Pill testing in perspective

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Groovin the Moo, Canberra 2018Australia’s first legal pill testing has been hailed as a success by the ACT government, the chief health officer, the chief police officer, paramedics and drug reform advocates. But is the claim that it saved lives legitimate? Australia21 Director Deborah Rice reviews the outcomes, assisted by drug and alcohol expert Dr Alex Wodak, former Federal Police Commissioner Mick Palmer and Smarter About Drugs project leader Rebecca Bunn.

The headlines seemed to say it all:

ABC NewsGroovin the Moo pill tests find lethal stimulant, paint and toothpaste in drugs

news.com.au: Two ‘deadly’ pills found during Australia’s first pill testing trial at Groovin The Moo festival in Canberra

The Australian: Groovin the Moo festival pill testing uncovers two potentially fatal chemicals

The Canberra TimesTwo ‘deadly’ substances found during pill testing at Groovin the Moo

Of the thousands of people who attended the Groovin the Moo music festival in Canberra, 128 used the free drug-checking service offered by the STA-SAFE consortium.

STA-SAFE reported the detection of two highly toxic chemicals in some samples. One was n-ethylpentylone (ephylone), a stimulant responsible for the hospitalisation of 13 people in New Zealand last month. It’s believed the other was NBOMe, a powerful hallucinogen linked to three deaths in Melbourne in 2017.

They also found ecstasy (MDMA), cocaine and ketamine.

Around half the ‘ecstasy’ pills tested were pure. The other half may have contained some psychoactive substances, but they also had varying degrees of contaminants including paint, muscle rub, toothpaste and condensed milk.

 

ABC News coverage of Groovin the Moo

 

Health warnings and safety information were provided to all participants, and several participants used the amnesty bins to discard their drugs after finding out that what they had bought was not what they expected.

STA-SAFE member and emergency doctor David Caldicott said five people threw away their pills in the testing tent and between 10 and 20 per cent said they were considering getting rid of them.

“Certainly more than that were convinced that it would alter the way they would consume drugs on that day.”

As far as the consortium was concerned, even that small step was a great leap forward in harm reduction.

“By coming to the tent to have their pill tested and to chat with the workers they’ve avoided a trip to hospital,” said Dr Calidicott.

But did the service actually save lives?

As Matt Noffs from STA-SAFE points out, it would never be possible to measure if people who chose not to take their drugs or who reduced their consumption as a result of the pill testing advice at the festival would have died otherwise — just as it would be impossible to calculate the number who avoid a fatal outcome in the future, by remembering the advice and following it.

“The correct question is not whether lives were saved, but whether harm was reduced,” says Mr Noffs.

“What we do know is that 128 people were given potentially life-saving information about risky drug use which they wouldn’t have received otherwise, and they were thankful they’d made use of the service. It was very well received.”

 

So, does the media hype stand up to scrutiny?

Australia21 has taken a look at the results so far and surveyed the media coverage and public responses and we’ve come to this conclusion: it’s too early to tell whether the Groovin the Moo data warrants the optimism about pill testing.

On the otherhand, the overwhelmingly positive data already collected outside Australia should give us every reason to be optimistic, according to Matt Noffs.

“Groovin the Moo was a significant milestone. We got a trial up and we’re heading towards a change in laws that will support similar initiatives elsewhere in Australia. More and more parents around the country are calling for this sensible approach, so we shouldn’t be knocking it, we should be celebrating it — and being optimistic about reducing drug harm.”

The trial at Groovin the Moo in Canberra was only a trial. It didn’t ever claim to be the definitive model for how such a program should be conducted, how the results should be interpreted, or how the potential toxicity should be classified and communicated through harm reduction circles, the media and the general public. It was a first step on the road to collecting evidence about the effectiveness or otherwise of such an operation.

The conditions under which the testing took place were not ideal. Only preliminary results have been released so far and STA-SAFE says there needs to be further testing of the samples taken in laboratories with more sensitive machines.

ACT Chief Health Officer Dr Paul Kelly says the government and the consortium will evaluate the results to determine whether pill testing becomes a regular fixture at ACT music festivals.

It’s unclear whether pill testing will be offered at Groovin the Moo’s upcoming dates in Bendigo, Bunbury and Townsville.

 

The Canbeera Times coverage of Groovin the Moo 2018

 

Small sample size

One Australia21 Facebook commenter said the harm reduction community was divided about pill testing and the Groovin the Moo trial has not changed that. He claimed the headlines misrepresented the effectiveness of pill testing.

“It would appear that no one amongst the other couple of thousand people that didn’t get their drugs tested was hospitalised or died. This is statically highly improbable unless the claims about the 2 samples referred to as containing an “absolutely lethal” or “deadly” drugs were grossly exaggerated along with the claimed benefits derived from the endeavour.”

