Drug experts say yes. Many politicians say no. What’s the evidence for pill testing?

ABC Health & Wellbeing

By health reporter Olivia Willis, first posted 21 December 2018.

It’s becoming something of a sombre routine: a young person dies from a drug overdose at a music festival, calls for pill testing are ignited, calls are summarily rejected, and we wait until another young person takes a gamble with their life — and the gamble doesn’t pay off.

Earlier this month, 19-year-old Callum Brosnan died of a suspected overdose after attending the Knockout Games of Destiny dance event in Sydney.

It’s the third death brought on by a suspected drug overdose at a music festival since September, and according to media reports, the tenth in the last five years.

Following the teenager’s death, New South Wales Premier Gladys Berejiklian extended her condolences to the young man’s family but said her government would not change its stance on pill testing.

“Unfortunately, we know that pill testing won’t work because it will give people the green light to take substances which in the end could still kill them,” she said.

But drug and medical experts reject this claim — and say pill testing leads to a reduction in the harms associated with drug use.

A new study published today backs this idea, too (more about that later). So how strong is the case for introducing pill testing in Australia?

Firstly, what’s the point of pill testing?

Pill testing, also known as drug checking, is a service that provides people with information about the content of illicit substances.

The idea is that individuals armed with more knowledge about drug composition and purity are able to make more informed decisions when it comes to drug taking.

Unlike pharmaceutical drugs, recreational drugs are unregulated, meaning the quality and strength of substances vary widely. This can sometimes lead to drug contamination, which can cause poisoning, or unintentional overdose, when people are unaware of the strength of the drug they are consuming.

According to the Alcohol and Drug Foundation: “Drug checking services tend to have three main goals: to prevent people from using especially dangerous or contaminated substances, to communicate safer-use messages, and to improve the users’ factual knowledge about substances and risks”.

Despite controversy in Australia, pill testing is not a new idea. It first emerged in the early 1990s in the Netherlands (where it is now part of national drug policy), and services are routinely available in several European countries, including Switzerland, Austria, Germany, Spain and France.

Pill testing is an approach to harm reduction (one of the three pillars of Australia’s National Drug Strategy), and research shows young people are largely in favour of it.

How does pill testing actually work?

Drug testing encompasses a range of testing facilities and capabilities — from informal DIY testing kits to advanced pharmacological analysis.

To understand how it might work in an Australian setting, let’s focus on Australia’s first and only trial of pilling testing, which happened at the Canberra Groovin’ The Moo festival in April.

  1. When a person first enters the pill testing area (set up in the festival’s health tent), they are met by a “harm reduction worker”. This person explains the pill testing process and advises the patron that there is no safe level of drug consumption, said David Caldicott, an emergency doctor and senior lecturer at the Australian National University.

“You are advised even before anything starts that if you want to be 100 per cent certain about not being hurt by drugs, you should not use any drugs,” said Dr Caldicott, who led the trial.

  1. Next, the patron hands over a pill (or capsule or powder) to a chemist who photographs and weighs the substance, and explains that the test results apply only to the test sample (which will be destroyed in the testing process).
  2. The sample — which may range from a thin scraping to an entire pill — is analysed using an FTIR spectrophotometer. This detects substances by passing an infrared beam through the sample and checking the result against a library of 30,000 substances.
  3. The chemist labels the sample with one of three classifications: white — the substance is what the person anticipated; yellow — the substance is different to what the person anticipated; or red — the substance is known to be associated with increased harm / multiple overdoses / death (or the machine is unable to identify it, suggesting the drug is new).
  4. This information is relayed to the person by a medical practitioner who outlines the potential dangers of each substance (that includes those identified a ‘white’ result).
  5. The person is directed to a drug and alcohol counsellor who provides information about the risks of consuming the substance identified, and ways they can reduce their risk (e.g. not taking the substance, or taking a smaller dose).
  6. Before leaving the tent, the person is advised of an “amnesty bin” in which they are able dispose of any drugs they have on them.

Won’t this kind of testing encourage drug use?

One of the main concerns about pill testing is that it may provide people with a “false sense of security”, and therefore lead to an increase in drug-related harm.

