Last Updated: August 15, 2023

While this article was written specifically in response to the supposed “injection drug attacks” at Astroworld Festival 2021, its contents are broadly applicable to any case where a person or media outlet claims that injection drug attacks may have taken place. The same questions should be asked, and the same information is relevant.

UPDATE: Just a few days after the initial announcement that a security guard was supposedly pricked in the neck and revived with Narcan, the Houston PD issued a retraction statement that the security guard did not actually get injected with anything, but was hit in the head and fell unconscious. Needless to say, this is a prime example of why it is so irresponsible to release such a bold statement without being able to back it up. Drug war hysteria takes space and time away from talking about the real issues at hand, like crowd crush or promoter negligence.

Preface: We are NOT here to invalidate the terror, confusion, trauma, and panic that comes from losing consciousness or blacking out. We are here to question the misinformation that spreads when statements are made about what happened to people’s bodies – and safety – without collecting facts. People deserve to know what happened to them. We cannot do this if we don’t make the effort to get to the bottom of things. 

Speculating on health-related incidents can cause rumors to spread like wildfire. These rumors quickly become very difficult to dislodge. We spend decades undoing the harmful effects of media misinformation, especially when it comes to already stigmatized topics like drugs and drug use (see: this one famous incident).

The practice of injecting drugs is deeply misunderstood and heavily stigmatized. People who inject drugs (abbreviated PWID) are often socially ostracized, cut off from their communities, and/or driven to use alone or hide their use. All of these circumstances increase a person’s risk of overdose, suicide, and other consequences of isolation. Social resources are frequently withheld from PWID, and it can be very difficult for PWID to find support services due to stigma.

Injection is just another route of administration. It has its own set of risks, benefits, and requirements to be effective at all. Making unsubstantiated claims about about injection attacks can negatively influence drug policy, needlessly put people on guard about some sort of injection attack bogeyman, and further stigmatize PWID. This threatens people’s lives. It contributes to a domino effect of moral panic, tightened drug regulation, and surveillance. As we’ll explain, there are requirements for an “injection drug attack” to be physically possible, and requirements for such a claim to be confirmed true. 

The body can act in bizarre and unpredictable ways. For us to understand what happened to someone, we need to understand how drugs actually work, and when/how/where/why they are used. This article is about informed consent and honest, fact-based education. 

We’ll break down exactly what is and is not possible in scenarios of potential injection drug attacks. Based on this information, we will explain why the claims about Astroworld are extremely improbable.

THE SITUATION:

There have been several articles circulating about the possibility of injection drug spiking at Travis Scott’s Afterworld festival in Houston, TX. It is possible that these reports initiated with the TMZ tabloid article claiming that a security guard had felt a “prick in the neck” and then fallen unconscious shortly after, later revived with Narcan. The article also claims there was some possibility that a third party was responsible for the eight deaths, also by way of injecting some unknown substance. 

The Houston Police Department issued a statement on Saturday corroborating this claim, stating that “one of the narratives was that some individual was injecting other people with drugs.” Police Chief Troy Finner went on to state that “there were some individuals that were trampled, and we want to be respectful of that.” No further information has been released at this time that we are aware of, although VICE News has released an evaluation of the likelihood of this having actually happened. (Spoiler alert: Multiple experts have agreed that it is extremely improbable.)

According to The New York Post tabloid: “Police have not yet interviewed the guard, Finner said, but medical staff that treated him said he was administered Narcan, a drug used to revive people who have overdosed on opioids, and they saw what looked like a needle mark on his neck. Narcan was used to revive some other concertgoers as well, Finner said, but he was unable to say how many. “We do know that there were several, many, instances where they did administer Narcan on site,” he said.”

Fear and panic around claims of supposed injection drug attacks has been rife in the UK in the past year, with widespread stories about women going to clubs and waking up with marks that appear to be punctures or stabs. The issue is broken down in this article (with a final verdict that echoes ours, as agreed upon elsewhere). UPDATE: Although police have since redacted the allegations and corrected the narrative, it is still important for our community to understand how to analyze these types of claims as they arise in order to make informed judgements and avoid spreading misinformation.

