On Thursday, Aug. 27, 2015, organizers of raves at the county-run Fairplex in Pomona, California, canceled an upcoming event in the wake of two teenagers’ deaths at their Hard Summer festival at the same venue during August.
Eighteen-year-old Tracy Nguyen of West Covina and 19-year-old Katie Dix of Camarillo died during the first day of the two-day electronic dance music (EDM) festival. Ecstasy use was suspected, but autopsy results were still pending. Nguyen was majoring in pre-business economics at UCLA. She was known as a dancer and is quoted in one of her last tweets: “Biggest fear for hard summer: dancing with a guy that can’t keep up with me.” The Hard Summer festival was staged by Live Nation Inc. of Beverly Hills, which issued a statement saying that one victim suffered from cardiac arrest and the other from possible seizure symptoms. Hard’s annual Day of the Dead party, scheduled for Oct. 31 and Nov. 1, will be scaled back, with reduced capacity each day, reduced hours, enhanced security, and increased the minimum age for party-goers, from 18 to 21. A proposal to ban the raves or make them safer is under consideration.
In recent years, a few exuberant young dancers have attended rave parties, become hyperthermic, or developed seizures, and have died. Ecstasy and energetic dancing may be the deadly combination.
The popularity of electronic dance music parties—“raves”—has exploded in recent years, by some estimates increasing 10-fold since 2007. Raves attract youth—most attendees are in their teens or early twenties. Older folks may find it harder to recover, go back to work, restore their hearing, or care for their young children after an all-night extravaganza of deafening, rhythmic, pulsating, electronic music that beckons dancing to the beat.
A Rave: A personal, close-up view
Near midnight on a warm tropical night in a southeast Asian country, I was picked up in an unmarked car by three undercover policemen, who escorted me to a rave. I had requested the experience of gracious hosts in the morning; at 11:30 pm a call came through on my hotel room phone requesting I meet them in the hotel lobby in 15 minutes. Dressed inconspicuously in black to blend into the crowd (deceiving no one), I witnessed this packed, hot rave party from midnight to 3:30 am, surveying, scrutinizing, and eavesdropping. It wasn’t scientific research, but a moment of reflection and a longing for authenticity: if I engage youths in discussions of raves and ecstasy, shouldn’t I know what they seek, what ambience and sensations of a rave are so compelling? What attracted them to dance all night, when others were deeply asleep recovering from long, tedious, laborious days?
The entrance was jammed with young, thin men and women, attired in skin-tight, fashionable clothing and edgy hair styles. Drugs were passed around surreptitiously, with handshakes, pocket-stuffing Then the party took off: the electronic harmonies started blaring, an overlay for a low pitched pulsating thunderous thud, and electronically coordinated with thin laser lights, expansive colored lights, zebra patterned, wavy, striped, swirling lights that swept and pranced across floors, walls, ceilings, the beat and visuals blending seamlessly. Up, down, sideways, walls, ceilings, floor—it was not possible to pinpoint my position in this three-dimensional space music-light continuum. I looked for walls to orient me, but they were shrouded in moving lights. The sensory overload was deliberate. It effectively erased time or space, obscured individuality, overwhelmed thoughts, and submerged intrusive instincts for self-preservation. In this mélange of blended, pulsating formless bodies, I could focus on a few people wearing striped shirts and at times watched them from a discrete balcony. They danced intensely, almost ferociously non-stop for at least three hours. No one spoke, no one communicated, no eye contact was made, no one faced each other, no one performed fancy footsteps for another, no one held hands, no one coordinated their moves with another, no couples danced, nor foursomes. The thunderous drumbeat, the pulsating lights, throbbing floors and walls depersonalized everyone. The sensorium was abducted by sound-light; nothing else could intrude. I wondered how the brain could process so much sensory input, how vision and hearing pathways were challenged to their limits, how drugs would magnify the experience, and what long-term consequences the combination would have on brain circuits.
Shortly after the rave began, the room became hot from the crush of people. Cold rooms on the margins of the main hall were refuges from sensorial and physiological excess; people sat in these rooms on lounges, staring ahead, mostly speechless, transfixed on images I couldn’t see or imagine.
At 3:30 am, I asked my reguardians to return to the hotel. With several presentations on the schedule for the following day, and a schedule beginning at 7 am, I needed some sleep. Yet it was impossible to sleep, as my head, eyes and ears pulsated with aftershocks for hours. Without formidable compensatory instincts, I wondered how many days it would take to restore lucid thinking to a frequent drug-using raver.
