Water, Hyponatremia, MDMA & Heat Stroke: How Not to Die

 

By Terry Gotham

Now that the summer festival season is in full swing and we’ve all been dripping with sweat once at least once, it’s time to have a little chat. If you’re one of the people who hasn’t pissed clear at a festival since Dubya was president, this is 100% for you. If you’re the person in your circle that hounds everyone else to stay hydrated and eat salty snacks Wednesday morning on playa, this is also 100% for you. For this edition of Do No Harm, I spoke to Dr. Daniel E. Rusyniak, Professor of Emergency Medicine & Adjunct Professor of Pharmacology/Toxicology and Neurology at the IU School of Medicine. He dropped a pile of knowledge, so I’m going to be able to walk you through what happens to your body when you roll your face off. Down to the hormonal level, putting yourself at risk for heatstroke & hyponatremia. And of course, also illustrate how to NOT do that.

In your body, there’s this antidiuretic hormone called Vasopressin, also known as ADH. ADH’s job is to ensure your body retains water (hence it being known as an antidiuretic), and to constrict blood vessels. By increasing the water pemeability of the kidneys, it plays a key role in keeping your fool ass hydrated. When it’s heavily secreted, your kidneys get the signal to fast track water reabsorption & pissing yellow. This happens in a few complicated ways you can read about here. Guess what MDMA happens to affect?MDMA, along with many of the novel psychoactive substances taken at festivals, regional burns, and EDM shows can be grouped in the term “amphetamines and stimulants.” Which have the much desired effect of decreasing fatigue, especially fatigue you generate from exertion. You know, that thing you’re actively taking drugs to ignore?  Kind of like missing red flags on date 3 & 4, ignoring warning signs from your cardiovascular systems can have disastrous effects on your health.

Fatigue is crucial in preventing heat stroke. The reason this signal is being sent, is to keep your temperature from spiking too high. The thing that everyone forgets about amphetamine use is that it doesn’t actually give you super powers. The fact that you’re getting tired more quickly in hot environments is a warning/break point signal to your body/mind that you’re being fatigued.  When sober, mammals reach a point of exertional fatigue and maximum temperature, at which point you begin to tap out.  Guess what amphetamines & stimulants do?

By allowing you to push past your operational limits, stimulants turn you from a person who will collapse before overheating into a person with a non-trivial risk of doing the exact opposite of that. The perfect storm Dr. Rusyniak described could be used for most, if not all of the MDMA death at festivals in recent years, especially the ones at New York City’s Electric Zoo.

The summer outdoor dance party is therefore the perfect condition for exertional heat stroke to occur. Warm environment (decreasing heat dissipation), increased exertion (dancing), use of drugs that blunt normal protective responses to exertional heat stroke.
~Daniel E. Rusyniak, MD (Medical Director of the Indiana Poison Center)

The problem is exacerbated by the fact that most usual methods for rapidly cooling MDMA users may not be applicable. That person sweating their face off/rolling so hard you can see them chewing the inside of their mouth off from 15 feet away, is probably not giving up his spot in the crowd to get water. Even if he did, especially on day 2 or 3 of the festival, hyponatremia becomes a real risk. Exertion when you’ve not had zero calories, zero sleep and a cocktail of uppers and downers amplifies this risk . This is the reason why smart festivals hand out Gatorade & salty snacks after day 1. This stuff isn’t rocket science, but it does need to be planned ahead and there are plenty of ways to mess it up if you’re not careful.

There are two other wildcards to the MDMA experience. At higher doses (you know who you are), MDMA has been seen to cause cutaneous vasoconstriction. This vasoconstriction increases your blood pressure and can hamper heat release at the same time it raises your temperature. You’ll feel exceptionally hot, and then drink a ton of water, amplifying your risk for hyponatremia. It’s very hard to troubleshoot what’s going on in your cardiovascular system when you’re running a 101 degree temperature in the middle of the dance floor during a Steve Aoki set.