When considering the likelihood of whether a person was the victim of an injection drug attack that could render them unconscious or blacked out, there are a few things to consider:

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1. Injecting someone requires either hitting a vein (which even practiced medical professionals sometimes fail to do when a person is sitting still with their arm exposed), or administering a drug intramuscularly. 

This means that claims of being injected in the neck, for example, would require that the assailant managed to somehow perfectly hit someone’s vein and hold a needle in there – usually while the person was in motion – OR that the drug in question could be administered intramuscularly in a split second, in a sufficient quantity, and in the right location.

According to VICE News, “Guy Jones, senior scientist at drugs charity The Loop, said: ‘Injecting adds a big ‘what?’ factor to the whole thing because few drugs would be able to be injected like this. Where drugs can be injected non-intravenously, there are specific injection sites that do not work well. The back is one of these unsuitable sites due to the low fat-muscle content, and high concentration of pain receptors.’” (P.S. We trust The Loop. They know what they’re talking about.)

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2. You’d need to inject a sufficient quantity of the drug in question based on where and how you’re injecting it. This usually requires around 20 to 30 seconds of slow plunging (with variation depending on the substance and type of needle). 

Injection does not work like it does in movies, where someone just quickly stabs you with a needle and that’s the end of it. In other words, you’d notice it immediately (it hurts) and move away from the source of the pain – especially if it were in your neck or another sensitive area like the inner thigh.

In addition to the onset time (the duration of time it takes for a drug to be metabolized and become active in the body), the location of the injection and the depth of tissue penetration are also important. Sticking a short needle into a layer of fat, for example, will result in a longer absorption time than a long needle because the short needle doesn’t penetrate as deep.

• In the realm of absolute theoretical possibility: A person could take the time and energy to engineer a dart-like device that was capable of quickly delivering a tiny quantity of a drug like fentanyl. There is not currently any evidence of such a device existing. Someone could also theoretically deliver something active in such minute quantities using a hypodermic needle (which would hurt a lot, and be immediately noticeable). In both of these cases, there is no incentive for someone to utilize such a device on someone else at a festival. So: The idea is in the technical realm of possibility, but at about the same level of likelihood (in practice) that Astroworld was actually a Satanic cult ritual sacrifice. 

• Also in the realm of absolute theoretical possibility: Someone could be so squished into a crowd that they were unable to move for so long that an entire 20-30 seconds of plunger delivered an overdose-quantity of a given drug into their system, but by this logic the assailant would also be incapable of moving at all, immediately debunking the outrageous claim that these nine tragic deaths were a product of some sniper-like attendee moving through the crowd.

• We’re basically only bringing this up at all because it (hopefully) illustrates how bizarre, baseless, and ineffective it would be, which is why we consider it to be a non-issue. 

John Slaughter, a senior forensic toxicologist at Analytical Services International, says that “‘If someone is jabbed with a syringe, then their reflex action is going to be to move away within a second or two. The opportunity for someone to actually inject enough drug from that syringe to have the effect, I would think, is fairly low. I’m not saying it’s absolutely impossible, I’m just saying, in my opinion, it’s unlikely.’ He added, however, that the fact the chances of effectively spiking someone with a needle are low doesn’t mean people aren’t being deliberately jabbed by sharp objects while on a night out.”

It is worth noting that twinges of nerve pain can also cause sensations of pricking on the skin, often from compressed nerves in the spine. Pricking sensations may also be caused by other people’s clothing, jewelry, accessories, or even an insect sting. While these explanations may seem too simple, it is infinitely more likely that one of them is the culprit than an injection attack.

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3. Since panic around the fentanyl crisis has led to widespread misinformation about how it can be ingested (reminder: no, touching fentanyl in any form except for prolonged exposure to several transdermal patches cannot cause you to overdose), opioid overdose is on everyone’s minds. 

Just because someone is unconscious does not mean that they’re overdosing, even if they have been Narcan’d and they wake up afterwards. Indeed, it is common for people who believe that they might have been dosed/overdosed to fall unconscious following panic, which leads to hyperventilation and syncope. 

