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Academic pro pill testing perspective

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The death of 19-year-old Georgina Bartter at a music festival on the weekend from a suspected ecstasy overdose could possibly have been avoided with a simple harm-minimisation intervention. Pill testing, or drug checking as it's known in Europe, provides feedback to users on the content of illegal drugs, allowing them to make informed choices.

Taking illicit drugs, especially ecstasy, is not particularly unusual for someone of Bartter's age. A 2010 survey found more than 11% of 20- to 29-year-olds and 7% of 18- to 19-year-olds had taken the drug in the previous 12 months. According to annual research among 1,000 ecstasy users, 70% of these pills are taken at clubs, festivals and dance parties.

Australia is internationally applauded for our harm-minimisation approach to drugs but we have failed to introduce pill testing, even though it is an intuitively appealing strategy.

Wide support

Pill-testing kits or booths at venues where pills are known to be consumed could inform users about the content of illicit drugs. As we have equipment that can test drugs in real time, people intending to take them could have them checked beforehand.

Research shows young people are highly supportive of pill testing; more than 82% of the 2,300 young Australians aged between 16 and 25 years surveyed for the Australian National Council on Drugs in 2013 supported its introduction. The finding is consistent with young people's overall views about drugs: they want better information in order to make informed choices.

Pill testing is not a radical idea. As a harm-reduction intervention provided by community and local governments, it's available in several European countries including the Netherlands, Switzerland, Austria, Belgium, Germany, Spain and France. But the legal status of the service is unclear and there is no formal government endorsement of the measure.

Nonetheless, its effectiveness is strongly grounded in evidence. There are good reasons why this country should introduce the measure.

Five good reasons

First, pill testing has been shown to change the black market. Products identified as particularly dangerous that subsequently became the subject of warning campaigns were found to leave the market.

Research also shows the ingredients of tested pills started to correspond to the expected components over time. This suggests pill testing might be able to change the black market in positive ways.

Third, pill testing changes behaviour: research from Austria shows 50% of those who had their drugs tested said the results affected their consumption choices. Two-thirds said they wouldn't consume the drug and would warn friends in cases of negative results.

Visits to pill-testing booths create an important opportunity for providing support and information over and above the testing itself. They enable drug services to contact a population that is otherwise difficult to reach because these people are not experiencing acute drug problems. Indeed, the intervention has been used to establish contact and as the basis for follow-up work with members of not-yet-problematic, but nevertheless high-risk, groups of recreational drug users.

Finally, pill testing means we can capture long-term data about the actual substances present in the drug scene. And it creates the potential for an early warning system beyond immediate users. This is becoming all the more important as new psychoactive substances that may be used as adulterants are appearing more frequently.

Not a panacea

A harm-reduction approach to drugs is always a balance between benefits and risks: the availability of pill testing reduces harm, but it may increase risks for some. Not everyone will use the service and some may ignore the results and risk being subject to potentially harmful drugs.

It may also lend the appearance of safety when, in reality, the pills remain illegal and potentially harmful. What's more, we will need to ensure that pill-testing results are accurate by researching the effectiveness of testing kits.

Of course, critics will argue the measure will "send the wrong message". But the messages we're currently sending are that we don't want informed consumers and we don't want to reduce harm from illicit drug use. They're clearly not quite right either.

Australia should run a trial of pill testing and assess its benefits and harms so we can then make an informed choice about this intervention.

The growth in new psychoactive substances and the ever-evolving chemical composition of drugs, coupled with the need to reduce the harms from pill use, means this is an idea whose time has come. And although the coroner has yet to confirm the exact cause of her death, the final reason for introducing pill testing is that it may help avoid the needless loss of young lives like that of Georgina Bartter.
Alison Ritter receives funding from Australian National Council on Drugs, which funded the youth survey mentioned in this article. This article was originally published on The Conversation. Read the original article.

