Emergency Info

Guidelines on when to call the Emergency Services 999 for unwell recreational drug users

Call 999 if ANY one of the following is present:

Unconsciousness – if the patient does not respond to vocal commands, requires painful stimulus (e.g. pressure across the fingernails) to respond or does not respond at all.

Significant agitation (e.g. pacing around the room) or aggression not settling within 15 minutes.

Seizures (e.g. a convulsion similar to an epileptic fit)

Breathing difficulties such as fast breathing rate which does not settle within 15 minutes.

Heart rate over 140 beats per minute not settling within 5 minutes.

Temperature over 38.5 not settling after about 5 minutes of rest, or if very flushed and feels very hot if no thermometer is available.

Blood pressure – Systolic (“upper pressure”) over 180mmHg, or Diastolic (“lower pressure”) over 110mmHg on two repeated blood pressure measurements.

Other concerns – if there are any other concerns (e.g. severe headache, chest pain).

 
IF IN DOUBT CALL 999

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A concise, factual overview of the current dance, music and drugs scene.

The media has a high level of interest in the late night economy and stories about such issues as binge drinking, alcohol-related violence, and ecstasy deaths are common.

Many of these stories are unsurprisingly sensationalist in tone, and sometimes give a misleading picture of the ways in which drugs and alcohol are taken at pubs and clubs and festivals. So, in this section of Safer Nightlife, we provide a brief, factual overview of the current dance and drugs scene.

Nobody knows for certain just how many people in the UK go out to music and dance events on either a regular or occasional basis. Nor do we know how much cocaine, ecstasy and other drugs are consumed before, during and after these events. What we do know, however, is that the dance music scene that emerged in the late 1980s has continued to grow and evolve over the past thirty five years. We also know that frequent clubbers are many times more likely to take Class A drugs such as cocaine1Home Office (2018) Drug Misuse: Findings from the 2018/19 Crime Survey for England and Wales..

Music and drug trends change all the time and different types of drug use are often associated with difference music scenes. While there has been a big reduction in the overall number of both pubs and clubs over the last decade, nevertheless as recently as 2016, 23% Brits described themselves as clubbers in a Mintel survey2Mintel (2016) UK Nightclubs market report.. And while pubs and clubs have been closing, the opposite has been the case with music festivals which have more than tripled in number over the last five years.

Trends in drug use

Fashions in drug use change all the time of course. Overall levels of drug use in England and Wales have remained fairly flat over the last decade and are actually at a lower level than 20 years ago, although they have started to rise again since 2016/17. The latest official data3 Home Office (2018) Drug Misuse: Findings from the 2018/19 Crime Survey for England and Wales. found that around one in 11 (9.4%) adults aged 16 to 59 have used an illegal drug in the last year, equivalent to around 3.2 million people. That figure is, unsurprisingly, much higher for young adults aged 16 to 24 where around one in five (20.3%) had taken a drug in the last year. The figures for regular drug use are of course lower: around 1 in 20 (5%) of all adults aged 16 to 59 had taken a drug in the last month, while around 1 in 9 (11.4%) young adults had done so.

Clubbers’ drug use

However, going out regularly, particularly clubbing, is associated with much higher levels of drug use. Frequent clubbers are many times more likely to take Class A drugs than non-clubbers, with 24.5% of frequent clubbers (defined as going to clubs 4 or more times a month) taking Class A drugs in 2018/19 compared with 2.3% of adults who had not attended a club in the last month4 Home Office (2018) Drug Misuse: Findings from the 2018/19 Crime Survey for England and Wales. .

Latest drug figures

As we have said, drugs go in and out of fashion but at the time of publication, Autumn 2019, we know that:

  • Cannabis remains the most commonly used drug with 7.6% of adults and 17.3% of young adults using the drug in 2018/19,
  • The second most commonly used drug is powder cocaine (2.9% of adults and 6.2% of young adults using it last year). Cocaine use has been on the increase in recent years; particularly since 2015. While prices have remained the same or even dropped, the purity of cocaine powder has almost doubled5The average purity figure for Cocaine seized by all police forces in the UK in the first quarter of 2019 was 70.14%.. Cheaper, stronger cocaine has resulted in a number of specific health risks which we cover here,
  • MDMA/Ecstasy use has also been on the increase again over recent years with 545,000 people and 300,000 young adults estimated to have used the drug last year. The concentration of MDMA in Ecstasy tablets is also much higher than it was a decade ago6The average purity figure for MDMA seized by all police forces in the UK in the first quarter of 2019 was 59.45%. and is linked to an increasing number of drug-related deaths every year7The average number of deaths where ecstasy/MDMA was mentioned on a death certificate as the underlying cause of death in England and Wales was 54 in the five year period 2013-2017 compared to 25 in the previous five year period (2008-2012)..
  • Ketamine use has also become much popular with the proportion of young adults taking it in the last year at 2.9%.
  • The use of LSD and magic mushrooms are both on the rise (about 0.4% of adults use both drugs last year) and are associated with the growing popularity of music festivals.
  • GHB and GBL, a very strong drug which needs to be taken very carefully in small doses, once thought to be only used on the gay scene, has now crossed over into mainstream use in some clubs.
  • The use of New Psychoactive Substances (NPS) has fallen markedly since they were made illegal in May 2016. However, official figures found that people who went to pubs or clubs are more likely to use NPS. The use of nitrous oxide/laughing gas remains popular with clubbers and festival goers.
  • The use of prescription medication for recreational purposes appears to be an increasingly common phenomenon.