The idea that you can actually overheat is real, verified science, and we need to stop pretending is a myth. It can happen and when you go hard, it’s much more likely. Take breaks, don’t party in direct sunlight for 15 hours a day (you know who you are), and try to be as consistent as you can with water. On playa, Piss Clear is well known, but I think Piss Clear Regularly, should become as important. Drink water consistently, starting early in the day, before you start feeling faint. This way, you’re not fucked up thinking you have to drink a gallon of water when your anxiety spikes and you start telling your friends you feel like you’re dying.

It’s important to build good habits that don’t involve your limits, because when you’re on stimulants of whatever that shady dealer is peddling as the purest molly this week, you might just forget they exist. Additionally, you’re not a varsity or high performance athlete. While it’s been shown that marathon runners and athletes can be cooled from temperatures exceeding 107 degrees, let’s not pretend that any festival will ever have the capacity for you to consider that a way to justify being irresponsible. If you’re LeBron, you can expect a cold water bath and sodium testing on game day; you better expect an hour wait for water and impure drugs. If you’re not LeBron, please follow these simple tips:

  • If a festival or party allows Camelbaks, BPA-free reusable water bottles or any form of BYOW, take advantage of it.
  • Know where the free water stations are at any festival. If you’re at a festival or party that doesn’t have free water, berate them on social media until they have them. Don’t pay for parties that don’t have readily accessible water.
  • If you’re one of those people who use repetitive motions when rolling to de-stress, attempt to build a habit of reaching for your Camelbak nib and taking water as one. That’s way less damaging than finding people to date or smoking cigarettes in response to the jagged energy.
  • Salty snacks and food with savory tastes are your friend, especially after day 1 of events.
  • Alcohol + MDMA = Dehydration Bonanza. Pick one. Seriously, that’s the express train to FailVille, population you.
  • If you feel like a sweaty mess, believe yourself and go get some water. If you don’t feel like a sweaty mess and you’ve been on the dance floor for an hour in direct sunlight, GO GET SOME WATER.
  • If you’re drinking, try to have at least 8-12oz serving of water for every 2-3 drinks. If you’re drinking and dancing, make that ratio as close to 1:1 as you’re able to.
  • Don’t be embarrassed if you need to slow down, take breaks, ask for help or flag down emergency services. That’s what the staff & EMTs are there for. If you try to shrug off serious symptoms of heat stroke, you’ll still need to see EMTs…you’ll be out of commission for much much longer.
  • Taking breaks earlier on are much more rejuvenating. Giving yourself breaks every couple of hours at a multi-day event can make day 2 & 3 a lot easier than forced crashing for 4hrs because you can’t handle it anymore.

Don’t try to be a super hero y’all. The summer is long, and Dr. Rusyniak & I want to make sure every single one of you see Fall 2017 as well as your favorite DJs over the summer.

5 Tips For Surviving Your First Burning Man Experience

A guest post by Adrian Stefirta

Screenshot 2017-05-31 12.13.42

Note: All images used in this article are copyright-free

5 Tips For Surviving Your First Burning Man Experience

Your first Burning Man should be a liberating experience. And by “liberating” I suppose it should be as far away from the outer world as it can safely be. There should be no Facebook feeds, retweets and all that meaningless stuff.

People claim that the Burning Man that is well prepared for is a spiritual experience like no other. That’s no mystery, I guess. Leaving your annoying nine-to-five job to interact with random people, far away from civilization, sometimes doing drugs you’ve never heard of can easily be one of the most thrilling experiences you’ve engaged in so far. Speaking of drugs…

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1. Make Sure You Get Tickets Early

Ever hear the saying “The early bird gets the worm”? Well, the early bird gets to go to Burning Man as well!

Before we even get to the tips for when you arrive at the event, let’s first cover the fact that you should get tickets early. This is not something you’ll want to wait last minute for.

Burners.me wrote back in 2015 about 14 Tips For Getting Burning Man Tickets. The advice is still good to this day.

 

2. Get in the zone

The festival is famous for the community. You’ll definitely encounter the most bizarre people that have lots amazing stories and experiences to share, and it would be a shame not to get out in the world and sink in the energy surrounding you.

Leave your camera, don’t worry about your friends’ gastronomic preferences in your social media feed, and forget about your outfit. Nobody cares, neither should you. As an EDM fan, you might imagine that a festival is a place you easily get the vibe.

