Vol 16 Edition 1

The ins and outs of pill testing

The controversial debate on pill testing has been reignited following recent deaths due to drug overdose at music festivals.

Some festival organisers have championed the idea of pill testing and they have the support of drug experts and even Australia’s peak medical representative body. Despite this support, authorities have so far resisted ongoing calls for this initiative.

Australians support pill testing

A recent study by Essential Research found the majority of the Australian public are in favour of pill testing, and Australian National University’s Dr David Caldicott, says research shows that pill testing can save lives.

“We’ve known from 2002, from the Three Cities Study [which looked at Amsterdam, Hanover and Vienna] that where you implement pill testing at music festivals, people use fewer drugs, the quantity of drugs they consume is reduced, and the rate at which they mix their drugs is reduced. These are all dependent factors for overdose,” says David.

“I don’t think it’s a panacea – we can’t do anything for kids that get run over by cars at music festivals, or other accidents, but if we can address the issues of overdoses at music festivals, we can probably reduce deaths.”

David’s stance is supported by the Australian Medical Association, which put its support behind the idea as early as 2005.

Premiers not moving

However, in Victoria and NSW (the states in which many of the music festival deaths have occurred), the governments have ruled out a shift towards pill testing, with Premier of Victoria Daniel Andrews stating last year, “there is no safe level at which these substances can be taken.”

New South Wales Premier Gladys Berejiklian has also expressed concerns that pill testing would give people a “false sense of security” and promote further drug use among young people.

“We do not support a culture that says it is ok to take illegal drugs, and I am worried about the number of people who attend these events who think it is ok to take illegal drugs,” Premier Berejiklian told the media in 2018 following two drug overdose deaths at Sydney’s Defqon 1 festival.

An opportunity to engage with people who use pills

David Caldicott, however, says that pill testing is not about encouraging people to use drugs, but rather it’s a means of connecting to drug users and encouraging them to reconsider their use.

“The pill testing business gives us a currency the consumers want, in which we can engage with them and talk to them about their habits. People think that pill testing is just like a delicatessen counter, you just take a ticket and get what you want. What they don’t realise is that people are also obliged to sit down for 20 minutes to talk to drug counsellors about their consumption,” he says.

A long history

Pill testing is not a new idea. It emerged in the Netherlands in the early 1990s, where it is now implemented as part of a national drug policy. The service is also routinely available in several European countries, including Switzerland, Austria, Germany, Spain and France.

Australia’s first and only pill testing initiative was trialled at Canberra in 2018, with the tests finding a lethal stimulant, paint and toothpaste in some drugs. Forty per cent of participants said they would change their drug consumption after finding out that what they were taking was cut with other substances.

The ACT government announced in February 2019 they would allow a second trial of the testing at this year’s Groovin’ the Moo festival.

The details

Pill testing, also known as drug-checking, involves testing illicit substances to provide people who use drugs with information on the pill’s content. It aims to arm individuals with more knowledge about drug composition and purity. The person can therefore make more informed decisions.

Pill testing tends to have three principal aims: preventing people from using particularly dangerous or contaminated substances, communicating messages about reducing harms and improving the person’s knowledge about substances and their related risks.

The main types of pill testing, says SafeWorks’ Andrew Leibie, include home kits, on-site testing at festivals, and laboratory testing. Each type offers a different degree of accuracy, speed, and ease of use, and a compromise between each of its benefits.

Reagents, or home kits, are a quick and low-cost option and can be easily performed without specialist knowledge. However, they are extremely limited in what they can detect and are unlikely to detect impurities.

The technology trialled at Groovin’ the Moo in Canberra in 2018 was a portable instrument that offers quick results but is limited in the number and concentrations of substances it can detect.

The most effective laboratory-based options, like mass spectrometry and liquid chromatography machines, are also slower, more expensive, immobile, and often require advanced training to operate.

Different approaches to pill testing – not just at music festivals

Central lab models have been trialled in the Netherlands and Spain and allow clients to drop in or post samples of their pills several days prior to expected consumption. The results are anonymously provided online.

This model also helps to provide real-time information about potentially dangerous drugs currently circulated the streets – valuable intelligence for health, drug and law services. This information can then be communicated to people who might potentially use the dangerous drug, says Andrew Leibie.

Internationally, drug-checking is also being trialled beyond music festivals. For example, in Canada the opioid crisis has prompted a safe injecting site in Ottawa to install a mass spectrometer to test drugs for potentially lethal contaminants including fentanyl.

Health Canada’s latest figures suggest the number of annual opioid-related deaths in the country has now surpassed 4,000. In Ottawa 30 per cent of overdoses involve fentanyl, according to Ottawa Public Health.

David Caldicott says that while the pill testing debate in Australia is mostly centred around music festivals, drug-checking would be more applicable to people who inject drugs.

“If you look at the burden of drug-related harm, it would be far more sensible to have it far more widely than music festivals. Festivals are really only the tip of the iceberg,” he says.

“This is a multi-pronged potential intervention to reduce harm. It’s quite simple really. If we can address the issues of overdoses, we can probably reduce harm.”

– Tom de Souza

Penington Institute recently ran public education about pill testing, which can be viewed on the Twitter feed.

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