The symptoms reported by these individuals are not consistent with opioid overdose. “Reviving” these individuals with Narcan has been reported despite toxicology reports showing that no opioids were present.

• In other words, just because Narcan was used and someone woke up does not mean that they overdosed on an opioid. 

The “revival” could be due to the unexpected sensation of intramuscular injection or intranasal administration of Narcan, the feeling of being moved and physically interacted with, or simply waking up after passing out. Correlation does not indicate causation. (See our article on passing out.)

As a note: Administering Narcan to someone who is unconscious (on the off-chance that they’ve overdosed) is common practice in the absence of more specific information about what happened. Administering Narcan to someone who has not overdosed does not have any known safety concerns, but it can make someone feel very sick if they use opioids regularly enough to have a tolerance.

This is an effective means of covering your bases just in case someone overdosed.

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4. More information is always needed about what exactly happened. 

1. What did the person feel in the moment?
   1. A needle is noticeable and it hurts. A “pinch” would not typically describe the pain of a dart or hypodermic needle being quickly jabbed into someone’s skin, particularly their neck. This is especially prevalent since you’d need to get it deep enough to penetrate the tissue.
2. How quickly did the person fall unconscious?
   1. Falling unconscious in seconds is usually a sign of syncope, or fainting attack, due to a sudden drop in blood pressure – which frequently happens from severe emotional stress.
      1. While an opioid overdose can happen very quickly, the onset of the drug would cause apparent symptoms like drowsiness, loss of motor control, and shallow breathing or slow heart rate.
         1. It takes several minutes (3-10 depending on the drug) for a drug to kick in if injected into a muscle, and could take several more for an overdose to occur. It does not always happen immediately.
         2. It takes only seconds for an IV drug to kick in, and still might take longer for an overdose to occur, but the likelihood of anyone successfully injecting into a person’s vein in the middle of a frantic crowd is effectively zero.
   2. When the person has fallen unconscious, an opioid overdose (or other sedation) will cause their heart rate to slow and their breathing to become slow and shallow. A fast or normal heart rate/breathing rate while unconscious is not a sign of opioid overdose.
3. How did they feel prior to falling unconscious? 
   1. Anxiety, a quick heart rate, and dizziness or sweating are signs of panic, not an opioid overdose.
   2. The experience of overdosing on an opioid is often likened to the kind of drowsiness that you feel right before falling asleep, peaceful and calm.
4. How quickly was Narcan administered?
   1. Opioid overdoses that result in loss of consciousness will not resolve on their own in just a few minutes. They require intervention to revive; non-lethal overdoses resolve after significant time has passed.
   2. If a person hit their head on the way down, however, head trauma could result in delayed awakening or even a coma.
5. How quickly did the person wake up after having Narcan administered?
   1. Narcan usually starts working in 2 to 5 minutes, but can also work much faster, in under a minute. For this reason, this metric isn’t that useful. You should wait 2-3 minutes before administering a second dose.
   2. Fainting usually lasts a few minutes at most, usually only seconds. If Narcan is administered quickly after fainting, it’s possible to mistake someone regaining consciousness after fainting for a “Narcan revival.”
6. How did the person feel upon recovery?
   1. People who experience overdose might be disoriented or agitated upon waking up, but all of these things can also be experienced after waking up from fainting. (It can be very unpleasant to faint.)
   2. Nausea and vomiting are typically only experienced by people who go into withdrawal because of Narcan. Someone who does not use opioids regularly would not go into withdrawal.
7. Has any kind of confirmatory testing been run?
   1. The only way to confirm that an injection drug attack took place is by running a toxicology report. 
      1. As we have stated above, there have been reports of people being “revived” by Narcan but showing no opioids present in their bodies after toxicology reports were run.
      2. At the very least, a multi-drug urine test should be taken within 24-48 hours of the incident.
      3. Bizarrely (but unsurprisingly), there are no cases that we can find of reported injection drug attacks where any kind of confirmatory testing supported the story. 
         1. The vast majority of people do not know how to identify an opioid overdose, or understand how drugs work on a more precise level. EMTs and paramedics do not have advanced background in the pharmacology and delivery of drugs in an illicit context. Even nurses and doctors have incomplete understandings of how illicit drugs work, especially those who come from general practice and do not have direct experience with drugs. 
         2. It is also very uncommon for any actual names and credentials behind the people who designate “drug overdoses” to be revealed. As we investigate claims of overdose, the paper trail often stops at “a medic said that…” without any additional information about what happened, or who that medic was and what they saw. This makes it impossible to confirm anything. The person who actually made the evaluation of an overdose should be the one reporting on what happened, not police officers or passersby through the grapevine. 
         3. Lack of confirmation has led to all kinds of ridiculous claims about fentanyl, with some rumors going so far as to claim that there was fentanyl-laced toilet paper at Lost Lands 2019. While this is absurd from a scientific and human behavior standpoint, it is, as we have said about “fentanyl darts,” in the technical realm of possibility, and therefore once the idea is planted we are expected to disprove it. 
         4. The reality is that there are very real and tangible threats to health and safety that we need to turn our attention to, and LOTS of far-fetched explanations for why people fall ill. Focusing our efforts on disproving improbable theories ends up being a waste of time and resources. Even this article is an example of it, because this claim was debunked/retracted after we’d already spent hours  pulling together this response. Instead, people’s energy and focus should be on holding promoters accountable for the deadly crowd crush that took place here.