 

3. Self-reliance is crucial

Moreover, you could even say that self-reliance is in the spirit of the event. You must be ready for nearly everything that could go wrong and the more precaution you apply to your preparations, the smoother the experience.

You’ll need a huge amount of things starting with a flashlight and a pack of zip lockers to lip balm and a bicycle. There are so many things you’ll need, you’re guaranteed to forget something.

As mentioned above, leave your designer clothes at home and only bring clothing that is useful, warm (it can get chilly at night), and durable. You’re going to be exposed to numerous hours of sun, sand, and wind, which will be very demanding of your body and your clothing. Bear in mind that you’ll probably eat quite an amount of sand in the process, so why not bring a mask that you can wear when the wind is strong.

You see, people who haven’t taken proper care of their provisions have a special name they’re called on the Playa – Sparkling Ponies. You don’t want to be one.

 

4. Bring gifts

The sky’s the limit, but why not grab some practical things in a light excess? If you still have some spare space in your car, don’t hesitate to grab some snacks, water bottles, and other things that people around you could find useful. However, do not misunderstand the essential idea around gifts. You shouldn’t rely on people swapping their resources on yours because they’ve probably messed up and forgot to bring a bunch of important stuff, just like you did.

Gifts are about offering and not about trading, so don’t be offended if you give someone your grandfather’s watch and all you get is a free hug. Do not forget about the emotional and spiritual imperative of the event.

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5. Sleep

This is your first Burning Man experience. It’s one of a kind, and none will be same. You’re stoked and you’re freaking out. Regardless of that, you need to sleep. This may sound like a bizarre thing to say, yet there are so many amazing things happening on the Playa every single hour, that you’ll probably feel like a fool if you missed any of those. But this is another thing you’ll have to let go of.

Let your body rest a reasonable amount of time. You’re permanently exposed to sun, wind, sand, loud music, random people, alcohol, and crazy experiences. Let your brain rest. This is not a marathon you need to win, this is supposed to be an inspiring and spiritual experience. Remember?

Some people simply sleep throughout daylight and rave all night, which isn’t necessarily the best pattern to experience what the Burning Man has got to offer.

 

Final Notes

As an EDM fan, it is crucial that you perceive the Burning Man as a concept in its entirety. You could say that the festival isn’t about electronic music, as much as it is about the counterculture and its fringes. Well, you may claim that, given its background.

In the mid-nineties, Burning Man featured the Techno scene that was continuously emerging from the ghetto as its central musical figure. Nowadays, Techno is still in the underground of contemporary culture, yet, you can easily spot artists like Calvin Harris and others in the festival’s line-ups.

Is Calvin Harris about counterculture? I can hardly imagine. So what you need to know is the following – the festival does not focus on music as much as it focuses on the spiritual experience. Depending on your musical preferences, you may or may not want to choose other places to visit.

In my humble perspective, as a very opinionated appreciator of underground electronic music, there is nothing that mainstream artists like the above-mentioned can bring to my table, in terms of spirituality. But it’s your call to be made, so choose wisely before you decide to visit the Playa, expecting it would even remotely resemble a club in Ibiza.

 Screenshot 2017-05-31 12.14.10 The Author:

Adrian Stefirta is an EDM producer & writer for MIDI Lifestyle. He’s also an aficionado of Techno and a resident at Waxtefacts Records.

 

 

 

 

Cocaine, “Narcan Resistance” & the Grey Death: Fentalogs in 2017

By Terry Gotham

If you follow the news about adulterants in the recreational drug supply, it’s easy to get overwhelmed with the news breaking every day. Last Friday, the medical examiner’s office of Cuyahoga County in Ohio disclosed that they’re on track to obliterate their overdose record from last year. With 187 heroin/fentanyl overdoses on the books since Jan 1st, if things don’t change substantially, they’ll blow past their 2016 total of 660 overdose deaths by over a hundred people. If you missed my last article, multiple types of fentanyl are now being found in overdoses & drug seizures. And I don’t mean one or two. 24 fentanyl analogs & metabolites were found in blood/urine in Ohio overdoses alone:

