Right: Modern music festivals run on sound and light stimulus. More and more, chemical stimulus is added to an already potent mix.
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Arguments in favour of making pill testing available in Australia
1. Drug use is a serious problem which has not been solved by prohibition and law enforcement
A December 2023 report into drug-related deaths at Australian music festivals reveals the seriousness of the problem. The report shows that in the twenty-year period between July 2000 and December 2021 there were 64 deaths. Drug toxicity was the primary cause, and the most-involved drug was ecstasy (MDMA). 73 percent of those who died were male and most of those who died were in their early twenties. The report concluded by stressing the need for pill testing and drug education. It stated, 'The findings suggest that drug-related deaths at music festivals in Australia typically involve young people using multiple illicit substances in combination with alcohol. Most are unintentional and could potentially be prevented through the implementation of a range of harm reduction strategies, including mobile medical care, drug checking services, and increased consumer education and awareness.'
Recent events have further highlighted the injuries and deaths occurring due to drugtaking at music festivals despite substantial police blitzes at these events.
On October 1, 2023, it was reported that two men died, and ten other people were taken to hospital after attending Sydney music festivals over the preceding weekend. The deaths prompted calls for more harm reduction strategies, including the adoption of pill testing. New South Wales Greens MP, Cate Faerhmann, and drug support advocates claimed that there is now enough evidence to show pill testing reduces harm. Faerhmann stated, 'It's incredibly frustrating that governments don't seem to act unless there's a crisis but then all they've done after the crisis is commission reports and then not act on the recommendations...We can't stop people taking drugs at music festivals, so let's focus on making everyone safer.' On January 2, 2024, there was a report of further hospitalisations, with four people being taken for treatment over drug-related issues after a Sydney dance held across the 2023 New Year's Eve weekend. On January 7, 2024, it was reported that eight people were in induced comas and another under hospital care following suspected drug overdoses at the Hardmission festival in Melbourne. Danny Hill of the Victorian Ambulance union stated, 'I think this highlights the dangers of some of the drugs that are passed around at rave parties and why there needs to be mechanisms to try and protect against them - it raises the issue of pill testing and pill checking.' Some critics have argued that a law-enforcement approach to preventing drugtaking at music festivals may make the problem worse. It has been claimed that facing the risk of detection, some young people panic and ingest drugs which they were trying to hide or carry for others. Such behaviour increases the risk of overdosing or mixing potentially fatal combinations of drugs.
Numerous authorities have argued that a prohibition and law enforcement approach to drug taking in Australia has clearly not solved the problem. These authorities have called for a different approach involving more harm minimization, where Australia recognises that some of its population will always take dangerous drugs recreationally and works to reduce the risk to life and health this behaviour causes. Pill testing and drug education are part of this harm minimization strategy.
A report released in 2015 has demonstrated the failure of drug prohibition and the need for drug law reform in Australia. The report was written by Dr Alex Wodak, a physician who was Director of the Alcohol and Drug Service at St. Vincent's Hospital, Sydney, for thirty years, from 1982 to 2012. Dr Wodak is currently President of the Australian Drug Law Reform Foundation and was President of the International Harm Reduction Association from 1996 to 2004.
In the 2015 report Dr Wodak claims, 'During the last 50 years, the drug market in Australia and other countries has continued to expand and become more dangerous. The production and consumption of drugs, the number of drug types and the hazardousness of drugs available have all increased. Prices fell, purity often increased, and an overwhelming majority of drug users continued to report that obtaining illicit drugs was 'easy' or 'very easy'. Although the aim of our drug laws was to protect the health and well-being of Australians, deaths, disease, property crime, violence and corruption have increased. For example, the rate of heroin overdose deaths in Australia increased 55-fold between 1964 and 1997.' Supporters of a harm minimization approach argue that it has been more successful and should either replace a prohibition and law enforcement approach or be used in conjunction with it. Dr Wodak has stressed the comparative success of a harm minimization strategy. In his 2015 report, Dr Wodak focused on the success of harm minimization when applied to heroin use in Australia. He stated, 'In contrast to the poor record of criminal justice measures, health and social interventions have often had impressive results. Harm reduction measures such as needle and syringe programs, strenuously opposed initially, averted the spread of HIV among and from people who inject drugs, thereby protecting the community. $1 spent on needle and syringe programs saved an estimated $4 of healthcare costs and $27 overall, while $1 spent on methadone treatment saved an estimated $7.6 The incidence of hepatitis C has declined substantially in Australia in recent years following expansion and improvement of the needle and syringe and drug treatment systems.'