Raves and Drugs
Not everyone who attends raves will consume illegal drugs, and not everyone who uses illegal drugs attends raves, but rave attendance is associated with specific patterns of drug use. People who attend raves tend to have more drug experiences than non-attendees. A recent survey of rave party-goers reported high rates of drug use. One out of five college seniors reported ever attending a rave, with 7.7% attending at least monthly. Highly religious students and females were less likely to attend raves, whereas students with higher incomes, city-dwellers, and weekly “fun-seekers” were more likely to attend. Twice as many “ravers” reported using illicit drugs other than marijuana compared with “non-ravers,” and were also likelier to use more frequently.
After effects of drugs used at raves can include insomnia, exhaustion, muscle aches, sweating, listlessness, depression—effects from the combined use of drugs and excessive exercise. There is also evidence that chronic ecstasy use permanently damages the brain and impairs cognition.
Raves, Drugs, Medical Emergencies
Why do young people, albeit few, at the prime of their lives, develop medical emergencies or die at rave parties?
MDMA or ecstasy is among the most widely used drug at raves. It is a “hybrid” drug, producing amphetamine-like high-energy stimulation (teeth-grinding is a manifestation) and serotonin-like hallucinations, empathy, and euphoria somewhat unique to this molecule (3,4-methylenedioxy methamphetamine). The dangerous or even lethal combination of MDMA, high temperatures and high-energy dancing is most frequently associated with toxicity. In a significant number of people who died in Australia, MDMA triggered a strain on an underlying cardiovascular pathology (typically atherosclerosis), leading to cardiotoxic effects or cerebrovascular hemorrhage and hypoxia. The prevalence of these underlying pathologies confers risk to users of MDMA, as do other psychostimulants such as cocaine and amphetamine. Accordingly, monoamine (dopamine, norepinephrine, serotonin) overactivity is implicated in the root causes of the medical emergencies. Most likely, crises arise because of a combined serotonin syndrome and sympathomimetic effects.
Yet the spectrum of reasons users die is not fully resolved. MDMA-induced toxicity is idiosyncratic and not dose-dependent. First-time users can develop a medical crisis with average doses, as can experienced users. Hyperthermia (high body temperature), hyponatremia (low blood sodium), dehydration, brain damage, cardiovascular collapse, and rhabdomyolysis are the most prevalent symptoms. Rhabdomyolysis or severe muscle injury or death is a serious condition. The death of muscle fibers releases their contents into blood, which challenges the kidneys to clear the waste products. Occasionally the kidneys fail and even this can cause death. Some users of “typical” dosages may experience serious life-threatening consequences.
The brain is another site of toxicity. MDMA-induced brain hyperthermia was recently shown to require social interactions in warm environments. Hyperthermia did not occur at normal room temperature, in a resting state. The mechanisms of elevated brain temperature are complex, but apparently require peripheral vasoconstriction, which prevents heat dissipation. Nontoxic doses of MDMA under cool, calm conditions can become lethal in the hot, crowded environments characteristic of rave parties. Because ecstasy is not necessarily the only drug in the pills or the only drug consciously used, it is sometimes difficult to attribute the cause of death solely to ecstasy. Research has shown that most substance-related problems were associated with ecstasy or alcohol use or both. Less serious medical care and not necessarily life-threatening emergency interventions can be encountered in rave-goers. In one study of 10,100 substance-related cases, 515 required professional medical care, of which 16 cases were life threatening. Other drugs that provoked medical intervention included alcohol, amphetamines, marijuana, cocaine, and GHB. Although most problems were minor, people using GHB more often required professional medical care those using the other substances.
Can Rave Parties Be Made Safer?
Can providing cooling stations, shaded areas, misting stations and free water solve the problem? The producers of the raves involving two deaths plan to distribute anti-drug/drug education messaging, and possibly screen for drugs. This strategy is based on the assumption that the young attendees will be using drugs, drugs that raise body temperature to dangerous levels, drugs that, combined with vigorous, unceasing dancing, dehydrate the body or deplete it of essential sodium, especially if excess water is consumed to compensate water loss but not replenish minerals.
How likely will these precautions and messages stop attendees from using drugs? Will educating young people about the hazards they may encounter with drug consequences enable them to seek help when they’ve reached a crisis? Will these responses reduce the risks? How likely is it that the educational approach will be relevant if other drugs, and not just MDMA or ecstasy, will be distributed?
Another concern, based on my anecdotal experience, is the conceivably long-term damage (the week after, or months or even years later) associated with a potentially neurotoxic combination of uncharacteristic steady thunderous sound, flashing, swirling lights, and drugs. The research data are not in, but it is a worthy pursuit.