GOVERNMENTS’ reluctance to consider pill-testing as a viable harm reduction tool is at odds with Australia’s National Drug Strategy, say experts who are calling for a greater focus on this useful harm reduction measure.

In a Perspective published in the MJA, Dr Jody Morgan and Professor Alison Jones of the University of Wollongong and the Illawarra Health and Medical Research Institute, wrote that the three pillars of the Australian National Drug Strategy were reduction in supply, demand, and harm.

“Despite harm reduction being a major focus, pill-testing, which fits clearly within the scope of the harm reduction pillar, is not currently being considered by Australian governments,” they wrote.

The article’s publication comes ahead of the release on 8 November of the NSW Coroner’s report into drug-related festival deaths in 2017 and 2018. Deputy State Coroner Harriet Grahame’s report, which was leaked to The Daily Telegraph in October 2019, is expected to support the introduction of pill-testing in the state.

In an exclusive InSight+ podcast, Dr Morgan said it was important to invest “money and effort” in all three pillars of in the drug strategy, but harm reduction was losing out.

“The disparity between the amount of money that is being invested into reducing the demand for drugs – that is, policing – and reducing the supply of the drugs, versus the amount that is being invested into harm reduction is absolutely staggering,” she said.

Dr Alex Wodak, President of the Australian Drug Law Reform Foundation, told InSight+ that pill-testing had been met with the same “trenchant, relentless” political resistance as other harm reduction strategies, such as medically supervised injecting room and methadone programs.

While he said the tide was turning – with the community and “virtually all the experts” supporting pill-testing – it was occurring slowly.

“Bad drug policy has often been good politics,” said Dr Wodak, who is also Emeritus Consultant, Alcohol and Drug Service, St Vincent’s Hospital. “Politicians fear being criticised for being ‘soft on drugs’. Also, police forces now charge promoters for policing at youth music events and probably make a tidy profit.”

Dr Morgan said drug taking at Australian music festivals and dance music nightclubs was common. She pointed to a survey of almost 650 music festival attendees that found that 73.4% reported drug taking, compared with 28.2% of the general population; while close to 60% of attendees had consumed 3,4-methylenedioxymethampheratmine (MDMA or ecstasy), compared with only 7% of the general population.

In terms of harms, the MJA article noted that 2.3% of Australian users sought medical attention following MDMA use, compared with the global average of 1%.

Dr Morgan said it was now important to consider what a best-practice pill-testing system would look like. The MJA authors said, of the pill-testing models used internationally, a UK model provided the most harm reduction benefits.

The model – used by The Loop program in the UK – provided the results of a test directly to the patron who submitted the pill and involved a face-to-face interaction with a health care provider. The public is informed only of especially dangerous pills.

This model was also used in the 2018 and 2019 pill-testing trials at the Groovin the Moo festivals in the ACT. The 2019 trial was deemed a success after the detection of seven samples containing a potentially lethal new psychoactive substance, n-ethylpentylone. Six of these samples were disposed of in the on-site bins, while the seventh patron advised that they would discard the sample off-site.

Dr Morgan said the interaction between patron and health care professional provided an important opportunity to deliver a harm reduction message to a hard-to-reach group.

“The Loop found that nine out of 10 users had never spoken to a health care professional about their drug use, so this is a group of people who are probably taking drugs on – what they could call – a casual basis,” she said. “They don’t believe that when they go for their check-up with their GP that [drug use] is something they need to mention. So, this is a really unique opportunity to speak directly to those people and explain to them exactly what harms these drugs are doing to their body and what risks they are taking by consuming these drugs.”

Dr Morgan added that the pill-testing process was not endorsing drug taking “by any stretch of the imagination”.

“It is genuinely telling these people that ‘drug taking is bad … even if we give you some guidance as to what might be in it, you still don’t know if that is going to be safe for you to take; it is not a regulated medicine, we do not recommend that you take it’,” she said.

The MJA authors also highlighted a model proposed by The Greens that included 18 pill-testing sites around the country, fully staffed and with spectroscopic equipment that would cost $16 million over 4 years.

Dr Wodak said the availability of off-site testing was becoming more important.

“Australia needs on-site testing at youth music events but also laboratory-based testing where people can attend at certain times of the week to test their drugs, including the drugs they intend to consume at a music event. Off-site testing is becoming more important because of the threat of fentanyl, which is now responsible for about 40% of drug overdose deaths in US.”

Dr Morgan said funding was now needed to determine the most effective testing techniques.

“We are calling for … funding to perform an analysis to see what kind of technique could produce the best results under [music festival] circumstances,” Dr Morgan said, adding that no such research has been conducted anywhere in the world.

Those opposed to pill-testing had raised several concerns about the techniques used, suggesting that it was not sufficiently accurate to identify all components of drugs, and that on-site techniques could not provide a quantitative analysis required to prevent overdose.

Dr Wodak said the question should not be “is pill-testing perfect?” but “is pill-testing better than no pill-testing?”

“In public health and harm reduction it’s important to ‘never let the best be the enemy of the good’. In other words, we shouldn’t oppose pill-testing because it won’t stop every death, as long as it saves some lives,” he said.

A spokesperson for the federal Department of Health said the Australian Government supported decisions not to use illicit drugs, and did not support pill-testing “as it could imply that illicit drugs are safe”.

