A spate of deaths across Australia has renewed calls for a move away from the current punitive approach to drug taking towards policies of harm-minimisation. Jake Kendall reports.

Following an investigation into a cluster of five drug-related deaths in Melbourne, a coroner has recommended the Victoria government implements an illicit drug-checking service as “a matter of urgency”. Delivering her findings, Paresa Spanos said: “If we accept there are unlikely to be any major changes to drug regulation in the foreseeable future, or any changes in an individual’s preparedness to use illicit drugs, Victorians will continue to be exposed to the risks of unregulated drug markets.”

She added: “The evidence available to me supports a finding that there is broad support for a drug-checking service and drug early warning network as evidence-based interventions — at least among those with knowledge and expertise in harm minimisation.”

A similar call for drug checking was made by a NSW coroner in 2019 after an inquest into the deaths of six young people at music festivals over two summers. Back then, deputy state coroner Harriet Grahame described the evidence to support pill testing as “compelling”. “Drug checking,” she said, “is simply a harm-reduction strategy that should be trialled as soon as possible in NSW.”

Public health experts agree. “The evidence presently available is sufficient to justify the careful introduction of pill testing around Australia,” said Paul Komesaroff, professor of medicine at Monash University. “Specifically, the availability of facilities to allow young people at venues or events where drug taking is acknowledged to be likely, to seek advice about the substances they’re considering ingesting.”

Quite clearly, a different approach to drug taking needs to be explored. High-visibility and punitive policing operations — such as random searches and sniffer dogs — are not only ineffectual and a waste of resources, but counterproductive. A heavy police presence at a festival, for instance, often precipitates panic ingestion and dangerous preloading, increasing the risk of illness or death.

“The reality is,” said Miki McLay, a teaching associate at Monash University’s department of criminology, “regardless of the efforts of law enforcement, there continues to be a significant market for illegal drugs in Australia. The primary risks associated with use of party drugs are related to their illegality.”

The unregulated nature of the drug market in Australia means anything goes when it comes to drug production. “People manufacturing drugs such as ecstasy pills will sometimes cut pills with other substances or substitute other more dangerous drugs entirely,” said McLay.

As well, MDMA and other drugs are becoming ever more potent, presenting risks to users in terms of overdosing. “People are often unaware of the health risks involved in consuming MDMA and other illicit drugs,” said McLay. “Drug checking provides us with a unique opportunity to respond to the risks effectively.”

So how would a drug-checking service work at a music festival, say? Well, using overseas models as examples, a typical drug-checking centre would comprise a mobile lab, a sampling area, and a counselling area. After submitting a sample for testing, users would receive unbiased health information and offered access to a range of services. Once the drug sample has been analysed, the festivalgoer will be told of the risks of consuming the substances identified.

Anonymised information about the sample is then usually shared with other consumers, emergency departments and law enforcement. Results from analyses are also retained by researchers for the monitoring of trends in the illicit drug market and used to contribute to scientific research, policymaking, policing, and emergency healthcare.

A common criticism of drug-checking services is that they promote drug use. It’s a view McLay firmly rejects. “Evidence would suggest that people don’t end up consuming more illicit substances as a result of a drug-checking service. Drug-checking services effectively encourage people who use illicit drugs to modify their behaviours in ways that reduce the risks of harm to their health.”

Detractors of the scheme also say that drug checking would imply that taking illicit drugs is safe. Again, McLay strongly disagrees. “Every drug-checking service out there operates on a harm-reduction basis. Even with precise testing,” said McLay, “service staff never tell users that what they are taking is safe. Because with all drugs the level of risk depends a lot on the characteristics of the person and the environment. Services provide information on contents, the risks involved, and how to reduce them.”

It appears sceptics of the scheme are at odds with most Australians, two-thirds of whom are in favour of pill testing at music festivals. About 63 percent of respondents to a survey conducted by the Australian National University agreed that pill testing should be employed at festivals, including 33 percent who strongly agreed. While the findings clearly show majority support for drug checking, the idea has largely been dismissed by politicians across the country — despite high-profile cases of deaths at music festivals.

NSW premier Gladys Berejiklian, for example, has consistently argued that drug checking sends the “wrong message” to young people and would give them “a false sense of security”. She instead thinks people should “just say no” to drugs altogether.

However, that campaign sailed and failed a long time ago. Indeed, 2019 data from the National Drug Strategy Household Survey shows drug usage rates in Australia the highest they’ve been in almost 20 years — particularly among people in their 20s and 30s.

Berejiklian’s opposition to pill testing goes against the implicit advice of the commissioner who led the state’s ice inquiry. Professor Howard delivered a four-volume report containing 104 recommendations to the government in January last year. The government immediately ruled out five key recommendations, including operating more supervised injecting centres, relinquishing sniffer dogs, and implementing pill testing. “Courage in relation to drug policy reform I think is very weak,” said Howard. “This is a once-in-a-generation opportunity to get this right, and I think we’re blowing it, frankly.”

So far, only the ACT has introduced a pill-testing policy, the aim of which is “to provide guidelines for event organisers to incorporate pill testing and other harm-reduction measures into event planning to promote patron health and safety”. While keen to demonstrate its commitment to the National Drug Strategy, the ACT government considers pill testing to be “a sensible approach to limiting the dangers of illicit drug use at ACT events”.

The move to implement a pill-testing policy came after an independent review confirmed a trial in Canberra encouraged users to discard unsafe drugs. An evaluation of pill testing at Groovin the Moo in April 2019 declared the trial of 234 festivalgoers a success because “all those who had a very dangerous substance detected disposed of that drug in the amnesty bin”. These included seven people whose pills were found to contain a highly toxic chemical associated with deaths in the US and New Zealand. “When a patron was told that their drug was not what they expected it to be, they were less likely to take that drug,” concluded the report.

The report’s lead researcher, Anna Olsen, said the fact the pill-testing service led to harm reduction behaviours was a key marker of a favourable outcome. “For people who went on to take the drug they had tested, we found evidence for risk-reducing behaviours such as taking less of the drug, spacing out their drug consumption and taking other safety precautions like drinking lots of water,” she said.

The ACT health and youth minister, Rachel Stephen-Smith, has urged other governments to seriously consider implementing a similar drug-checking service. “Across the country we have seen too many avoidable deaths. It is obvious current processes and policies are not working and more needs to be done.”

The Melbourne deaths are a tragic example of that. Thinking they were taking MDMA or magic mushrooms, the five young men who died had unknowingly consumed a combination of highly potent psychoactive substances: 25C-NBOMe and 4-Fluroamphetamine (4-FA). Monica Barratt — a senior research fellow at RMIT University — was an expert witness at the coronial inquest into their deaths. “I argued if the deceased had known the drugs contained 25C-NBOMe combined with 4-FA, it’s reasonable to presume they either wouldn’t have taken them or may have avoided snorting them in favour of a less risky route, such as swallowing.”

Barratt believes that — “in the current context of drug prohibition” — drug checking is “the most promising pathway to reduce harm among people who use drugs” in Australia. However, added Barratt: “It’s important to acknowledge that if we had a legalised and regulated supply of MDMA, we wouldn’t need to analyse samples to work out what’s in them.”

• Source material by Miki McLay