Matt Noffs’ response is simple: “Are you a doctor? Because when a doctor tells me something’s lethal or deadly, I generally believe them.”

As far as statistics go, the sample size was limited. That’s because one of the challenges faced by those conducting the trial was that they were unable to let festival goers know about the service prior to the event, provide directions to the testing tent on the day, or encourage people to use it.

STA-SAFE pill testing equipmentAustralia21 agrees it’s important not to make assumptions about all drugs on the market or at a particular event from a small cross section of self-selected participants. It’s too easy to ascribe meaning to something when there is only correlation rather than causation.

But it’s also important not to assume something hasn’t occurred because it’s ‘statistically improbable.’ Human behaviour is one of the many variables that needs to be considered. The argument about improbability rests on the assumption that all those who were taking illicit drugs at the festival were taking the same pills, from the same batch, from the same supplier — which is highly unlikely. Indeed, it’s possible that people who chose to have their pills tested were conscious that the substances they had obtained were in some way different or had come from sources that might be more risky than usual, and that was the very reason they came forward to use the service when thousands of others didn’t. We simply don’t know the answer yet.

Evaluating the trial will have to take into account many interacting variables and the validity of the claims should be tested and retested as more data is collected. What it is safe to conclude is:

  • further trials with greater capacity to test pills would allow additional quantitative and qualitative analysis that would provide greater rigour; and
  • future trials would benefit from more favourable conditions.

 

Disputed deadliness

Some critics have taken exception to the shorthand used to refer to the two samples identified as deadly in a character-limited tweet by STA-SAFE member Matt Noffs, when he announced that the operation had been a success.

Mr Noffs says we have to rely on the raw data until it’s analysed.

“As I’ve said, when a doctor tells you that something is deadly, you generally don’t quibble about how much of it can be consumed.”

 

The pills found to contain deadly ingredients at Groovin the Moo may have only had traces of them, but that doesn’t mean the ingredients themselves were not potentially lethal. It’s important to keep in mind that what is fatal often depends on how much of the active ingredient is taken — as Paracelsus said, ‘The dose makes the poison.’ Think of aspirin, one of the world’s most widely used medications: in the right dose it can decrease the risk of death, but an overdose can be lethal. That’s why we regulate the poisons we call medicines and advise on the safest way to use them. The manipulation of semantics can be just as misleading as the manipulation of statistics.

The physiology and condition of the person consuming the substance is also significant. Many may tolerate what a very small minority cannot, as anyone with a peanut allergy can tell you. This applies equally to the substance people intend to consume and the contaminants that they don’t.

There’s also a danger in assuming that if a drug is ‘pure’ it won’t harm you, as the ACT’s chief medical officer pointed out.

“I think many of patrons initially thought that a product that contained MDMA of high purity was a success and of course we were able to disabuse them of that because of course the purer an MDMA product is, the more likely you are to overdose on it,” said Dr Kelly.

Far from encouraging Groovin the Moo festival-goers to believe a substance was safe just because the content had been analysed, the STA-SAFE team made sure they knew that could never be guaranteed.

The team was also able to advise the paramedics and first-aiders on duty at the festival about the types of substances in circulation, so they’d be better prepared to make clinical decisions if any emergency treatments were needed.

 

‘Encouraging’ drug use

The ACT Opposition slammed the Groovin the Moo pill testing trial, claiming the government appeared to be endorsing or encouraging recreational drug use.

“It became a legal free-for-all, a go zone where you could take drugs,” according to the Shadow Attorney-General Jeremy Hanson.

That claim was not backed up with any evidence.

 

Groovin the Moo, Canberra 2018

 

In fact the operation had the opposite effect, according to Dr Kelly: the STA-SAFE team were careful not to give the impression any drug was safe, or encourage a false sense of security.

“The ACT Government still believes that not taking any drugs is the message we are giving to people and certainly that was the message given to everyone taken into the tent yesterday, but what we’ve seen yesterday is a different approach,” said Dr Kelly.

“We could see yesterday people changing their behavioural choices on the basis of that information that they were given.”

It must be remembered that the sole purpose of pill testing is to improve the safety of those who’ve made a personal decision to take recreational drugs at these events — which already happens (end has been happening for decades), despite them being illegal.

As Matt Noffs puts it, “Any teenager can get drugs on the street corner. This is about giving them information and advice that can save lives and help them make safer decisions.”

 

Disrupting the criminal business model

Another common fear about legally sanctioning pill testing is the assumption that it will be effectively free advertising for drug pushers, encouraging people to buy because they won’t get caught by police.

It may seem counter-intuitive, but as Australia21 has examined previously, pill testing and other harm reduction strategies actually have the potential to disrupt the black market in drugs and reduce the power of the criminals selling drugs to young Australians. You can read more about that by clicking here.