• Law enforcement officers are NOT medical or drug experts, and they are notorious for spreading blatant misinformation about drugs through their public platforms and speaking power.

This is especially apparent when law enforcement officers claim that they overdosed by touching fentanyl, a myth that has been consistently, systematically disproven by medical and health professionals around the world. 

Law enforcement officers have also been known to use drug checking tools that produce false positives (like the time that they arrested someone after testing Krispy Kreme donut flakes, which popped positive for meth), falsely accuse people of being on drugs with sometimes very dangerous consequences (like Rodney King), and make outlandish claims about drug trends. 

Law enforcement officers usually have little to no understanding of drug effects, and they are responsible for enforcing draconian drug laws that destroy people’s lives. In short: We do not believe anything that any police officer says about anything related to drugs, unless they are quoting a toxicology report. Even then, we want to know the specifics of the lab and tools used.

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5. Event medics do not have the tools to positively confirm opioid overdose, unless…

…advanced drug checking materials are on site, like FTIR or GC/MS, and the person is a) revived by Narcan and b) able to produce a sample of the substance they consumed for testing.

Even doctors and nurses hospitals cannot positively confirm whether certain drugs were involved in a medical emergency without running a toxicology screen. 

Without a toxicology screen, all medical observation is still speculation with varying degrees of confidence, depending on the background of the provider.

It is not uncommon for doctors and nurses without specialization or experience with illicit drugs to make hard statements about what drugs contributed to a medical emergency. 

For example: We receive lots of reports from people who say that their friend/partner/brother ended up in the ER and the nurse told them they overdosed on fentanyl-laced weed, BUT no toxicology reports were ever run, and neither DanceSafe nor any of our international drug checking affiliates have yet to report seeing an actual confirmed case of fentanyl in weed. (Update in 2023: There has now been exactly one laboratory-confirmed case of cross-contamination in weed.)

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THE WRAP:

Things change constantly in the drug world. Information is always fluctuating, and speaking with neutral, thoughtful voicing is important for emphasizing the holes in our knowledge and the facts that we are not sure of.

The Houston Police Department engaged in a major breach of responsibility by suggesting that “injection drug attacks” may have taken place at an event where crowd crush was clearly the cause of nine (or more) tragic, preventable deaths. If we’re not talking about what actually caused these deaths, how can we make plans to prevent them going forward? 

Hint: It’s not by arbitrarily pulling drugs into the mix because they’re an easy target to hate and fear.

The bottom line is, while it is not technically impossible for someone to experience an injection drug attack, the act is so nonsensical and completely unlikely that we would be stunned if there were ever a true confirmed case of it in a music/gathering setting. Which, to our knowledge, there hasn’t been. 

We’re much more worried about you being dehydrated or not wearing earplugs.

Stay safe out there,

Sputnik & The DanceSafe Team