2. Pill testing services reduce the risk of drug users taking adulterated or too-potent drugs
Studies have shown that the pill adulteration and potency warnings that pill testing services provide have led many potential drug users to discard the products they were going to take. Supporters of pill testing claim that this will have protected the health and possibly saved the lives of these drug users.
The selling of falsely labelled illicit drugs is a significant problem, with users potentially consuming dangerous drug combinations or drugs at higher levels of potency than they believed. Recent pill testing trials at the Groovin the Moo Festival in Canberra and a United Kingdom festival found that 20-43 percent of drugs tested were not what festival attendees believed they had purchased, placing them at risk of consuming contaminated or mislabeled products.
Similar results have occurred in North America. A Canadian survey of samples of illegal drugs tested between April 2018 and August 2019 found that 13 percent of opioid-containing samples contained at least one other psychoactive substance. The same survey found that 11 percent of methamphetamine-containing samples contained additional psychoactive substances. Overseas testing has also revealed that in addition to containing other active adulterants, some illegally purchased drugs contained none of the substance the purchaser believed s/he had bought. Of the drugs tested at a British Columbia festival in 2018, 11 percent of the supposed ecstasy samples submitted for testing contained no MDMA. Of the cocaine samples submitted for testing 8 percent contained none of the expected drug. The widespread misrepresentation of illegally sold drugs has led many spokespeople to call for the general introduction of pill testing.Some of the adulterants being used are known to be lethal. In 2007, a 20-year-old Sydney dance teacher died after dropping two caps of what she believed to be MDMA but which, unknown to her, contained the adulterant para-Methoxyamphetamine, or PMA. In 2017, three people at Melbourne's Revolver nightclub were killed by what was initially described as 'a bad batch of MDMA', but which was later revealed to be 'a cocktail of illicit substances' - including a lethal strain of the powerful hallucinogen N-benzyl Methoxy, or NBOMe.
Numerous studies have shown that when warned that the drugs they had purchased were falsely labeled or mixed with other substances many buyers would often discard their purchase. A study published in the United Kingdom in December 2018 found that 20 percent of users disposed of substances when a drug testing service revealed them to be other than what the buyer had intended to purchase. Australian data from the same period shows a similar pattern among Australians who used illicit recreational drugs. The pilot pill testing service, set up at the Canberra Groovin' the Moo music festival in April 2018, found that 35 percent of patrons who had their drug tested indicated that they would change their behaviour as a result (including 18 percent who indicated they would not consume the drug, and 12 percent who would consume less).
The 2019 pill testing trial at Moovin the Groove was even more successful, with everyone who was told their pills contained other substances, safely discarding their drugs. The results of the first fixed-site pill testing centre set up in Canberra showed that in December 2022, after six months of operation, 10 percent of drugs were immediately discarded. The data does not indicate how many of the remaining 90 percent had been found not to be contaminated or to be the product the purchaser believed it to be. After a year of operation, the discard rate was higher with 33 percent reporting they would not use the drug when testing showed it did not meet their expectations. There is also data to suggest that as drug using populations become more informed, their readiness to discard suspect substances may increase. A 2019 survey of 719 regular participants in the Berlin party scene found that if a test revealed the sample to contain a high amount of active ingredient, 91 percent of those surveyed indicated they would take less of the substance than usual. Two-thirds (66 percent) said they would discard the sample if it contained an unexpected/unwanted agent along with the intended substance. If the sample contained only unexpected/unwanted substances and not the intended substance at all, 93 percent stated they would throw it away. Those conducting the survey concluded drug checking or pill testing as a harm reduction tool was highly accepted in the scene, and most participants stated they would align their consumption behaviour to accord with test results.
3. Pill-testing services do not suggest that drugs are safe
Supporters of pill testing argue that education is at the centre of the service. They claim that the purpose of pill testing is to change drug takers behaviour, up to and including to discourage them from taking any drug at all, by explaining the risks associated with drugtaking. Those who have established and continue to run pill testing services claim that they never suggest that any drug is safe and actively discourage those who visit them from thinking this.
