Right: Victorian coroner John Cain on a pill-related death: "A drug-checking service would have at least created the opportunity... to receive tailored harm reduction information"
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Arguments against making pill testing available in Australia
1. Pill testing will not prevent many drug-related deathsSome opponents of introducing pill testing services in Australia argue that these are not necessary to prevent many drug-related deaths, especially those associated with ecstasy (MDMA) use. Drug testing is used to gauge the potency and possible contamination of a drug. Critics claim that neither of these factors is significant in deaths attributed to ecstasy.
Ecstasy is a widely used drug associated with an increasing number of deaths. It is one of the more commonly used illicit substances in Australia, particularly among young adults. It is very commonly taken at music festivals. The most recent National Drug Strategy Household Survey (2019) found that ecstasy was the third most used illicit drug in Australia after cannabis and cocaine, with use reported by 3 percent of Australians aged 14 and older in the previous 12 months. According to the 2019 Global Drug Survey, Australia has the second highest rate of MDMA use in the world, after the Netherlands.
It has also been claimed that ecstasy use is increasing in Australia. In 2023, ecstasy and cannabis were the most reported drugs of choice for participants in the Ecstasy and Related Drugs Reporting System (EDRS). When the past 6 months were compared with the previous year, Ecstasy use was reported by 95 percent of those surveyed, an increase from 88 percent in 2022. There were 392 MDMA-related deaths in Australia between 2000 and 2018. Death rates increased significantly between 2001 and 2007, declined between 2008 and 2010, and increased again between 2011 and 2016 consistent with international supply trends. Deaths occurred predominantly among males in their mid-twenties, with females likely to be significantly younger. Most incidents occurred in private locations. It has further been noted that this number of fatalities is likely to be an understatement. National Drug and Alcohol Research Council information officer, Paul Dillon, has stated, 'It's very difficult to know the numbers because people often die a number of days after from complications, so MDMA does not appear on the death certificate.' It is also claimed that the non-lethal effects of MDMA are underacknowledged. Mr Dillon has stated, 'There's a range of other consequences such as psychological problems. I think people need to know there are risks when taking any drug - it does not matter whether they're legal or illegal.' Despite the risks represented by ecstasy use, critics of establishing permanent pill testing centres argue that this strategy is unlikely to reduce ecstasy-related deaths. Commentators have noted that those who die because of taking MDMA do not do so because of overdosing; therefore, pill-testing to determine ecstasy concentration per table would not have prevented these deaths. The medical literature notes that users can take massive doses of MDMA and live. At the same time, users die with less than one eighth the MDMA blood levels of the average Australian fatality (0.85mg/litre) making pill testing purity assessments of limited value in reducing MDMA fatalities.
In a submission made to the Northern Territory Legislative Assembly in February 2019, Drug-Free Australia claimed, 'Many deaths can be attributed to something akin to an allergic reaction, where four friends can ingest identical MDMA pills purchased from the same dealer but only one die. This was exactly the case with...Australia's first MDMA death in 1995. Some have correctly likened ecstasy use to playing Russian roulette...The argument that pill testing personnel can enhance safety, advising users to take half or quarter a pill where MDMA purity is high, may be as safe as doctors telling those suffering anaphylactic shock from a peanut allergy that they should eat quarter instead of the whole.'
It has further been claimed that though MDMA-related deaths can occur because of other toxic drugs being mixed with, or fraudulently sold as ecstasy, this is not commonly the case. In an Australian study examining ecstasy-related deaths between 2001 and 2005, 82 percent of the 82 deaths were attributed to MDMA. The other 18 percent were 'primarily due to pathological events/disease or injury, with MDMA a significant contributing condition.' The conclusion that Drug Free Australia has drawn from this, and other data is that 'There are no mysteries about party pill deaths in Australia. Almost all, according to the many coroners reports, are from ecstasy itself.' Drug Free Australia uses the claimed primacy of MDMA in causing these deaths as a justification for arguing that pill testing is not needed to determine what other potentially harmful substances recreational drug users may be taking along with the ecstasy they consume.
2. Pill testing is not completely accurate or sufficiently comprehensive
Those opposed to the establishment of pill testing services also argue that the testing methods used are not always accurate and are not sufficiently comprehensive, that is, they are not able to detect all the potentially harmful substances in the drugs submitted to them.
Critics of setting up pill testing services are skeptical about the value of the results given by the tests that are performed. Three types of testing have been supplied at the ACT fixed-site pill-testing clinic during its six-month trial operation. The first type of test uses Fourier-transform infrared spectroscopy (FTIR).