“What would be horrific would be if you had such a regime, something was deemed safe, and you have multiple deaths as a result,” Ms Berejiklian said in September.

But Dr Caldicott said this is a fundamental misunderstanding of how pill testing works.

“You will not be told at any stage that your drug is safe,” he said.

Prior to the testing process, each person is advised (and required to sign a legal waiver confirming they understand) the test does not provide evidence of drug purity, safety, dosage, or information about how they will individually respond to the substance being tested.

“We advise people that it’s not a medical consult … we don’t know enough about them to tell them whether it is safe for them or not,” Dr Caldicott said.

It has also been suggested that introducing pill testing at music festivals would lead to “an increase in drugs and a greater rates of death and greater harm to our society”.

But Alison Ritter, a drug policy expert from the University of New South Wales who co-authored a global review of drug checking services in 2017, said there is no evidence to support this claim.

“We know that it doesn’t produce an increase in drug use … and there’s no evidence of harm associated with pill testing,” said Professor Ritter.

Both Professor Ritter, director of the Drug Policy Modelling Program at UNSW, and Dr Caldicott said pill testing was about targeting people who already have the intention of consuming illicit substances — and helping to mitigate their risks.

It’s a view backed by the Alcohol and Drug Foundation: “Drug checking does not promote illicit drug taking, and people who choose to get their substances tested have already purchased their drug with the intention to use them.”

Research shows pill testing can reduce harm

Despite concern about pill testing increasing the appeal of illicit substances, research shows it can lead to less drug taking, and help people consume drugs in a safer way.

“What’s clear from the results of the services operating [in Europe] is that people make different choices based on the results of the testing — some choose to put their drugs into an amnesty bin, others choose to take half as much as perhaps they thought they would,” Professor Ritter said.

In the US-Australian study published today in the Drug and Alcohol Review journal, 54 per cent of ecstasy users surveyed said they were less likely to use ecstasy again if they learned their ecstasy contained ‘bath salts’ (synthetic cathinones) or methamphetamine.

Similarly, an evaluation of the UK’s first pill testing trial found one in five substances tested at the festival was not what people expected, and among people mis-sold substances, two thirds chose to hand over further substances to be destroyed.

Lead researcher Fiona Measham, a professor of criminology at Durham University, said by identifying toxic and potentially lethal contaminants, the pill testing service was able to reduce drug use and “therefore reduce drug-related harm”.

“There was a 95 per cent reduction in hospital admissions that year when we were testing on site,” Professor Measham told ABC Radio Sydney.

She added that pill testing provided an opportunity for healthcare workers to engage in a dialogue about health and harm with a group of young people who don’t usually access drug and alcohol services.

In April, at Australia’s first pill testing trial, 42 per cent of people who brought drugs for testing reported that their drug consumption behaviour would change as a result of the testing.

Dr Caldicott said in addition to reducing harm at an individual level, pill testing services are able to obtain valuable information about what drugs are circulating on the black market, which can be used to tailor public health alerts and assist law enforcement.

“One of the biggest problems in Australia right now is the diversity of the drug market,” he said.

He said new drugs were emerging at such a rate that it was possible the test would not recognise some substances, in which case, they would be given a ‘red’ classification.

Pill testing a ‘pragmatic response’ to drug use, experts say

Australians are among the leading consumers of ecstasy in the world — 2.1 million of us report having used the drug at least once.

Research shows that in NSW between 2010 to 2015, hospitalisations from ecstasy use nearly doubled among people aged 16-24.

“We’ve got 20 years of attempts at prohibition, and now a demographic which is largely immune to this approach,” Dr Caldicott said.

He said in order to reduce harm, we needed to treat drug use as a health issue — not an “ideological” one.

“Pill testing moves the debate from being ‘just say no’ to ‘let’s talk about this’ … to a non-judgemental, health-based discussion about drug use.”

Professor Ritter said although pill testing wouldn’t be a panacea to illicit drug use, it would offer a “pragmatic response” to “the reality that young people use drugs, and will continue to use drugs”.

“It’s not going to prevent all harms — not taking drugs is the safest option, clearly,” she said.

“But I don’t think encouraging young people not to do drugs is mutually exclusive from offering pill testing … you can do both things at once,” she said.

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