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https://www.infirmiere-canadienne.com/blogs/ic-contenu/2018/02/07/project-safe-audience-du-rave-a-la-realite

Two nursing students launch a harm reduction project targeting high-risk behaviours at rave events in Winnipeg’s underground music scene

Feb 07, 2018, By: Bryce Koch, RN, Joseph Keilty, RN

Project Safe Audience is a harm reduction initiative for the rave population in Winnipeg, founded by two nursing students. Raves are late-night parties featuring high-decibel electronic dance music.

For years, music lover Bryce Koch had been attending raves across Canada. He began to notice a troubling lack of harm reduction practices at these events; people were taking large amounts of illicit substances, not practising safe sex and not bothering to use hearing protection. Teaming up with fellow nursing student Joseph Keilty, he set out to provide a safer environment for people to party in by providing harm reduction information and supplies.

Koch wanted to incorporate the experience he had gained from volunteering in the medical tent at the Shambhala Music Festival in 2016. One of Canada’s premier electronic music festivals, Shambhala prides itself on its harm reduction focus. The organizers provide drug information, drug testing and a sanctuary for anyone experiencing a rough psychedelic trip. While volunteering, Koch met Layla Page, an RN who worked with the Shambhala medical team in 2015 and 2016. She mentored him in harm reduction practices and providing health services in a rave environment.

The idea for the project began when we (the authors) were students. It grew out of our interest in health promotion and illness prevention and our recognition that the rave community was vulnerable. We had connections with two organizations with a harm reduction focus: Main Street Project, a not-for-profit where we had done our community rotation, and Street Connections, a branch of Winnipeg Regional Health Authority’s public health program. After we explained our plan, these organizations were open to giving us the supplies we wanted to offer at raves: condoms, lube, information cards on substance use and earplugs. Street Connections gave us training in naloxone administration. We knew we would need to have naloxone-trained people on the floor.

The Project Safe Audience services offered at our first event in September 2016 were basic. Because we had no initial funding, we purchased naloxone kits and quantities of earplugs, drug information cards and hearing protection cards out of our own pockets. With permission from the event organizer, we set up a table with the free supplies. We used a friendly and outgoing approach when interacting with attendees, numbering about 200. Many wanted to make physical contact, as they were high on drugs such as MDMA. We had to be open-minded, yet aware of our personal boundaries. Attendees at raves often express themselves by wearing vibrant clothing or by wearing nothing at all. We needed to keep in mind that we were there to provide a service, not to judge clothing and other forms of personal expression.

Many attendees were not wearing ear protection; those who did had not always inserted earplugs correctly. The earplugs we offered were especially popular and supplies eventually ran out, but we were pleased to have teachable moments with attendees, showing them how earplugs should be used.

Initiating conversation was the most effective way to get attendees to grab a condom. As we were telling a person about the project, we explained that the condoms are free and then proceeded to directly offer one. More often than not, people felt more comfortable taking a condom once that rapport was established.

The hearing protection cards have information about what can cause hearing loss, signs and symptoms of hearing loss, methods of reducing risk and how to use earplugs. The drug information cards list commonly used illicit substances in the rave scene and include drug classification, what the effects are, what a normal dose is and whether the drug is addictive.

We accepted offers of help from fellow nursing students and attendees and recruited an individual with a criminology degree who has experience in substance presence testing using a reagent. With this addition to our group, now comprising four nursing students, we could offer substance testing on site and give attendees guidance into what might be in these drugs. This additional service has been well received by the rave community we are working with.

We also began to offer psychedelic crisis intervention. A psychedelic crisis is also known as drug-induced temporary psychosis. Using information gleaned from programs in the United States and British Columbia, we designed a training module for volunteers that allows them to assist anyone experiencing a difficult psychedelic trip. The module outlines how such an experience can be turned into one of personal reflection and growth for the attendee. Essentially, its focus is on providing a safe environment, where those who are under the influence of a substance can express themselves and feel safe in doing so. Feeling overwhelmed while under the influence of psychedelics (e.g., LSD and mushrooms) is common. We address the issues that can cause them to feel this way (e.g., lack of warmth, lack of food, needing to talk to someone, needing a quiet space, needing distraction). We try to remove any other stressors so they can focus on the psychedelic experience, rather than on whatever is bothering them. Collecting information from the person and others and assessing for physical safety of everyone involved is the top priority.