Different frequencies of infrared light are passed through a very small drug sample. Because different substances absorb different light frequencies, analysts can use this absorption data to determine the chemical composition of the sample being tested. The FTIR is commonly used for testing at music festivals because it is portable and supplies results quickly. The other form of testing used in the Canberra fixed-site trial is an Ultra-Performance Liquid Chromatography-Photodiode Array (UPLC-PDA) analysis. The UPLC-PDA can test the purity and identity of a specified ten drugs in ten minutes. The service also uses fentanyl test strips (FTS) to look for fentanyl derivatives. FTIR pill testing is the primary form of testing supplies at festivals and other temporary sites.Several concerns have been raised about the adequacy of FTIR pill testing. Toxicologist, Dr John Lewis, at the University of Technology, Sydney, has explained, 'You get a scraping of the pill and you put the grains onto a plate, or a diamond and the infrared beam passes through it and produces a spectrum. That spectrum is analysed mathematically and if it matches, let's say ecstasy, it will give you a probability. It might be 80 or 90 percent. However, data from Europe - where FTIR has been used for the purposes of pill testing for several years - has highlighted some limitations.'
Forensic toxicologist and marketing director at Safework laboratories, Andrew Leib, has similarly stated, 'FTIR is not very good at detecting poly-drug mixtures, so once you get more than two or three drugs in your sample - which is extremely common - you get too much noise, and it can't identify the drugs very well. The other thing is it doesn't tell us anything about the dose, and that's critical, certainly in the harm-minimisation aspect of some of these pills.And the final point is, a lot of the newer drugs feature much more dangerous compounds, new psychoactive substances, or NPS. There is a real zoo of these things out there, literally hundreds that have only been recorded in the last few years. The newer and the more exotic these compounds are, the less likely FTIR is to be able to detect them, because it relies on a library match - if it hasn't been told what some of these new drugs look like, it just won't see them.'
Concern has also been raised that FTIR's inability to gauge the potency of a drug could lead to overdosing in a variety of circumstances. Dr Lewis has argued that when you are comparing commercially produced and regulated drugs with the erratic manufacturing practices of illicit drug producers, FTIR's inability to gauge potency is a problem. He has explained, 'If you get a pill made in Bankstown or Guancheng ...What if this becomes a very slow release because of all the muck that's been put into the pill? The person says, "I've bought a dud, it's not working", and they take another one. By that time, the first one's dissolved, and so they've actually overdosed.'
There has also been some concern about the limitations of Ultra-Performance Liquid Chromatography-Photodiode Array (UPLC-PDA) analysis. The ACT pill testing centre describes the UPLC-PDA as 'the real pill testing fire power' as it can detect key components of a drug and contaminants and indicate the proportion of each within a compound. However, the test centre admits that this testing also has limits and will later be upgraded to incorporate mass spectrometry (MS) to improve the pill testing centre's ability to identify sample contaminants occurring at lower proportions of the drug samples.
3. Pill testing offers a false sense of security
Critics of pill testing argue that the process offers a false sense of security, encouraging drug takers to believe that inherently dangerous substances can be consumed safely.
Opponents of pill testing stress the inevitable danger associated with taking illicit drugs, either singly or in combination, and argue against pill testing because they believe it masks this danger. In a statement made in February 2019, the then Victorian Deputy Police Commissioner, Rick Nugent, stated, 'Victoria Police is not supportive of pill testing. There is no such thing as a safe illicit drug. An identical drug can affect different people in different ways. Illicit drugs affect people different depending on the purity of the drug, tolerance level, or medical conditions that people may or may not know they have. The majority of overdoses at music festivals are caused by poly drug use - that is multiple drugs consumed by the person. Pill testing does not prevent this... Drugs are manufactured by criminals with absolutely no regard for the safety of the people who take them.'
The same view has been expressed by a former New South Wales Health Minister, Brad Hazzard, who in 2019 stated, 'There is no such thing as a safe illegal drug. Pill testing or "drug checking" may test for the presence of particular compounds in a pill or capsule - it does not indicate that a pill or capsule is safe to consume. It gives people a false sense of security that may leave them brain damaged or physically disabled.' Critics of pill testing argue that a pill test which confirms to a potential user that the substance s/he has purchased is chemically what they believed it to be can act as an assurance that it is safe to consume. This point has been made by Paul Spinks, a MICA paramedic, trauma counsellor and mental health advocate. Spinks states, 'Those who have resisted using drugs out of the fear of ... not being certain of what was contained within them will now have a government endorsed message that these drugs are safe to use and that there's nothing to fear.'
