(26) Factors Associated with Drug Harm Reduction Among Electronic Dance Music Event Attendees

Background & Introduction: Electronic dance music (EDM) events, also known as raves, attract millions of attendees annually. Studies have shown that rave attendees represent a high-risk group for recreational substance use. The use of 3,4-methylenedioxymethamphetamine (MDMA), also known as molly or ecstasy, as well as cocaine and ketamine, has become increasingly popular at these events and has coincided with a rise in use-related adverse events among users. While studies have examined substance use within the EDM scene, there is a notable gap in research on substance-related harm reduction (HR), defined as strategies to limit personal adverse experiences resulting from substance use, particularly among rave attendees in the United States. This study aims to investigate associations between demographic factors, substance use patterns, and event attendance frequency with HR adoption to inform educational initiatives and promote more equitable health outcomes among EDM event attendees.

Methods: This cross-sectional study included adults aged 18 years or older who had attended at least two EDM events in the United States within the past two years and reported any substance use at these events. An anonymous Qualtrics survey was distributed via social media and remained open from September 2024 to January 2025. The questionnaire assessed 11 HR strategies for MDMA and 12 HR strategies for cocaine and ketamine using a Likert scale. Each participant who reportedly used MDMA, cocaine, or ketamine received “safe” and “risky” scores for each substance. Participants earned a point toward a substance-specific “safe” score by reporting often or always performing an HR behavior and a point toward a “risky” score by reporting rarely or never performing a behavior.

HR scores were analyzed across demographic factors, drug use frequency, and event attendance frequency. Mann-Whitney U-tests were conducted for two-group comparisons while Kruskal-Wallis tests with post hoc Dunn’s tests were conducted for multi-group comparisons, with significance defined as p < 0.07. For parameters with significant differences, logistic regression models were used to assess the magnitude and direction of relationships with fourth-quartile safe or risky HR scores, in which p < 0.05 were considered statistically significant.

Results: 398 participants completed the survey. Of these, 319 used MDMA, 183 used cocaine, and 150 used ketamine at least once at an EDM event. The median safe score for MDMA, cocaine, and ketamine use was 8 (IQR: 7–9), 6 (IQR: 5–8), and 4 (IQR: 0–7). The median risky score was 1 (IQR: 0–2), 3 (IQR: 2–5), and 1 (IQR: 0–3), respectively.

For MDMA, risky scores differed by usage frequency (U = 14139, p = 0.007) and employment status (U = 4663, p = 0.026). Safe scores differed by usage frequency (U = 9174, p < 0.001) and event attendance frequency (U = 14268, p = 0.043). Employed individuals trended towards lower odds of high risky scores compared with individuals who were not employed (OR = 0.53, 95% CI = 0.27 - 1.06, p = 0.066). Frequent MDMA use was associated with lower odds of high safe scores (OR = 0.47, 95% CI = 0.26, 0.83; p = 0.010) and trended towards higher odds of high risky scores (OR = 1.61, 95% CI = 0.95 - 2.77, p = 0.081) compared with infrequent MDMA use. Event attendance frequency was not associated with high safe or risky scores.

For cocaine, differences in safe scores were observed across age groups (H = 13.47, p = 0.0092), with differences between the 18–22, 27–30, and 31–34 groups compared to the 35+ group. Event attendance frequency was also associated with safe scores (U = 4837, p = 0.025). Individuals in age groups 18-22, 27-30, and 31-34 had lower odds of high safe scores compared with individuals aged 35 and older (OR = 0.21, 95% CI = 0.06 - 0.66, p = 0.009; OR = 0.32, 95% CI = 0.12 - 0.82, p = 0.021; OR = 0.26, 95% CI = 0.09 - 0.75, p = 0.015, respectively). Event attendance frequency was not associated with high safe or risky scores.

For ketamine, risky scores differed across age groups (H = 13.51, p = 0.01), with differences between the 23–26 and 31–34 groups. Event attendance frequency was associated with safe (U = 3102, p = 0.026) and risky (U = 2034.5, p = 0.042) scores. Individuals aged 23-26 had higher odds of high safe scores than those aged 31-34 (OR = 4.92, 95% CI = 1.22 - 33.29, p = 0.047). Event attendance frequency was not associated with high safe or risky scores.

Conclusion & Discussion: Overall, safer behavior was observed with MDMA use compared to ketamine and cocaine use, highlighting the need for more substance-specific harm reduction education. Frequent MDMA use was associated with more risky behavior, suggesting higher exposure may normalize unsafe practices, while employment was associated with decreased odds of risky behavior, potentially reflecting the stabilizing effects of a more structured lifestyle routine. Younger cocaine users demonstrated lower odds of safe behavior, emphasizing the need for youth-focused HR education. While significant differences were found between specific age groups for ketamine-related HR, no overall trends were present.

To our knowledge, this study is among the first to examine factors influencing HR practices at EDM events in the United States, revealing substance- and demographic-specific gaps. The lack of consistent predictors across substances highlights the need for inclusive education to improve safe recreational substance use across all populations.

Study limitations include reliance on self-reported data and potential selection bias from voluntary participation. The study also lacked data on the incidence of substance-related adverse events or barriers to HR practices. Future research should address these gaps to inform targeted interventions for EDM attendees.

References: 1. Palamar, J. J., Acosta, P., Le, A., Cleland, C. M., & Nelson, L. (2019). Adverse Drug-Related Effects among Electronic Dance Music Party Attendees. The International Journal on Drug Policy, 73, 81–87. https://doi.org/10.1016/j.drugpo.2019.07.005
2. Palamar, J. J., Griffin-Tomas, M., & Ompad, D. C. (2015). Illicit drug use among rave attendees in a nationally representative sample of US high school seniors. Drug and Alcohol Dependence, 152, 24–31. https://doi.org/10.1016/j.drugalcdep.2015.05.002
3. Palamar, J. J., & Keyes, K. M. (2020). Trends in drug use among electronic dance music party attendees in New York City, 2016–2019. Drug and Alcohol Dependence, 209, 107889. https://doi.org/10.1016/j.drugalcdep.2020.107889