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Six reasons Australia should pilot 'pill testing' party drugs

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The death of 19-year-old Georgina Bartter at a music festival on the weekend from a suspected ecstasy overdose could possibly have been avoided with a simple harm-minimisation intervention. Pill testing, or drug checking as it's known in Europe, provides feedback to users on the content of illegal drugs, allowing them to make informed choices.

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References to Dr Caldicott

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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.

2. 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).

3. 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.

4. 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).

5. 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).

6. 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).

7. 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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Pill testing is often misunderstood. This is how it actually works

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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.

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Different perspectives

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Updated December 22, 2018 10:44:35

We asked four Australians under 30 whether pill testing should be allowed at music festivals.

Following three festival deaths in four months from suspected drug overdose, debate has reignited over whether pill testing could save lives or gives the green light to illicit drug use.

Australia's first and only trial of pill testing took place at the Canberra Groovin The Moo festival in April.

Shelley Smith coordinates policy and harm reduction campaigns for youth service provider Noffs Foundation.

She advised festival-goers at the trial.

DJ and event producer Ayebatonye Abrakasa has seen friends make hurried decisions around drug-taking when police have been present at music festivals.

Sam Hurrell is a clinical science student who will start a medicine degree next year.

His close family member has struggled with methamphetamine addiction for several years.

Samraat Joshua Grewal is national president of the Christian Democratic Party's youth wing.

He says that pill testing gives a green light to drug use.

Australian ecstasy pills rank among the highest in the world for concentration of dangerous ingredients.

It can take up to a week of lab analysis to show a drug is completely free of lethal toxins.

Advocacy groups called on the NSW Government to support pill testing after two young people died at the Defqon.1 festival in September.

The pressure has been renewed after another teenager died from a drug overdose at a Sydney dance festival in December.

The NSW and Victorian governments have both stood by their opposition to pill testing in the wake of several suspected overdoses.

Several drugs tested at Groovin the Moo this year carried a high probability of users developing dependence.

The same batch of toxic pills that killed four people in the UK claimed no lives in the Netherlands, where pill testing is part of government health policy.
Watch the full discussion on YouTube
Credits

Story, video and photography: Mridula Amin and Jack Fisher

Additional filming: Edwina Storie, Abubakr Mahmoud, Dave Maguire

Cover image: Jack Toohey

Topics: law-crime-and-justice, australia

First posted December 22, 2018 06:04:40

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A DJ, a Christian, a medical student and a youth worker: This is what they think of pill testing

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Updated December 22, 2018 10:44:35 We asked four Australians under 30 whether pill testing should be allowed at music festivals. Following three festival deaths in four months from suspected drug overdose, debate has reignited over whether pill testing could save lives or gives the green light to illicit drug use.

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Useful global context

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Testing drugs at festivals is ‘a lifesaver’, study finds

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Drug-related hospital admissions down 95% after onsite testing at festival in Cambridgeshire

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Dr Caldicott said one of the big myths is that pill testing encourages young people to take drugs.

''The first thing we say is that if you want to stay safe today from any harms associated with drug consumption, you shouldn't use any drugs today,'' he said.

''The idea that in some way this is encouraging drug use is a nonsense.''

Dr David Caldicott said at every stage of the process people are told drugs are harmful. Credit:Christopher Pearce

Dr Caldicott said the post-doctoral chemists who test the drug will explain how the drug is manufactured, before the test results are passed on to a doctor like himself to explain the medical issues which could arise from taking the substance.

''That will be my opportunity ... to say to the punter, 'that's not great then is it?','' he said.

Dr Caldicott said research from Europe showed that after drug testing, about two-thirds of people did something other than consume their whole pill.

"So it may be that they take less of it, or they abandon it," he said.

Does pill testing tell people their drug is safe?

Dr Caldicott said they never class drugs as safe or unsafe, but rather colour code them: white means the drug is what the festivalgoer expected it to be, yellow denotes a substance other than what the person expected, and red means the drug is potentially deadly.

"In the music festival environment, consuming something other than what you expected is a very dangerous practice," Dr Caldicott said.

"We are not giving them any false reassurance."

