posts and the CVO-data we could get quite a complete picture of the situation on raves.

Feeling well and seeking help

One of the most remarkable findings is that feeling unwell and visiting a (first-)aid post do not always link. One-third of party-goers have - at one time or another - felt unwell at a rave; only 10% ever ended up in a (first-)aid post at a rave. But 78% of the ravers who ever felt unwell, did not go to a (first-)aid post for help. They were helped by friends, other ravers or not helped at all. Only 22% of the people who felt unwell went to a (first-)aid post.

This is quite an important result, especially regarding the fact that we are now very busy in the Netherlands developing training programmes for (first) aid helpers, door men and staff. In the light of this result we also should ‘train’ the ravers themselves. Most of the partygoers appear to know quite well what to do in order to help their friends, but they might not know enough. Therefore it is quite essential to find out what they do to help their friends and inform them to seek professional help when needed.

Moreover, (first-)aid helpers can’t be everywhere and many clubs are too small to pay a professional (first-)aid team. Of course, we can train people who work at those clubs too, but there is often a rapid turn-over of staff, so it is quite important to pay some attention to informing the ‘ravers’ themselves.

Symptoms

From the registrations of visitors of the medical aid post of Educare, we know that between 1% and 2% of the visitors of a party end up in a (first-)aid post. Most people at the medical aid post suffered from sickness or stomach problems (64%); another quarter (27%) had a small physical accident (for example a sprained ankle) and the other 8% seek assistance with health questions or psychiatric problems. Furthermore, one in ten thousand ravers ends up in a hospital because he or she feels unwell and one in five thousand ravers ends up in a hospital because of a physical accident (like breaking a leg).

Figure 2 Type of symptoms of visitors of the (first-)aid post (registrations Educare)

Kind of help and seeking help

From these figures we learn that the chance of serious accidents is quite small. People who feel unwell often just need to take some rest or to have a drink of water (and AA), etc. According to the ravers themselves and some experienced (first-) aid helpers, medical skills are less important than the helpers’ attitude towards ravers who feel unwell. The victims are often afraid and feel embarrassed about their drug use. When helping them it is important to make them feel at ease and safe.

We noticed a difference in the way help was sought for between people who use ecstasy and people who use amphetamines. Ravers who feel unwell because of the use of ecstasy are quite eager to seek help as they like to be assisted, but the opposite is true for ravers who feel unwell from amphetamines. They do not admit that things are wrong and rather drop another pill to feel better. If they go to a (first-)aid post, it is often quite late and at this stage it is difficult to help them. Moreover, the problems do not always stop when the party is over. Ravers who feel unwell from amphetamines or hallucinogens like LSD sometimes still feel unwell when the (first)aid helpers go home, so they leave the party still feeling unwell. All the more reason to inform the ravers themselves about what to do if things go wrong.

Polluted market

Ravers might also feel uncomfortable because they do not exactly know what was in the pill they used. In 1997 the ecstasy-market was very polluted. We know this from DIMS: the drug monitoring system by which people can have their pills tested.

In the same year we saw a change in health problems at the (first-)aid posts. In the first half of 1997 the number of ravers that ended up in a (first-)aid post was twice as large as before.

Furthermore, the ecstasy-related health problems reduced, whilst the amphetamines-related health problems stayed equal, and the psychiatric problems increased. From DIMS, we learned that many of the ravers used amphetamines instead of ecstasy in those days. The stable number of amphetamines-related health problems in (first-)aid posts can be explained by the effect of amphetamines mentioned earlier. People who feel unwell from amphetamines are less likely to seek help. Moreover, we saw an increase in small accidents as a result of aggressive behaviour. Since amphetamines make people tougher, the increase in small accidents can be explained by the increased use of amphetamines.

Conclusions and recommendations

The first question, ‘Is it really necessary to establish all these safety rules and have professional aid helpers at all places where people might use drugs?’, can be answered in both a negative as well as a positive way. Of course, it would be wonderful to have experienced (first-)aid helpers in all clubs and discos, but reality shows us that it is not possible. More important is that both catering people and the ravers themselves know where to go and what to do if something goes wrong.

Moreover, the guidelines should not be taken as strict rules and should not have to be maintained at all raves. Earlier experiences with a party organiser, the kind of visitors expected, the location of the party and so on should play a decisive role as to which rules are convenient in a certain case. The guidelines are now often used by local governments as a means to try to cancel a rave. The guidelines are meant to help to reduce risks at raves.

The answer to the second question, ‘Why isn’t the number of accidents higher in places where they do not follow the safety rules?’, cannot be supported by strong facts but from the data it appears that ravers themselves build up some experience in helping each other if things go wrong. Prevention activities and training programmes should use this knowledge and involve the ravers more in the development of their harm reduction programmes.

References

Bruin de D, Maalsté N & Wijngaart van de G (1999). Goed fout gaan. Eerste hulp op grote dansevenementen. Utrecht: Centrum voor Verslavingsonderzoek.

Wijngaart van de G, Braam R, Bruin de D, Fris M, Maalsté N & Verbraeck H (1998) Ecstasy and the Dutch Rave scene: A social-epidemiological study on the nature and the extent of and risks involved in using ecstasy and other party drugs and dance events. Utrecht: Addiction Research Institute, Utrecht University.