Support for Spinks' concern can be found in a 2003 study of the effect of pill testing on United States college students who had not yet tried illicit drugs. In a survey of non-drug users, 19 per cent reported that they might be more likely to try ecstasy if pill testing were available. The study concluded 'it gives an artificial shine of safety to a group of diverse drugs that remain both illicit and potentially harmful'. Spinks also argues that if a test demonstrates that the product they have bought was as advertised by the seller, who will act as an endorsement of the safety of other drugs supplied by the same seller. Spinks writes,' Once their supply has been tested why would the same source for the drugs not be OK to use elsewhere?'
Critics of a drug user feeling confident in the quality of already tested drugs note that drug suppliers do not supply a consistently reliable product. An American ABC news report published in February 2023 noted, 'Legal pharmaceutical products are manufactured with safeguards in place to ensure quality control. Drug dealers may not have professional chemistry skills and may not have quality control tests...' Opponents of pill testing argue that because one test of one pill from one batch sold by a supplier was 'safe', this does not mean that other pills from the same supplier will be.Recent concerns about pill-tests giving drug users a false sense of security have been raised about fentanyl test strips. Fentanyl is a pharmaceutical opioid that is prescribed for the management of severe pain. It is about 80 to 100 times stronger than morphine. The ACT testing centre uses fentanyl test strips to help guard against this growing threat; however, critics are concerned the testing procedure is not adequate. Fentanyl test strips have been found to give false negative readings. In a 2017 Canadian trial of 70 fentanyl test strips 63 accurately identified that opioids were present; however, in three samples, the fentanyl test strips gave false negatives, indicating no opioids present, when the lab tests indicated they were. Health Canada advised that the risk of a false negative is particularly concerning, because it could 'lead to a false sense of security which may result in overdose or death.'
Accuracy issues remained in 2020. A Brown University study found of the 210 samples tested using fentanyl strips, the strips gave false negative readings on 3.7 percent of tests. Critics note the risk of false readings and overdose remains as indicated by Canada Health's warning.4. Pill testing appears to give government sanction to drugtaking and so normalises the behaviour
Opponents of pill testing believe that the amnesty from arrest or having drugs confiscated that exists at pill testing services contradicts the illegality of the drugs being tested. Critics claim that these tests undermine the laws prohibiting drug use. They further note that governments who establish pill testing are acting against laws they have helped to enact and are normalising drugtaking.
Critics of governments establishing pill testing argue this would reduce the public perception that drug taking is illegal and begin to normalise the practice. They claim that once drug taking begins to be normalised, its frequency will increase. The 2016 National Drug Strategy Household Survey found that 31.1 percent of Australians who did not use illicit drugs refrained because the substances were illegal.
Sociologists and criminologist argue that laws shape people's behaviour either because they fear punishment if detected or because they recognise that the law demonstrates that the outlawed behaviour is harmful in some way. A 2021 British study explaining how laws shaped people's perception of acceptable behaviour stated, 'Laws not only affect behaviour due to changes in material payoffs [rewards or punishments], but they may also change the perception individuals have of social norms, either by shifting them directly or by providing information on these norms.' Several commentators have argued that the government would be sending mixed messages about the seriousness of the law if it allowed pill testing services to be established. Sky News commentator Alan Jones, congratulating New South Wales on not approving pill testing, has stated, 'It surely is beyond ludicrous to be saying to young people, drug taking is illegal, but we will test your illegal product, with taxpayers' money, to tell you whether you are likely to die or not... The NSW Premier, Gladys Berejiklian has, to her great credit... held her line.'
3AW radio commentator, Tom Elliott, has similarly stressed that governments must continue to adhere to their states' laws. Elliott stated, 'The law makes it very clear: party drugs, MDMA, ecstasy, all those sorts of things... they are illegal. The idea that there are safe illegal drugs and unsafe illegal drugs is not what our legal system says.'
Finally, an editorial published in The Sunday Telegraph in January 2019 stated, 'There is a real sense of desperation in the notion that government should pay for a test to make sure the illegal drugs a teenager is about to take are actually an illegal substance and not washing powder ... the notion that a government which has clear laws about drug usage designed to keep people safe would offer teenagers a quick, free test to ensure the pills that they just bought were what the dealer said they were wouldn't pass the pub test.' Government ministers past and present have also stated their belief that governments would be failing in their responsibility to send the right message to the electorate if they established pill testing services. Former New South Wales deputy premier, Tony Grant, has indicated that governments cannot consistently uphold the law if they allow pill testing. Grant stated, 'What you're proposing there is a government regime that is asking for taxpayer's money to support a drug dealer's illegal business enterprise.'