Does telling someone their drug is pure encourage consumption?

After festivalgoers have spoken to the chemist and the doctor, and before they decide whether or not they want to keep their pill, they will speak to a harm reduction worker.

Jessica Murray, from peer-led harm reduction organisation DanceWize, said it's the job of harm reduction workers to explain why taking the drug - no matter how pure it is - is a bad idea.

"We say 'this is very strong and it's highly likely to lead to a very bad time for you and you may get sent to hospital, please don't do this to your parents and friends'," she said.

Ms Murray said workers will explain how factors like extreme heat, alcohol consumption and other drugs like antidepressants can have an impact on their reaction to substances like MDMA.

"We get people to think about, deeply, what it is they are trying to achieve by taking this drug or being at this festival, and why it is they think it's a good idea," she said.

"Then we say, 'but do you also understand the environmental factors that could lead to an adverse health outcome?'

"These are the things that most people don't understand, and this is where people get into trouble."

But what happens if someone takes the drug anyway?

Dr Caldicott said they cannot prevent people from taking their pill after all the advice being given to them by the experts, much like people cannot be prevented from discharging themselves from hospital despite medical advice.

Gino Vumbaca, the president of Harm Reduction Australia, said another important aspect of pill testing was that it provides people a judgment-free environment to return to if they do experience adverse effects.

"We'll let you know what actually you're going to consume, but more importantly we'll talk to you about what the risks and harms are associated with that, and just as importantly what to do if there's an adverse outcome - if there's a problem, what to do to get help, and the importance of getting help immediately," he said.

Rachel Clun is a journalist at The Sydney Morning Herald.

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'We are not giving them any false reassurance': Busting the myths of pill testing

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Dr Caldicott said one of the big myths is that pill testing encourages young people to take drugs. ''The first thing we say is that if you want to stay safe today from any harms associated with drug consumption, you shouldn't use any drugs today,'' he said.

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Basic info

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The basic aim is to enable recreational drug users to make informed decisions about what substances they take.

Pill testing is part of the Netherlands national drug policy - it was introduced there in 1992. Government-sanctioned services have been in Austria since 1997, Belgium since 1993 and Switzerland since 2001. Pill testing is also available in Portugal, France and Spain. Not-for-profit organisations have been testing in the US and Canada since 1999 and in the UK since 2013.

In New Zealand, pill testing is offered at festivals by the volunteer group KnowYourStuffNZ, which is independent but supported by the New Zealand Drug Foundation.

Australia's first professionally administered pill-testing outfit was in a mobile laboratory at Canberra's Groovin' the Moo festival in April. The testers used an infrared spectrometer to identify substances in a sample of each pill.

(Commercially available "do it yourself" pill-testing kits have been used by some festival-goers for years. Each kit contains a solution which, dropped onto a grounded-up sample of a pill, will change colours to show the presence or absence of a substance such as MDMA. But these kits cannot confirm dose levels of a particular drug and do not provide information on other potentially dangerous cutting agents.)

Party drugs: they don't come with a list of ingredients. Credit:Alamy

How does pill testing work?
Based on the Canberra's Groovin' the Moo festival, the process works like this:

Attendees queue outside a tent in the medical precinct of a festival.

Once inside, they sign a waiver releasing the testers from liability.

They also speak to a peer educator to ensure they understand that the test does not guarantee the safety of the drugs. "We're quite explicit in telling people that this test doesn't tell you if your drug is safe," says Dr David Caldicott, an emergency medicine consultant at Calvary Hospital in Canberra and a leader at the Groovin' the Moo trial. "It just tells you what we're able to find in your sample."

Each attendee provides a sample of their drug to a licensed chemist who photographs and weighs it before putting it under an infrared spectrometer where it is mounted on a piece of diamond and shot with laser light. Through the light reflected, the chemist can tell what is in the sample.

The attendee then has a consultation with another peer educator to discuss their options now they know what's in their drug.