“All illicit drug use contains inherent risks and even taking a known substance can result in unintended harms,” they said, adding that the issue of pill-testing was largely a matter for the states and territories.

 


Poll

Pill-testing should be introduced as a harm reduction strategy
  • Strongly agree (53%, 23 Votes)
  • Strongly disagree (21%, 9 Votes)
  • Agree (9%, 4 Votes)
  • Neutral (9%, 4 Votes)
  • Disagree (7%, 3 Votes)

Total Voters: 43

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7 thoughts on “Pill-testing: governments drop ball on harm reduction

  1. Anonymous says:

    If we are serious about removing harmful substances at music festivals etc., all attendees should be searched and illicit drugs confiscated!

  2. Anonymous says:

    Maybe Parliament House should be searched regularly for harmful drugs — sniffer dogs are apparently available if not reliable.

  3. Dr. Peter C. Stephenson says:

    Pill testing at festivals just means that some drugs are OK to take and some are poisonous. Stupidity rules! As Anonymous says above: “If we are serious about removing harmful substances at music festivals etc., all attendees should be searched and illicit drugs confiscated!”

  4. Greg Heron says:

    To the “just say no” / “drugs are bad” crowd – you’ve been on the wrong side of history since prohibition in the 1930’s.
    When will you ever learn ?

  5. Ian Hargreaves says:

    Prohibition works beautifully. Just ask any marketing manager of a tobacco or alcohol company, who will fight tooth and nail against any restriction of advertising or sales. And those marketers are operating within legal parameters and government regulated advertising ethics.

    Those who sell the illegal drugs have a lower ethical standard, selling a product which has no legal approval. These pills can be lethal with the first dose, which is why unlike fentanyl or oxycodone, they cannot even be prescribed by an intensivist in a public hospital ICU.

    Prohibition is the best harm reduction strategy, which is why we have never had a machine gun massacre at a music festival, like they did in Las Vegas, with legally acquired firearms. We don’t need to have bullet testing at the entrance: “That’s a dodgy hand reload, which might blow up in your face, you shouldn’t use that” versus “That’s a perfectly good Glock 9 mm. Use it responsibly.”

    Alcohol, tobacco, guns – the evidence is overwhelming that availability increases harm, due to deliberate or inadvertent misuse.

  6. David Raynes says:

    The suggestion that on-site testing of ilegal drugs at festivals will reduce the TOTAL harm from such drugs is wrong. Superficially attractive, a moments serious thought tells us it gives a misleading impression, that only impurities or high strength drugs can cause harm or kill.

    The most commonly used festival drug MDMA (ecstasy) kills at random. It destabilises the temperature control mechanism of the body and individual reactions are just that, individual and unpredictble.

    Novice users, perhaps persuaded to try drugs for the first time at a festival, on the grounds that “they have been tested”” will doubtless go on to use more and differrent drugs (untested) outside their first festival, putting themselves at vastly increased ;omg term risk.

    Austrailians should be very suspicious of the motives of those who promote such tests, many in my long experience in the UK, are active drug legalisation crusaders. full legalisation and immense personal and social harm is the obvious destination.

  7. paul calle says:

    DRUG TESTING ON FESTIVALS: most likely no value for (public) money

    We should move from ideologically charged discussions to an evidence-based approach.
    Principally, one should acknowledge that at present there is no proof at all of a survival benefit via drug testing on festivals. At best, there are promising results on intermediate outcome parameters: detection of unexpected and dangerous substances, new opportunities to give harm reduction advises to difficult to reach groups, and willingness of patrons to discard (dangerous) samples.
    Furthermore, simple mathematical logic points against favorable health economic effects. As there are fortunately only a few deaths among the many thousands of illicit drug users at festivals, one may assume to need an extensive and hence expensive drug testing program to have a chance to save one single life.
    There is obviously also an ethical and legal dimension. The focus of drug testing is mainly on harm reduction of deliberate drug use, and not on prevention in the real sense. This brings us to the question to what extent public money has to be spent on programs to create safer conditions for party drug use at festivals (which is an illicit risk seeking behavior, and not an illness), especially when the efficacy of the program is uncertain. Does anyone think of offering street racers special training sessions and a perfect technical maintenance of their vehicle to minimize the risks of crashing the car into a tree? Or providing daredevils at railway crossings with fancy devices warning when a train really gets too close?
    Some elements have to be added as food for thought. First, on-site drug testing by police forces on seized materials and samples found on intoxicated patients with widespread distribution of relevant information may also help to limit incidents with unexpected and dangerous substances. Second, accurate information on the substances ingested does not exclude serious health problems. On the one side, even a known substance taken at a low dose may cause severe medical problems in a vulnerable person. On the other side, binge drinkers, as a rule, know exactly how much alcohol they consume and are well aware of the risks of drunkenness. Nevertheless, many got in (serious) trouble. Third, with regard to prevention, we should learn from successful examples such as campaigns for wearing seat belts and smoke-free areas. And why not try to start a campaign with popular electronic dance musicians promoting drug-free partying? Fourth, harm reduction can also be obtained via earlier recognition of drug-related problems by friends and better on-site medical care.
    Finally, it should be stressed that drug testing at festivals is by no means comparable with drug testing as part of a harm reduction program for heavy drug abusers (which are to be regarded as patients, and not as persons with a risk seeking behavior).

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