Pill testing: the facts

Following a number of recent drug-related deaths at music festivals across Australia, pill testing has again become a hot topic across media outlets. But how does pill testing work, and does it really encourage drug use? UQ’s Dr Cheneal Puljević, Dr Ellen Leslie and Associate Professor Jason Ferris provide a brief overview of the available evidence.

What is pill testing?

Pill testing, also known as drug checking, involves the chemical analysis of illicit or unknown substances, to inform the owner of the contents of the pill. European countries such as the Netherlands and the UK have been providing pill testing facilities to the community or at festivals for years. In 2018, Australia held its first pill testing trial at the Groovin’ the Moo Festival in Canberra.

How does it work at festivals?

When a patron first enters a pill testing area, they meet with a trained harm reduction worker who explains the process. At the outset, patrons are informed that there is no safe level of drug use. Patrons then provide a sample of their substance – a thin scraping of a pill or sample of powder is enough – and a trained chemist analyses the sample, usually with an FTIR spectrometer, a device used to identify legal and illegal substances using a huge database of substances measured by labs around the world.

The chemist labels the substance as one of three classifications –the substance is what the person expected; the substance is different to what the person expected; or the substance contains a dangerous or undocumented substance. An example would be discovering the inclusion of fentanyl, a synthetic opioid 50 times more potent by weight than heroin, and often associated with overdose deaths.

After testing, a trained medical practitioner or harm reduction worker sits down for a private conversation with the patron. They discuss the potential dangers of using the substance and how to reduce their risk (e.g. not taking the substance or adjusting the dose). The patron can also be informed of appropriate health or drug services they can access.

The facts

Ultimately, pill testing allows people to make an informed decision about their drug use, which is often very difficult considering the unregulated nature of illicit drug production.

Recent pill testing trials at the Groovin’ the Moo Festival in Canberra and a UK festival found that 20-43 per cent of drugs tested were not what festival attendees believed they had purchased, placing them at risk of consuming contaminated or mislabelled drugs.

Pill testing also provides a crucial opportunity for health and harm reduction services to connect with people who use recreational drugs –one of the core objectives of pill testing. People who use recreational drugs are typically a difficult-to-reach group, as they often have little contact with health or drug services and are understandably tight-lipped about their drug use due to its illegal nature. However, it’s estimated that the UK trial reached one in five drug users at the festival.

After pill testing, people may choose to dispose of their drugs through safe disposal methods offered by pill testing facilities, or to modify their use to reduce the risk of harm. In the UK trial, two-thirds of patrons whose sample was not what they thought they were disposed of further substances.

At Groovin’ the Moo’s pill testing trial in Canberra, 18 per cent of patrons decided not to use illicit drugs at the festival, while 12 per cent said they would use less of that drug.

Information gained from pill testing can also have an impact beyond the individuals who use the service. It can be used to inform early warning systems and drug market monitoring and assist emergency service provision (as evidenced by The Loop UK and Trimbos instituut). Information and warnings can also be communicated to the wider population of people who use drugs through announcements or texts sent by the festival and relevant health services, posts on drug-specific websites (e.g. pillreports.net), and through word-of-mouth. For example, at the Groovin’ the Moo trial, 90 per cent of people who used the service and knew others using the same drug reported they would share their test results.

Does pill testing encourage drug use?

No. All patrons are told, at least once, that the safest thing to do is to not take drugs. Pill testing provides a unique opportunity for harm reduction workers to inform patrons about the risks of the drug and what to do in the event of experiencing an adverse reaction. Whether we like it or not, people use drugs. In 2016, 43 per cent of Australians aged 14 and older said they had used an illicit drug at some point in their lifetime. A comparison of countries with and without pill testing services indicated no evidence of an increase in rates of drug use or mortality in countries with these services.

Ultimately, while not taking drugs is always the safest option, pill testing is a pragmatic approach that provides a unique opportunity to reduce the risks of potentially inevitable drug use. As explained by Director of the Drug Policy Modelling Program at the University of New South Wales Professor Alison Ritter – an expert in drug policy, encouraging young people not to do drugs is not mutually exclusive from offering pill testing – we can do both things at once.

Dr Cheneal Puljević is a Research Fellow in the area of substance use harm reduction at the Centre for Health Services Research at The University of Queensland.

Dr Ellen Leslie is a lecturer in alcohol, tobacco, and other drug use at the School of Public Health at The University of Queensland.

Associate Professor Jason Ferris is an expert on drug epidemiology from the Centre for Health Services Research at The University of Queensland.

The Loop Australia and Pill Testing Australia are not-for-profit organisations aiming to develop the sustainable provision of drug checking services in Australia.

We acknowledge Rebecca Lang from QNADA and Cameron Francis from The Loop Australia for their comments on this post.

People who support pill testing are encouraged by the authors of this blog to fill out this e-petition lodged with the Queensland Parliament.