The links between drugs and music

Different patterns of drug use are associated with different genres of music and different settings. These associations change too rapidly and vary too much between regions for us to provide reliable information in this guide. However, those putting on music events and festivals will have a good idea of which particular drugs are most popular amongst the target audience and need to plan security, health and welfare provision accordingly.

Footnotes   [ + ]

1. Home Office (2018) Drug Misuse: Findings from the 2018/19 Crime Survey for England and Wales.
2. Mintel (2016) UK Nightclubs market report.
3. Home Office (2018) Drug Misuse: Findings from the 2018/19 Crime Survey for England and Wales.
4. Home Office (2018) Drug Misuse: Findings from the 2018/19 Crime Survey for England and Wales.
5. The average purity figure for Cocaine seized by all police forces in the UK in the first quarter of 2019 was 70.14%.
6. The average purity figure for MDMA seized by all police forces in the UK in the first quarter of 2019 was 59.45%.
7. The average number of deaths where ecstasy/MDMA was mentioned on a death certificate as the underlying cause of death in England and Wales was 54 in the five year period 2013-2017 compared to 25 in the previous five year period (2008-2012).

Safer Nightlife does not provide detailed information on the health risks of different substances since the most important information for those involved in running pubs, clubs and festivals is to take the prompt action detailed here

However, there is still some value in understanding the main risks associated with the substances most commonly used by people going for a night out. You can view a list of the substances in the order of their popularity amongst pub and club goers here.

It should be remembered that many people take a combination of substances and alcohol and that the effects of these combinations can be unpredictable. Illegal drugs can also interact badly with prescribed medicines or those bought at a high street pharmacy. The same substance can have a different effect on different people, depending on their gender, weight, individual tolerance and emotional state.

Although the focus of Safer Nightlife is providing information on the safer management of illegal drug-related harms at pubs, clubs and festivals, we would of course be remiss not to include alcohol in the resource.

Those involved in selling alcohol in the hospitality industry will be familiar with the main risks associated – aggression and violence, drink driving, accidents and, occasionally, serious harm or even death to the person consuming excess alcohol, particularly when combined with legal or illegal drugs.

There are a number of reputable training courses1 For example: Drinkaware runs e-learning around alcohol vulnerability for staff working on licensed premises. https://www.drinkaware.co.uk/work-with-us/alcohol-vulnerability-awareness-e-learning/ to help licensed premises equip their staff with both knowledge about their legal responsibilities and duties and skills such as how to refuse to sell alcohol to an intoxicated customer in a way that does not provoke a disturbance.

Alcohol-related ill health

Alcohol is a massive health issue in England. In 2017/18 (the last year for which official statistics are available2NHS Digital (2019) Statistics on Alcohol, England 2019) there were 338,000 hospital admissions where the main reason for the admission was alcohol and there were 1.2 million admissions where the primary reason for hospital admission or secondary diagnosis was linked to alcohol – one in 14 of all hospital admissions. These figures are about 15% higher than those of the previous decade. A number of people also die every year from alcohol poisoning – consuming too much alcohol on one specific occasion.

Alcohol trends

Overall, though, we are starting to consume less alcohol as a country with young people leading the way. The proportion of men and women usually drinking at levels with an increased or higher risk of harm decreased between 2011 and 2017 (from 34% to 28% of men, and from 18% to 14% of women). The proportion of men and women usually drinking over 14 units in a week varied across age groups and was most common among men and women aged 55 to 64 (36% and 20% respectively).

Young men aged 16 to 24 years old are the age band least likely to drink at “increased or higher risk of harm” levels. While for women those aged between 55 and 64 are most likely to drink at these harmful levels.

In addition, one of the main risk factors from taking illegal drugs is to combine that activity with drinking alcohol.

Footnotes   [ + ]

1. For example: Drinkaware runs e-learning around alcohol vulnerability for staff working on licensed premises. https://www.drinkaware.co.uk/work-with-us/alcohol-vulnerability-awareness-e-learning/
2. NHS Digital (2019) Statistics on Alcohol, England 2019

The rise of the music festival

While more than a quarter of pubs and clubs have closed during the last decade, the number of musical festivals, many of whose participants see drug-taking as integral to the occasion, has risen rapidly, reportedly exceeding 1,000 in 2016 and still growing1Bernadette McNulty (2017) Has the UK’s festival scene reached saturation point? Financial Times..

The result is a shift in the festival ecosystem, with a marked rise in the number of city-based and one-day events and a decline in traditional camping weekends.

Whereas, until recently, people living in many parts of England and Wales would have had to plan ahead and travel large distances to attend a festival playing the types of music they liked, now they are spoilt for choice and can often make last-minute decisions based on the latest headlining acts and the weather forecast.

Planning

This provides additional challenges for those planning and regulating festivals who need to be prepared for a last-minute drop or surge in the number of people attending. This has particular consequences when planning to manage drug-related harms; ensuring that there are sufficient numbers of security and welfare/medical staff to meet everyone’s needs on the day or weekend (and sufficient revenue to pay them).

Outdoor festival planners also have to factor in the impact of the weather on their events. There were problems at an outer London Festival in 2019 when a new digital admissions system failed and thousands of festival goers, many of whom had been preloading on alcohol and drugs, were left outside without protection from a very hot sun and started fainting and suffering other adverse effects from dehydration.

Footnotes   [ + ]

1. Bernadette McNulty (2017) Has the UK’s festival scene reached saturation point? Financial Times.
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