Pill testing 'essential' for saving lives

Despite the success of pill testing trials in Australia, there continues to be ideological opposition to a practice that could save lives.

Pill testing (often called “drug checking”) is designed to simultaneously prevent people from using drugs in such a way that it causes them harm, while also sampling and monitoring a rapidly fluctuating drugs market in real time.

In 2005, The Australian Medical Association (AMA) became the first body in Australia to endorse an “medically supervised … ethically approved trial … of pill testing in [the Australian festival environment]” (here). It subsequently took well over a decade to implement, but Australia now has a home-grown expertise in this field, designed and implemented for the Australian market, and one of the more technically sophisticated in the world (here and here).

Despite initial support from the AMA, there has been vigorous political opposition to pill testing ever since, even in the face of potentially preventable deaths.

The evolution of pill testing

In January 2017, three young people died and 20 people were admitted to hospital following an overdose of a “bad batch of ecstasy” (here) at The Revolver Nightclub in Melbourne. The nature of those products was never contemporaneously released to health care providers, but the forensic findings revealed the bad batch contained a toxic “cocktail of illicit substances, including 4-fluoroamphetamine (4-FA) and 25C-NBOMe” (here). Since then it has been the universal finding of any of the many coronial inquiries from music festival deaths that pill testing should be at least trialled (here, here and here).

The first of those trials of drug checking in Australia was conducted at the Groovin’ the Moo music festival in 2018, by a group that came to be known as Pill Testing Australia (PTA). The story of how that happened is discussed elsewhere (here) but “how” we do it is a matter of record.

The workhorse of the analytical process for PTA, as it is with many countries that now conduct pill testing, is a device known as a Fourier transform infrared (FTIR) spectrometer (here). Put simply, this illuminates the sample to be tested with an infrared laser, causing a spectrum, or “fingerprint” unique to the product being analysed. This is compared to a library of tens of thousands of reference spectra to find the best match and so identify the sample. The FTIR is a sturdy “nugget” of a piece of equipment — one that is more than robust enough to cope with the harsh environment of Australian music festivals and festivals across the world. It’s very quick — a few minutes per sample. Recently, it was used to good effect to analyse 210 samples for 257 patrons over four days in a Queensland first implementation of pill testing at the Rabbits Eat Lettuce festival in the rural setting of Warwick (here).

At a fixed site, such as CanTEST in Canberra, we can run more sensitive equipment, which is considered the “premier division” of drug checking globally. Ultraperformance liquid chromatography-photodiode array (UPLC-PDA) provides more detail on sample composition and gives the ability to identify and assess purity for a range of targeted drugs (here and here).

Unique processes for Australian pill testing

The process of dealing with potentially illicit drugs is one developed over two decades by PTA, and designed specifically for the Australian environment. We have shamelessly borrowed the best elements of services that preceded us overseas — with permission, acknowledgement, and direct collaboration — and adapted them for the initially complex legal variations between Australian jurisdictions, as well as the apprehensions of expert colleagues and the general public. However, there are fewer barriers than might first be apparent, with the Medicines, Poisons and Therapeutic Goods Act 2008 permitting our Chief Health Officer to license testers.

In The Netherlands, The Drug Information and Monitoring System (DIMS) is widely regarded as the best in the world and is ideal for the Dutch environment. But such are the differences in attitudes between The Netherlands and Australia that it would have been initially unworkable in Australia. It is for that reason that drugs analysis is conducted by qualified chemists, affiliated with the Australian National University, under the rigorous supervision of one of the authors. A clinician closely clinically reviews the results, session by session. PTA are the first service of this sort to establish an ethical code of conduct, to which the majority of supporters in Australia are aligned (here).

The secret sauce of the process, however, is neither the analytical process nor the clinical oversight, it’s our harm-reduction workers. They are the interface between officialdom and the consumer — an interface that determines the success or otherwise of any service. Derived originally from the ranks of DanceWize (Victoria) and CAHMA and now including alcohol and other drug practitioners, this workforce can contextualise results, personally, for the two-thirds of service users who may have never had a conversation about their drug use with an health professional (here).

Opposition continues despite success stories

By way of illustration as to how well our system now works, a punter presented on a Friday in February 2024 with a product they believed to be 2C-B. Instead, onsite analysis revealed a mixture that was found to be identical to that which harmed so many in Victoria in 2017. The handling of that information could not have been more different from that previous incident. Within an hour of detection, ACT Health were advised of the findings, and within 24 hours this was disseminated across networks around Australia. A red community notification was issued on a variety of social media platforms, directly to users, across Australia — an alert repeated by authorities in at least one jurisdiction (here).

On this occasion, there were no overdoses with the same mixture of drugs as there were in Victoria in 2017.

Over Easter 2024, PTA provided the first government-sanctioned pill-testing for Queensland and was the first ever multiday festival pill testing in Australia. Along with the large amount of data that we generated during our testing, there were two aspects that we were most proud of: over 10% of festival attendees were contacted, and there were zerohospital transfers from the venue. 

The opposition to pill testing in Australia in 2024 can now be best described as either ideological or political. There are clearly individuals who would prefer to contemplate an Australia devoid of drug consumption. Alas, that is magical thinking. Objecting to the implementation of pill testing, as for any long overdue drug policy reform, has been the default political position in Australia for the past 20 years. This is despite numerous independent coronial inquiries (here, here and here), senate inquiries, and special inquiries (here) all arriving at the same conclusions: that pill testing should be at least trialled across jurisdictions.

Our observation is that pill testing creates a dialogue with consumers — a shared, but guided, decision-making process — instead of a speech from a bully pulpit. And that seems to work better in reducing harms than what we’ve been doing up until now.

Dr David C Caldicott is an emergency consultant at North Canberra Hospital, a conjoint academic with University of Canberra and the Australian National University (ANU) and clinical lead for Pill Testing Australia (PTA) and the CanTEST Health and Drug Checking Service.

Professor Malcolm D McLeod works at the Research School of Chemistry at ANU and is chemistry lead for PTA and the CanTEST Health and Drug Checking Service.

The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated. 

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