The whole focus of the pill testing process is to warn and explain. David Caldicott is the Clinical Lead for Pill Testing Australia and for CanTEST (the group which manages the administration of pill testing in the Australian Capital Territory). Dr Caldicott notes that when clients visit a Canberra pill-testing service, they are first spoken to by the post-doctoral chemist who will conduct the test. The chemist will explain how the drug is manufactured. Caldicott has noted, '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.' The test results are then passed on to a doctor who explains to the festivalgoer what medical issues could arise from taking the substance. Caldicott, who, as a doctor, has often performed this role, notes 'That will be my opportunity ... to say to the punter, "that's not great then is it?" ... So it may be that they take less of it, or they abandon it.' Dr Caldicott claims research from Europe shows that after drug testing, many people did something other than consume their whole pill.
After festivalgoers have spoken to the chemist and the doctor, and before they decide whether they want to keep their pill, they will speak to a harm reduction worker. Jessica Murray, from peer-led harm reduction organisation DanceWize, is a harm reduction worker. Murray states, 'The job of harm reduction workers is 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." Murray has noted that 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. Murray states, '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.' Gino Vumbaca, the president of Harm Reduction Australia, has summed up the whole process, '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.'
An additional part of the process is that the drug user is required to sign a waiver. This is intended to free the pill testing service of legal liability should the drug taker suffer injury or death because of consuming the drug that is tested. However, it is a further guarantee that the drug taker is aware that the substance s/he consumes is not safe. The drug user signs a document which explicitly states that s/he was not advised that the substance being tested is safe.
Pill testing services are intended to function as sources of education and information for drug users, helping them to make the best and safest decisions possible. ANU Associate Professor Anna Olsen, who led an evaluation of CanTest's first six months of operation, stated, 'CanTEST provides critical information about drug contents to service users and the wider community. The evaluation shows that 70 per cent of users had never discussed their drug use with a health professional before visiting CanTEST. The service is reaching a unique group of people who use drugs.' Professor Olsen's review noted other ways in which CanTEST sought to promote the safety of drug users. The evaluation noted that CanTEST delivered more than 1,000 health interventions to service users in the first six months of operation, including harm reduction, overdose prevention, mental health counselling and other general health advice.
4. Pill testing services have not led to an increase in drugtaking
Defenders of pill testing services argue that they do not lead to an increase in the consumption of illicit drugs by encouraging their use.
Public health and addiction and drug use specialists argue that no studies have linked pill testing to promoting and increasing drug use. Dr David Caldicott, the Clinical Lead for Pill Testing Australia and Professor Alison Ritter, Director of the Drug Policy Modelling Program at the University of New South Wales claim that there is no research or evidence to support the view that pill testing increases drug use. Both say pill testing is about targeting people who already have the intention of consuming illicit substances and helping to reduce their risk. The Alcohol and Drug Foundation has also stated its support for this view and states that 'drug checking does not promote illicit drug taking, and people who choose to get their substances tested have already purchased them with the intention to use them'.
Alison Ritter additionally stated, 'There is no evidence showing increased use of drugs with the presence of pill testing, and strong evidence of reduced consumption in association with pill testing.' Finally, researchers and academics at the University of Technology Sydney's Centre for Forensic Science have all endorsed the claim, 'There's...no evidence to suggest that pill testing leads to a higher prevalence of drug use. The opposite is actually true - educating young people about the potential dangers of certain drugs makes them less inclined to take them.' Overseas studies have also demonstrated that pill testing services do not lead to increased illicit drug taking. A 2011 study in Zurich Switzerland examined the effects of drug checking, a practice usually referred to in Australia as pill testing. Streetwork, the youth advisory service of the city of Zurich, has provided onsite and stationary Drug Checking facilities since 2001 and 2006, respectively. The 2011 study used surveys completed by over 7,000 participants to determine the impact that drug testing had on their behaviour, including their readiness to begin drugtaking and to increase their drug use. The study concluded, 'The results indicate that a Drug Checking service combined with a consultation session does not, as some would claim, encourage consumption. As shown, there was no increase either in the frequency of consumption of most party drugs or in polydrug use over the years.' The authors of the study noted that the benefits resulting from drug testing combined with the absence of negative consequences should encourage setting up more drug testing facilities. They stated, 'The knowledge developed within the present evaluation will hopefully encourage other party metropolises [cities] to create new and improved services or to redefine existing services based on a realistic and acceptance-based drug prevention approach embedded within an overall local concept.'