It’s possible that the media coverage of Australia’s first pill testing trial, along with the provision of similar services at further events, will influence both those buying and selling illicit drugs to move in the direction of lower risk — a better informed, more discerning ‘customer’ with the ability to test the claims of the ‘vendor’ can put pressure on the market to provide a more widely acceptable, safer product. Again, it will take quantitative and qualitative data to establish whether this is actually the case with pill testing. Meanwhile, the Grooving the Moo trial got festival-goers, their friends and the general public talking about possible toxicity in the substances many will take, whether pill testing is available or not. That has to be a positive outcome.

 

Australia21 - Cover of report Can Australia respond to drugs more effectively and safelyDoes pill testing go far enough?

A further objection to the Groovin the Moo trial was on the grounds that pill testing could never be capable of reaching nearly enough people to significantly reduce drug harms. There was a call for efforts to be redirected into legalising drug use so it can be regulated.

Australia21 agrees that pill testing is not going to be a silver bullet. Any harm reduction strategy needs to be multi-pronged, as we recommended in our 2017 report backed by senior law enforcers, ‘Can Australia respond to drugs more effectively and safely?’.

Australia21 believes a range of drugs should be decriminalised and regulated, with the aim of:

  • minimising harms for drug users and those around them,
  • reducing the use of untested, unregulated drugs in unsafe environments,
  • providing health and social programs to reduce drug-related problems,
  • reducing and even eliminating criminal control of the drug market,
  • reducing the prison population and its associated progress to hard drug use,
  • supporting police and the judicial system to focus law enforcement more usefully.

 

Raising awareness among young people

The number of people who used the pill testing service at Groovin the Moo may have been limited, but it’s important not to rule out a far wider impact. It wasn’t just mainstream media that reported on the historic move. It was also covered by the channels and sites used by music fans generally and young Australians in particular.

 

Triple j Hack coverage of Groovin the Moo 2018    Hit 104.7 Canberra coverage of Groovin the Moo 2018   Music Feeds coverage of Groovin the Moo 2018

 

No-one should underestimate the value of those platforms warning people about the dangers of taking drugs, and the power of the word of mouth and social media.

Triple J Hack: What went down with pill-testing at this weekend’s Groovin the Moo

The Music: Australian First Pill Testing Trial Proves Effective At Canberra Groovin The Moo

Music Feeds: “Deadly” Drug Contaminants Found In Groovin The Moo Pill Testing Trial

Hit 104.7‘Deadly’ pills uncovered at Canberra pill testing trial 

The Brag: It looks like pill testing at Groovin The Moo Canberra was a success

Junkee: Politicians Are Finally Getting On Side With Pill Testing After The Success Of Groovin The Moo

Many platforms also reported on a powerful showdown over one commentator’s ill-informed and out of touch opinions on The Project, summarised here on news.com.au.

 

news.com.au coverage of Steve Price's comments on pill testing

 

Allowing evidence-based debate

One benefit which is already obvious is that the first legal pill testing in Australia has encouraged a conversation about harm reduction within our communities.

It’s not just music fans who’ve been talking about it.

Doctors are now calling for pill testing in Tasmania.

The Australian Medical Association Tasmanian president Stuart Day said it should be part of a suite of harm reduction measures, including needle exchanges and decriminalisation for some drugs.

“Pill testing provides an opportunity for early intervention, an appropriately trained professional talking to festival goers and providing them with information about what they are taking. The model that has been used overseas… means that people have access to a doctor in a tent with other clinicians, chemists, counsellors and peer educators,” said Dr Day.

Pharmacists have been paying attention too. The Australian Journal of Pharmacy highlighted the potential role for local chemists to assist with pill testing, if it’s ever extended to the wider community beyond festivals.

The calls for a change in approach also crossed political divides.

Outspoken Coalition backbencher Warren Entsch threw his weight behind the trial.

“How many funerals do we have to go to of people that have taken these substances and found out they’re not what they’re sold?”

Federal Labor backbencher senator Lisa Singh did too.

“If we are going to get serious about harm minimisation, then pill testing at a health facility at a music festival without fear of police needs to be an option.”

 

The willingness of politicians to speak up in support of pill testing was news in itself.

ABC AMFederal politicians unite to encourage more pill testing trials

SBS: Pill testing finds supporters across political spectrum

Herald Sun: Federal MPs back more festival pill tests

That political support for pill testing is made possible by shifting public attitudes.

The evidence around drug harm reduction is complex and the arguments are nuanced. No tweet, news story or blogpost can do them justice. What they deserve is open-minded consideration and honest debate. Australia21 believes our nation is ready for that.

 

The Groovin the Moo pill testing trial had the full support of the ACT Government, ACT Health and ACT Police as a harm reduction measure.

http://www.health.act.gov.au/pilltesting

 


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