In Canberra, of the 83 samples tested in April, just 42 contained mostly MDMA, the active ingredient in the drug known as ecstasy - even though 70 people thought they had bought ecstasy pills. Seventeen of the samples had "fillers" or cutting agents as their main ingredient.

Other substances found included antihistamine, caffeine, dietary supplements, oil, "foodstuff" and toothpaste.

One man discovered that the main ingredient in what he thought was "meth" was actually N-Ethylpentylone, a stimulant that had been responsible for the hospitalisations of 13 people in New Zealand.

Many partygoers change their mind about taking their drugs when they find out what's really in them.

Does pill testing change people's drug-taking?
There are people at music festivals who'll never take drugs and those who will take drugs no matter what, says Dr Caldicott. But the biggest group using drugs at music festivals are those whose behaviour pill testers aim to change. "I would say perhaps 80 per cent of people at music festivals are prepared to modify their behaviour if they're provided information that allows them to do so - and that's the group we're targeting."

Similarly, when people discover that the drugs they have are not the substances they thought they were, about half say they won't take them, according to Know YourStuffNZ's Dr Jez Weston. He says his group's non-judgmental stance is one of the factors in changing behaviour as are the trust and reciprocity involved in the process, the attendees' involvement in testing and the immediacy of the results.

"Our approach acknowledges the agency of the user," Dr Weston wrote on scientific blog Sciblogs, "and therefore encourages mature decision-making''.

A recently-published US-Australian study which surveyed ecstasy users at dance parties in New York found a similar percentage of participants reporting they would be less likely to use drugs found to contain unexpected substances.

Gladys Berejiklian may be softening her stance. Credit:AAP

What do the politicians say?
NSW Premier Gladys Berejiklian has said pill testing gives drug users "a false sense of security" and her job as Premier was to keep the community safe.

But following the recent deaths, Ms Berejiklian appears to have softened her stance. "If there was a way in which we could ensure that lives were saved through pill testing we would consider it - but there is no evidence provided to the government on that," she said.

NSW Opposition Leader Michael Daley recently signalled that pill testing "should not be off the table".

Former Australian Federal Police commissioner Mick Palmer has urged NSW to consider allowing pill testing. "How a government which presides in a jurisdiction in which a medically-supervised injecting centre has operated successfully and with indisputable success in Kings Cross over 18 years, can be so vehemently opposed to trialling - or even discussing or considering - pill testing is difficult, almost impossible, to understand," he wrote in The Sydney Morning Herald.

In Victoria, pill-testing supporters include the Greens and the Reason Party but the Victorian government is not in favour. "We have no plans to allow for pill-testing at events in Victoria," Mental Health Minister Martin Foley said in December. "Advice from Victoria Police tells us it can give people a false, and potentially fatal, sense of security about illicit drugs."

However, Dr Caldicott says, "I can't fathom how anyone who is in regular contact with young people would believe, ever, that turning up with a shipping container, with some of the most-advanced technology available, with a team of doctors and chemists who, at the very get-go, tell the people presenting to the pill tester that they could die if they use drugs today - it's beyond me how that encourages drug use."
Who else is in favour of pill-testing trials?
The Australian Medical Association. And Professor Alison Ritter, from the National Drug and Alcohol Research Centre, lists several reasons to pilot pill testing. They include that pills exposed as dangerous have been found to leave the black market; ingredients of tested pills start to correspond to the expected ingredients over time; pill testing changes behaviour once the ingredients are exposed; and pill-testing booths offer support and information over and above the actual testing.

"As an emergency doctor," Dr Caldicott says, "when we give news about somebody being unwell and go, 'I'm sorry I can't tell you whether they'll survive or not', there is not a parent I've ever spoken to who is prepared to turn around and say; 'Do you know what? As long as their death serves a lesson to others I'm OK with it'."

Yan is a reporter for The Age.

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The basic aim is to enable recreational drug users to make informed decisions about what substances they take. Pill testing is part of the Netherlands national drug policy - it was introduced there in 1992. Government-sanctioned services have been in Austria since 1997, Belgium since 1993 and Switzerland since 2001.