Recent Australian research has also indicated that pill testing does not result in increased drug use. A 2021 study, led by Edith Cowan researcher Sherri Murphy, surveyed the behaviour of 247 people attending a Western Australian music festival. The survey results indicated that access to pill testing did not increase the likelihood that those questioned would either increase their drug use or begin using drugs. Murphy stated, 'My results indicate that for both ecstasy-naïve and ecstasy-initiated individuals, a pill testing service is unlikely to increase an individual's intention to use ecstasy.
It has been argued that rather than harm minimization approaches, such as pill testing, increasing drug use and deaths, the reverse may be the case. Critics of Australia's prohibitionist approach argue that it has allowed recreational drug use to boom. Ugur Nedim and Zeb Holmes, writing for Sydney Criminal Lawyers, have stated, 'According to the 2014 UN World Drugs Report, Australians have the highest rate of MDMA ('ecstasy') consumption in the world despite our 'zero tolerance' approach to illicit drug use. In 2015, it was reported that 8 percent of Australians aged 20 to 29 had used ecstasy in the preceding 12 months.'
5. Pill testing services alert authorities to new trends in drug supply, distribution, and use
Supporters of pill testing argue that the results obtained from sample testing indicate the type of illicit drugs being supplied and used in Australia. This is valuable information which can be given to health authorities to enable them to treat people suffering the adverse effects of a particular drug or drug combination. The same information can also be supplied to police and customs to assist in their work detecting drug smugglers and local manufacturers. Advocates argue that pill testing can monitor drug markets for new or particularly dangerous substances and contribute to an early warning system for dangerous substances.
In 2015, Dr Andrew Groves, a lecturer in Criminology in Deakin's School of Humanities and Social Sciences, explained the importance of identifying and tracking drug use. Grove noted that monitoring systems could warn of changes in the drug market, identifying the drugs in use by which social groups. This information is important to health authorities trying to assist users and it is important to police trying to locate drug suppliers. In Australia this monitoring is done through the Ecstasy and Related Drugs Reporting System (EDRS), which compares interviews with drug users and key professionals to map trends in drug use, price, purity, and availability.
This data is used primarily by health care providers. Information used by law enforcement officers typically comes from the Illicit Drug Reporting System (IDRS); however, the two systems contain the same data from the same sources. Drug users are most frequently interviewed through police or support services such as medical centres and doctors. The EDRS finds it difficult to monitor users of 'party drugs' such as ecstasy. Party drug users are a diverse group of consumers, many of whom are educated, socially and economically stable and rarely interact with criminal justice, treatment, or support services. They often regard themselves as only 'occasional' users and are outside the usual data collection pools. Pill testing allows for the substances being taken by party drug users to be tested at the sites where they are being used. Supporters of pill testing argue that it can be particularly valuable in alerting authorities when new drugs enter the country or arrive within a particular location. It can also warn authorities when a dangerously potent or contaminated drug is circulating within a particular region. Dr Groves has stated, 'On-site testing has the capacity to act as an early warning system to identify the emergence of new drugs more quickly than retrospective analysis such as waste-water testing.'
The value of pill testing as an early warning system was demonstrated on December 31, 2022, when the ACT government released a 'red alert' over a drug detected through Canberra's fixed-site pill testing centre. The pills had been falsely sold as oxycodone. In fact, they contained metonitazine, a potentially lethal synthetic opioid linked to fatal drug overdoses in New Zealand and the United States. The counterfeit pills were detected after they were submitted for testing at the free pill testing service CanTEST. Stephanie Stephens, acting head of Directions Health Services, said it is positive that the substance was detected before it caused any deaths from being ingested. Stephens noted that this detection indicated another important service that pill testing centres could provide and warned there will need to be careful monitoring in all jurisdictions in Australia, particularly with the party and music festival season upon us when unmarked tablets could be in higher circulation. Dr David Caldicott, the Clinical Lead for Pill Testing Australia, has also stressed the value of the monitoring system that pill testing can help to provide. Dr Caldicott has stated, 'The combination of onsite testing, fixed site testing and monitoring provides the greatest coverage of drug intelligence, much in the same way that different levels of flu-tracking allow us the best analysis of what lies in store and is circulating. [Different levels of pill-testing] allow services to detect and issue warnings about harmful substances that are circulating. The United States Center for Disease Control (CDC) has recommended drug checking as a way of monitoring the fentanyl crisis in that country. Any future CDC in Australia should strongly consider incorporating such surveillance in its remit.'