Pill testing: life-saving evidence prevails in A.C.T., now rest of Australia needs to act

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Australia21 - Spilt Milk festivalAustralia21 congratulates the ACT Government on its groundbreaking decision to allow free pill testing at the Spilt Milk music festival* in Canberra in November 2017.

The initiative comes in the wake of recommendations by senior police, retired judges, prison and parole administrators, health workers and drug law researchers, detailed in our report, ‘Can Australia respond to drugs more effectively and safely?’

In particular:

The emphasis should shift from trying to stamp out personal use of these drugs, to assisting people to make wiser choices about their use and minimising harms when they make unwise choices.

Currently, people purchasing illicit drugs from criminal sources have no idea about the purity or safety of the drugs they plan to consume. In order to be better informed and protected, users should be able to submit the drugs for testing in a controlled environment.

Like the ACT Government, Australia21 doesn’t condone drug use, but we recognise pill testing is an important harm reduction strategy which is needed to keep young people safe.

In making the announcement, ACT Health & Wellbeing Minister Meegan Fitzharris said there was strong international evidence that providing consumers with information about the content of illegal drugs can reduce rates of overdose or toxicity, especially from pills that are cut with unknown substances or substituted with even dangerous drugs.

“Pill testing means young people who are considering taking drugs can be informed about what’s really in their pills and how potent they are. And it creates an opportunity to remind them of the risks before they make the final decision to take a drug,” the Minister said.

To those who may be worried about the decision, she pointed out there’s no evidence that having pill testing available results in increased illicit drug taking.

 

Australia21 - pills in gloved handHow the pill testing will be done

The anonymous, free service will be provided by a consortium led by Harm Reduction Australia whose President, Gino Vumbaca, praised the ACT Government.

“Good on the ACT,” Gino told Triple J’s Hack, “They’re quite progressive and they’re actually prepared to have an open mind and listen to the science and evidence.

“One thing that we’ve made very clear is that we won’t be telling people that it’s safe to use a particular drug. There are harms associated with any drug use. What we’re trying to do is make it safer.

“It won’t be promoting drug use, but it won’t be condemning drug use either. It will be a non-judgmental approach,” he said.

The details are still being worked out, but the testing is likely to include:

  • A short survey to check what festival goers think they’re taking.
  • A very small scraping of the pill for testing and analysis in a mobile laboratory, which normally takes 10 to 15 minutes.
  • Results detailing the main content and the levels of the different chemicals in the pill, including contaminants.
  • Feedback about what those particular chemicals are and what dangerous effects they may have.
  • Safe destruction of any pills that festival-goers decide not to take.

The volunteer medical staff and counsellors won’t be able to stop festival goers taking pills against their advice. But if someone has an adverse reaction and can tell paramedics exactly what they took, it could save their life.

The testing facility will be enclosed to provide privacy and Gino Vumbaca said police definitely won’t be waiting to arrest people having pills analysed.

“That would shut down the service and no one would ever go again.”

 

Making pill testing available nationally

The service will collect evaluative data on the safety an operational aspects, to help with planning similar services in the future.

Pill testing facilities have been effectively used internationally since the 1990’s and are currently available in approximately 20 countries in Europe, the Americas and New Zealand.

But the ACT is the first Australian government to be brave enough to sanction pill testing, albeit only for one event so far: it’s a bold political move and we applaud their leadership. Other jurisdictions haven’t been as open-minded. Australia21 hopes they’ll now consider the risks to peoples’ lives ahead of their own political survival – our research indicates they’ll win significant voter support for it anyway.
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(*UPDATE: Despite government approval, the Spilt Milk organisers pulled out of the pill testing trial in October, blaming a documentation delay. Others claimed it was due to pressure applied by those opposed to the initiative.)

Australia21 calls on all Australian governments to put harm reduction first.

So how can we move forward? Two of Australia21’s drug policy experts, former Federal Police Commissioner Mick Palmer and President of the Australian Drug Law Reform Foundation Dr Alex Wodak, offer their advice below.