1-3-Methylfentanyl; 4ANPP; Acetyl Fentanyl; Acetyl Fentanyl 4-Methylphenethyl; Acryl fentanyl; AH7921; Alfentanil; Beta-Hydroxythiofentanyl; Butyryl Fentanyl/Isobutyryl Fentanyl; Butyryl Norfentanyl; Carfentanil; Despropionyl Para-Fluorofentanyl; Fentanyl; Furanyl Fentanyl; Furanyl Norfentanyl; Norfentanyl; ParaFluorobutyryl/4-Fluoroisobutyrylfentanyl; Para-Methoxyfentanyl; Remifentanil; Remifentanil Metabolite; Sufentanil; U-47700; Valeryl Fentanyl
~Research Update on Fentayl Outbreaks in the Dayton, OH Area, Boonshoft School of Medicine, Wright State University, 4/28/17

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Do No Harm: Safe Injection Facilities in Fentanyl’s World

Analysis by Terry Gotham

But until recently, politicians dismissed the idea of a safe-injection site as being too controversial. More controversial than people dying in libraries and babies picking up needles on the beach? Please. San Francisco has essentially become one big unsafe injection site.
~Heather Knight, SF Chronicle “Safe injection sites offer hope in scourge of discarded syringes”

I wasn’t sure how to start this piece, a feeling I think mirrors the paralysis many policymakers feel when it comes to moving away from puritanical, expensive & needlessly harmful criminalization of controlled substances. In the case of the city policymakers, the opioid overdose epidemic has gotten so bad, they may be getting over it.  The SF Department of Public Works collected 13,333 syringes in San Francisco. In March. That’s 430 a day. In Ohio, there were 100 accidental drug overdoses in Mongomery County, Ohio in January & February alone, with an average age of 40. Here’s the kicker, 99 tested positive for fentanyl, and, 56% tested positive for acryl-fentanyl, 3 carfentanil cases, and 24 total fentanyl analogs and metabolites were found in total. 24. The majority of the cases tested positive for more than one “fentalog.” But of course, straight from the report:

All acryl fentanyl and furanyl fentanyl cases also tested positive for fentanyl; about 45% of acryl fentanyl cases also tested positive for furanyl fentanyl.
~Research Update on Fentanyl Outbreaks in the Dayton, OH Area: Acryl Fentanyl & Furanyl Fentanyl Commonly Found in Overdose Death Cases.

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Why We Burn: Heavy Meta

(Returning to my Why We Burn series, I wanted to cast the spotlight on Heavy Meta, a majority woman-built/non-American Art Car that will be hitting Hyperborea (a new Ontario Regional Burn) and the playa this summer. When we last spoke with Kevin Bracken, we spoke about Brooklyn, Toronto and Opulent Temple. This time, I’m so pleased to have spoken to his colleagues, a group of kick-ass ladies who are turning this car into a legit metal dragon. Enjoy this discussion about Burning Man in Canada, dystopian, welding & being awesome. And don’t forget to smash the play button on their favorite tunes from Art Cars over the years!)

Interview by Terry Gotham

After hearing from the team that’s behind this Leviathan, I began to grasp just how different the perspectives of non-American Burners can be. While I’ve spoken to non-American Burners before, there’s a lot of good stuff in this chat, not just including the fact that in Canada, you can get high school credit by working on an art car! Who knew\ “the low Canadian dollar” could be used as a reason when you’re completing your Low-Income Ticket application, so all you Canadian Burners who need a little bit of help, take note!

Kevin: We actually have two teenagers who come to the shop regularly, Jackie and Alex. Jackie is indeed completing a high school credit by working on the dragon, and we met her teacher yesterday! The first time Jackie came in, and Alex too, the American in me was definitely anxious, thinking, “If they get hurt, their parents will totally sue me!” However, Canadians are considerably less litigious than Americans, and each of them came vouched for by a different maker space, which put me at ease. On top of that, Jackie has completed a welding course and a workplace safety course, plus she can lay down a nicer weave than I can on the welder! Obviously we don’t let under 19s drink in the shop (the drinking age here is 19.) Finally, considering I went to my first rave in Jamaica, Queens at 15, I thought it would be hypocritical to keep them out just because they’re young.

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