Wastewater Analyses for Psychoactive Substances at Music Festivals: A Systematic Review

Music festivals have emerged as venues for the consumption of recreational drugs and novel psychoactive substances. This systematic review provides the first critical evaluation and synthesis of published wastewater analyses for detecting recreational drug use at music festivals worldwide. Following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, we systematically searched PubMed, Embase, MEDLINE, and SCOPUS databases using terms combining music festivals, drugs, and wastewater analysis. Twenty-three studies were included, spanning festivals with 6200 to 600,000 attendees. Two primary sampling approaches emerged: wastewater sampling (16 studies) and pooled urine sampling (7 studies), using Liquid Chromatography-Tandem Mass Spectrometry or Liquid Chromatography-High-Resolution Mass Spectrometry for chemical analysis. 3,4-Methylenedioxymethamphetamine (MDMA; ecstasy) emerged as the most consistently detected substance. Regional variations included a dominance of methamphetamine in Eastern Europe, MDMA use in Western Europe, and a high prevalence of cocaine use in South America. Regarding the music genre, electronic dance music events showed markedly higher MDMA rates. Limitations include geographic underrepresentation of African and Asian countries and a gender bias in pooled urine sampling. Future research should work on enhancing sampling infrastructure, analytical capabilities, public health surveillance, and harm reduction strategies.