Drug-testing trial momentum grows

THE push to trial drug checking at music festivals continues to gather pace with Australian researchers calling for improved drug monitoring and surveillance to mitigate the harms associated with a wave of new psychoactive substances hitting the Australian market.

A Perspective published in the MJA last week outlined the case for a high-quality research trial of drug checking, along the lines of European models, to be conducted in Australia.

The call comes in the wake of separate plans to establish a drug-checking trial to seek to reduce the number of deaths associated with 3,4-methylenedioxy-methamphetamine (MDMA or ecstasy) and new psychoactive substances (NPS), which are often sold at music festivals.

Dr Alex Wodak, president of the Australian Drug Law Reform Foundation, together with Canberra emergency specialist Dr David Caldicott and Will Tregoning of Unharm Australia, have announced plans to establish a pill-testing trial in an effort to reduce the deaths and other harms associated with the proliferation of NPS here.

Dr Wodak welcomed the MJA article, saying that a drug-checking trial was important to identify the benefits, any unintended negative consequences and the costs associated with drug testing.

• Related: MJA — Drug checking to improve monitoring of new psychoactive substances in Australia
• Related: MJA — A bolt out of the blue: the night of the blue pills
• Related: MJA InSight — Media fuels drug dangers

Lead author on the article, Dr Robin Butterfield, of St Vincent’s Clinical School at the University of NSW, said it was crucial to gather more information about NPS to support clinicians to provide the most appropriate advice and care.

He said clinicians were currently treating patients without any knowledge of the substance they had taken, the time course of the drug or the elimination rate.

The article noted that European monitoring systems had identified more than 100 NPS coming onto the market in the previous year, and this was also likely to be the case locally, Dr Butterfield said.

He said the catalyst for writing the paper was an episode last year when there were 11 simultaneous emergency presentations to Sydney’s St Vincent’s Hospital, with patients showing hallmarks of sympathomimetic poisoning, but there was no identifiable substance. Four required intensive care.

With no knowledge of what those patients had taken, the emergency staff were forced to rule out other diagnoses.

“We are obliged to unnecessarily investigate because you can’t be sure that what we’re seeing is not meningitis or some other horrible condition,” Dr Butterfield said.

However, Dr Butterfield said it was important not to be “too hasty” in implementing drug-checking trials, and there were many issues to consider in developing trial models.

He said the priority should be on the surveillance of the types of drugs being used to better inform treatment and identify emerging hazards.

“My take on things is the need for surveillance of the drugs that are actually being used, rather than putting in place a full-blown public health awareness message,” Dr Butterfield told MJA InSight. “We would like to learn about the things that are actually being taken.”

Dr Wodak said there were many barriers to overcome before a trial could be put in place. He said his group had been inundated with offers of support and funding, and a crowdfunding site would be established to both raise the $100 000 funding required and to demonstrate support to governments. The legal implications for doctors and for users also had to be considered.

“It would be a lot easier if the government allowed this to go ahead,” Dr Wodak told MJA InSight.

“We have to work out what our real legal risks are, both for us and for the people who use our service. We don’t want to have to take legal risks, but if we do, so be it.
But we don’t want the people who use our service to have to face legal risks.”

Both the Victorian and NSW governments have opposed plans to trial drug checking, with the NSW Police Minister Troy Grant warning that those conducting drug-testing programs were in “legal jeopardy”. 

However, Dr Wodak said a 2005 federal Department of Health and Ageing report has come to light that had found that a person conducting drug checking in NSW was unlikely to be found guilty of possessing or supplying an illicit drug, or aiding and abetting an offence.

Dr Wodak said he was approaching the issue not only as a doctor, but also as a father and grandfather.

“At the end of the day, my colleagues and I want to stop the deaths. That’s the number one priority,” Dr Wodak said. “Stopping drug use is a priority, but it’s not the number one priority. According to the opponents of harm reduction, if drug use goes down but deaths, disease, crime, corruption, violence all go up, well that’s still a good result. Not in my book.”

Dr Wodak said the National Drug and Alcohol Research Centre estimates about 82 deaths have been associated with so-called “party drugs” in the 5 years to June 2005.

“Under current policy – which relies very heavily on drug law enforcement, customs, police, courts and prisons — drug use has increased in leaps and bounds, and the drugs used have gone from less dangerous to more dangerous,” Dr Wodak said. “The do-nothing approach is in itself risky.”

While crude drug-testing kits are currently legal and available, he said these did not come with the information and education that could accompany a public health response.

Dr Wodak said a pill-testing trial would incorporate an information and education component to ensure that users were aware of the risks they were taking, and to provide more practical advice to help users to avoid harm.

“Ideally, no young person would ever take psychoactive drugs ever again, agreed, but I don’t see any greater sign of young people giving up drugs forever, than of young people giving up sex forever,” Dr Wodak said, adding that drug checking was overwhelmingly supported at the annual parliamentary drug policy summit, held in Canberra earlier this month.

Dr Butterfield said the key message in the MJA paper was that the only way to be safe was to avoid these drugs completely. “But we need to recognise that people are going to take these drugs and we need to be able to recognise what they’re actually taking.”

Dr Butterfield said the European experience had indicated that drug-checking could trigger a market response whereby drug purchasers returned adulterated pills to sellers to seek a refund, prompting drug sellers to discontinue selling these more dangerous drugs.

“When a product has been identified that is dangerous, it’s not law enforcement that has cleaned it up, it’s just the market itself,” he said.