Results

We have had an overwhelmingly positive response. We have not conducted a formal survey to evaluate the project, but our plan is to develop a simple questionnaire attendees and organizers can use to rate our services and provide comments. However, because of the many one-on-one interactions we have had with attendees, we can report that many tell us they are grateful and appreciate what we do.

At first, the organizers did not fully understand our purpose; harm reduction services in the rave community are few and far between. Most organizers now realize the value in our work, and some are donating supplies.

Because the supplies disappeared quickly, we realized the importance of starting to record the number of items we hand out and the number of people we engage with. We estimate that at the first three events at which Project Safe Audience had a presence, we handed out more than 600 sets of earplugs, 500-600 condoms and about 100 of each type of card. Ten attendees asked us to test substances just before they were about to use them. Two of the tests we conducted on MDMA came back positive for methamphetamine. In both cases, the individuals chose not to take the drug.

We presented an overview of the project at the 2017 Canadian Nursing Students’ Association national conference. This PowerPoint presentation was the focus of a workshop for students and board members that incorporated everything we had learned and gave an opportunity for them to practise substance presence testing using a reagent.

Lessons learned
The biggest hurdle for us in interacting with the rave community was not knowing the lingo. Each person has names for the drugs taken. An example is MDMA, for which the term ecstasy is no longer used. Molly and Caps are the two most common names we are hearing.

We saw a need to change what the volunteers were wearing, to appear more like attendees and less like young professionals. We looked out of place in our standard uniform of black shirts and khakis. We now wear bright clothing and will even don a string of lights.

At the first rave, we did not have a product displaying the project name. A simple banner would have helped us in starting conversations. A donation box to collect money to purchase supplies and cards printed with an e-mail address and a link to our Facebook page were also identified as essentials.

Through conversations with the ravers, we realized there was a need for a safe space for people who are having a psychedelic crisis or who otherwise feel overwhelmed or uncomfortable. We now seek out an isolated section of the venue and equip the space with blankets, soft lighting, bottles of water and colouring books. A large sign identifies the area, and we set up Christmas lights that help draw people in. When someone is in the safe space, a Project Safe Audience volunteer is always present.

A lot of the attendees have been to Shambhala, which has an excellent harm reduction program. Those who are familiar with that program immediately trust us. They are eager to come up to us to talk, shake hands, hug and ask questions. Attendees know we have testing kits, and this has also encouraged them to approach us.

Next steps

The Project Safe Audience team has been at 12 rave events in Winnipeg. The plan is to have a presence at one event a month. Although we and the other nursing student volunteers have now graduated, we will continue to try to prevent the long-term damage that can be sustained by not taking proper precautions before partying at raves.

We want to develop a training program for rave organizers, with a 45- to 60-minute PowerPoint presentation and a block of time for questions. It will cover how to communicate and interact with the rave community, what to do if someone is having a psychedelic crisis and how to solicit donations of harm reduction supplies.

Organizing naloxone training for event organizers and venue staff is the future of Project Safe Audience. This past August, we were at Shambhala to train about 90 volunteers who had expressed interest. We have also trained two event organizers in Winnipeg. Even if our volunteers aren’t able to attend the rave, we will have someone on the ground who has the knowledge to reverse an overdose and save a life.

Bryce Koch, RN, works in the emergency department at Seven Oaks General Hospital in Winnipeg. He was a nursing student at the University of Manitoba when he co-founded Project Safe Audience. Before enrolling in nursing school, he completed primary care paramedic training and licensing through Criti Care EMS.

Joseph Keilty, RN, works in the emergency department at Seven Oaks General Hospital in Winnipeg. He was a nursing student at the University of Manitoba when he co-founded Project Safe Audience.