Former New South Wales Police Minister David Elliott has stated, 'Pill testing ... sends the wrong message to young people about the consumption of illegal substances. All illicit substances carry the real risk of harming, or ultimately killing, the person who takes it. We have not forgotten the tragic drug-related deaths of so many young people only a couple of years ago.' In 2021, Queensland LNP deputy leader Tim Mander stated, 'I strongly support education - what we have to do is convince our young people that taking drugs is not the way to have a great time at concerts.' However, regarding government-endorsed pill testing centres, he argued, 'Drugs are illegal for a reason - they are dangerous, they can kill, and they do kill.' 5. There is no reliable evidence that pill testing has reduced drug consumption or mortality rates
Critics of pill testing argue that it is being offered to the public without reliable evidence of its effectiveness.
Several recent Australian studies and literature reviews have failed to find substantial evidence demonstrating the effectiveness of pill testing. A study conducted by Ian and Russ Scott that was published in Internal Medicine Journal in January 2020 concluded, 'Recent pill-related deaths of young people at music festivals in Australia have led to a concerted push for on-site pill testing as a means for preventing such events. However, whether pill testing (also termed 'safety checking') is an effective harm reduction strategy remains uncertain. This narrative review concludes that pill testing currently lacks evidence of efficacy sufficient to justify publicly funded national roll-out of on-site pill testing programs.'
A 2022 in-the-field evaluation of the effectiveness of pill testing noted the positivity of participants' responses, however, it also noted the difficulty of determining the reliability of their responses. One of the key areas where critics detect a lack of evidence is in pill testing leading to reduced drug use. A comment posted by the Sydney-based Marsden Law Group states, 'Whilst pill testing is common in Western Europe, its effectiveness in saving lives is still questionable. There is very little data to show that pill testing ultimately leads to a reduction in consumption rates. The only proven benefit of pill testing is that the analysis of drugs allows the Government to detect bad batches of drugs and issue public health warnings. Nevertheless, there is still no evidence to demonstrate that pill testing leads to people no longer taking pills. Whilst public health warnings may persuade many people to not consume pills from an identified bad batch, there is no evidence to illustrate that they will not simply purchase new pills, those that do not originate from a bad batch, and consume them.'
Andrew Groves 2018 study noted, 'Like most debates about policy reform, a key question in the rationale for pill testing is whether it "works". The literature is complicated, and, to date, no studies have fully tested in a controlled way, whether pill testing reduces harms. Most evaluations concern attitudinal change (e.g., what people would do), legal issues and the integrity of various analytic procedures, with others describing program features or contextually relevant praxis, so... a large, multi-site systematic review of testing practices is needed.' There is also limited evidence that pill testing significantly improves health outcomes or reduces mortality. An overview of drug testing effectiveness produced by the Australian National Centre for Education and Training on Addiction noted, 'Evidence for the effectiveness of drug testing to improve safety or reduce risk of harm is limited. Few quality evaluations of drug testing programs have been undertaken...'
Some critics have noted that it would be almost impossible to assess whether pill testing had reduced the risk of mortality. They claim that even if pill testing were to be associated with an apparent drop in user deaths, this would need to be balanced against other factors. One such factor is the possibility that pill testing has led to greater drug use, thus the benefit of pill content warnings would have to be balanced against the harm of increased use. This point has been made by Drug Free Australia who have stated, 'The purported "safety" of pill testing would be expected to broaden the pool of users, thus increasing deaths, matching any decreases in bad batches.' Critics note that even among those who recommend a continuation of pill testing services, evidence-based claims of effectiveness are cautious and inconclusive. The evaluation conducted after the ACT Pill Testing Trial 2019 stated, 'Overall, the evaluation produced no strong arguments against the development of further services that provide pill testing and harm reduction information for people who use illicit drugs.'
The 2022 evaluation of the ACT Pill Testing Trial, while recommending the program continue, also acknowledged limitations in its findings. The evaluation noted, 'As a small pilot study in a real world, there are limitations with the data set. In addition to missing questionnaire data (particularly the post-testing survey), the follow-up data set is small. Studies such as this, that use self-report data, particularly regarding illegal behaviour like drug use, are prone to social desirability bias; in this case, the under-reporting of socially disapproved behaviour.'