 

Mick Palmer AO APM

The decision by the ACT Government is very good news – albeit, it could be said, perhaps too little too late. It is to be hoped, however, that the ACT will allow genuine time to assess the value of pill testing and not simply tick the “one festival” box.

Reforms of this nature will always be gradual and cautiously implemented but it is promising that – at last – a Government in Australia has had the courage to take the first step.

The perspective which we need to remind ourselves of is that pill testing is aimed at reducing harms and preventing deaths. No one suggests it offers a perfect remedy or will single handedly change drug use habits, but the evidence is that it can and will make a positive difference. The abject failure of our current prohibitionist approach almost screams at us to try a different way.

Sanctioned pill testing will be conducted by trained professionals who are in a position to accurately determine the ingredients contained in a pill, advise whether it is safe to consume the drug (and whether it is the drug that the users believed they had purchased), as well as also providing an opportunity for explanations to be given as to the test results and the risks and dangers that are likely to be involved in consuming the drug. None of this can possibly be harmful, surely. It should be remembered that currently drugs and pills are obtained from a totally unregulated criminal marketplace in which there is no quality control whatever.

Clearly, accurate evaluation will take time and effort but pill testing numbers, ambulance and hospital treatment and admission figures, and interviews with festival and party goes all provide a source of information which can paint a clearer picture.

Internationally, particularly in western Europe, an increasing number of countries have commenced allowing pill testing and in some cases the testing has been permitted for several years. Police support has been strong and whilst the models of testing vary, the evidence (as I understand the situation) is consistently positive.

User habits have changed for the better, dealers are seen as being more likely to quality control their own drugs and provide the drug that is being sought, and the knowledge and understanding levels of drug users is improved. Additionally, the role of police and policing has changed to a much more supportive one, with police being able to play a constructive role in the drug use environment. Under the traditional law enforcement approach police are placed in a difficult and frequently combative position, are seen overwhelmingly as the enemy, and are required to enforce laws which many – particularly young police officers – know are ineffective.

The ACT Government should be applauded and all governments further encouraged to trial similar initiatives.

 

Australia21 - ACT Health Spilt Milk pill testing poster

 

Harm reduction includes measures aimed at reducing the adverse health, social and economic consequences of the use of drugs, for the user, their families and the wider community. Harm reduction makes up one of the three pillars of the balanced harm minimisation approach outlined in the National Drug Strategy 2017-2026 — ACT Health

 

Australia21 - Dr Alex Wodak at youth drug forum

Dr Alex Wodak AM

The decision by the ACT government is only for one youth music dance event for the ACT, which accounts for less than 2% of Australia’s population. But still, that’s more approval than we had before the decision.

When the NSW government approved a needle syringe program in 1986 to slow the spread of HIV among and from people who inject drugs, it was also a minimal decision. It took another two years before every state and territory had a needle and syringe program. Then it took many more years before the program was expanded to the scale needed to control the epidemic. Every part of this expansion was vigorously resisted. Critics argued that the Sky Would Fall In and HIV would still spread. We can also expect the same pattern with pill testing. Every millimetre will be fiercely fought over. That’s the nature of harm reduction. What makes these battles so hard is disproving a negative assumption.

Pill testing involves providing high quality scientific testing of recreational drugs supplied by a black market, to reduce deaths, illnesses and costly admissions to hospital. The testing is backed up by well trained and supervised health educators explaining the results and advising how to reduce risks. The irony is that authorities have never tried to stop the use of poor quality, inaccurate qualitative pill testing kits without medical advice! It’s only the high tech scientific testing with expert drug education and harm reduction that governments have been worried about.

It’s hard to assess whether the kits have made any difference. Since they became available, a small number of deaths have still occurred at these youth music dance events from year to year. Although that small number is still way too many, the statistical significance is minimal – so hospital admissions are often uses to analyse trends. But hospital admissions are also influenced by many subjective factors, such as the availability of beds. By contrast, a medically supervised pill testing regime will provide valuable data, including how many dance participants throw away their pills after being told that analysis indicates they are dangerous.

The international experience now goes back more than two decades. A growing number of countries have started to allow pill testing on site. Some also allow off site testing in the days leading up to a youth event.

It is hard now to believe that a raging battle lasting several years was waged over the introduction of needle syringe programs in Australia in the 1980s. Every new harm reduction strategy faces the same vehement debate between supporters of pragmatic harm reduction and supporters of harm elimination. We had similar debates over the introduction of car seat belts, as well as the promotion of condoms to reduce HIV, sexually transmitted infections and teenage pregnancy. It was the same for methadone treatment for heroin dependence, drug consumption rooms, heroin assisted treatment and e-cigarettes.

The battle to encourage the ACT coalition government of Labor and the Greens to approve even this limited trial required a ridiculous amount of effort for several years. But there was no alternative. There never is.

These debates often put our police and other law enforcement officials in a terrible situation, where they are required to enforce laws they know only too well are not just ineffective but also positively harmful, but where they cannot speak out in public. There are good reasons for requiring law enforcers not to run a continuous commentary about their views, but the costs of not getting any feedback from them are too high. The community knows, more or less, that the current system of relying heavily on arrests to control personal drug use is broken.

Once a leader in pragmatic approaches to illicit drugs, Australia is now a laggard. We watch and talk while other countries do. This is, of course, not just true of our drug policy. Our political system used to function reasonably well, but has been dysfunctional for the last decade. Kicking the can down the road to delay the inevitable is now the pattern.

Fortunately, the issue of pill testing was rescued from obscurity by a brilliant ABC TV Four Corners program. An interview with NSW Police Minister, Troy Grant, demonstrated the vacuous nature of the opposition. He claimed there were deaths in the Netherlands despite pill testing, but Four Corners checked and found there was no pill testing regime in place at music festivals and public events in The Netherlands.

Since when has public health been improved by keeping people ignorant about substances they intend to ingest?

 

More from ACT Health

 

What evidence is available that pill testing actually reduces harm?

Available evidence indicates that providing consumers with information about the content of illegal drugs they intend to ingest can reduce rates of overdose or toxicity from unknown substances.

There is also evidence that pill testing facilitates engagement of festival patrons in counselling. A report from Austria found that half of those who had their drugs tested stated the results affected their consumption choices and two-thirds said they would not consume the drug and would warn friends in case of negative results.

A recent published review of pill testing by an NGO at eight festivals in New Zealand analysed 330 samples. The testing service identified 39 different psychoactive substances. More than 75 per cent of patrons believed their substance was MDMA or LSD. Only 66 per cent of samples were actually MDMA or LSD, and 38 per cent of samples were not exactly what patrons believed them to be.

The NGO reported the impact on patron’s behaviour being significant with patrons making more considered and safer decisions. 63 per cent of patrons indicated they did not intend to take the drug when they learnt it was not what was expected.

The available literature does not provide evidence that pill testing prevents deaths among festival patrons. Any such effect would be difficult to study due to the unpredictable nature of adverse events from illicit drug consumption.

 

Does pill testing promote or condone drug use?

No- evidence suggests that people don’t end up consuming more illicit substances as a result of a pill testing service. Pill testing services are a unique opportunity to effectively encourage people who use illicit drugs to modify their behaviours in ways that reduce risks of harm to their health.

 

Is there community support for pill testing?

ACT Health together with Justice and Community Safety Directorate (JACS), ACT Ambulance Service (ACTAS) and ACT Policing formed a cross government working group. The working group has undertaken significant consultation that was overwhelmingly in favour of pill testing being allowed to take place in the ACT.

Consultation with the wider Canberra community in the form of a Canberra Omnibus Survey run by Winton Sustainable Research Strategies found nine in ten people (89.8%) say they support a harm reduction approach.

 

More Australia21 articles on this issue:

 

*Despite government approval, the Spilt Milk organisers pulled out of pill testing trial blaming a documentation delay, but others claimed it was due to pressure applied by those opposed to the initiative.



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