Pill testing as a harm reduction strategy

March 13, 2017 The Noffs Team Comments

- Updated 1 February 2019.

Harm reduction measures aim to reduce the risks associated with illicit drugs and create a more informed environment surrounding drug consumption, ultimately improving the welfare of the community. Whilst we do not see any one, single, harm reduction measure as the holy grail, regulating certain measures such as pill testing programs would give users more information, and may lead to them deciding not to consume a potentially dangerous substance.

In this four-part series, we will examine the history of MDMA as a medical substance, the context in which it developed its negative reputation as a party drug and thus became illegal, and how testing can help counter some of the risks associated with consumption of illicit drugs.

The scientific approach

There is no way of knowing the contents of a pill or capsule simply by looking at it [1]. While various online drug forums such as Pill Report have compiled a database of pills and their contents based on anecdotal evidence, this is far from a foolproof strategy. A pill testing program can benefit recreational drug users by scientifically testing and revealing the contents of the substance they are intending to consume [2]. An individual can then make an informed decision as to whether or not they will use the drug. Pill testing programs have added benefit to societies and governments by obtaining precise information about the composition of the black market, monitoring trends and patterns in drug use, and identifying which demographics use these substances and who is at risk [3].

What pill testing can solve

Pill testing is a step towards regulation as it can actually have an effect on the black market. Products found to contain dangerous substances via pill testing can become the subject of warning campaigns, leading to their removal from the market [4]. If governments endorse a pill testing program in their jurisdiction, that would allow them to have a measure of control and regulation over the illicit drug market, which is extremely difficult under prohibition [5].

Policies of prohibition have proven to be ineffective in reducing drug-related harms, and are causing negative interactions between young people and the police [6]. Meanwhile, international evidence suggests pill testing services are having a positive effect in educating young people about harm reduction [7]. Considering Australia ranked highest for adulterated, and more ‘dangerous’ ecstasy pills [8], it must follow that Australian recreational drug users would have an increased risk of experiencing adverse reactions, including effects of drug toxicity, hospitalisation and death. A string of deaths at Australian music festivals over the past few years emphasises this [9], and highlights that extant policies of prohibition within Australian jurisdictions are not preventing these deaths. The increased presence of emerging psychoactive substances (EPS) is of great concern, as they often mimic the effects of drugs such as ecstasy and LSD yet do not contain chemicals associated with either drug [10]. The risks to public health presented by these drugs could be mitigated if they were able to be tested on the spot.

Traditional methods of controlling drug use come at a large cost to governments and the taxpayer. Amongst people aged 16-24, hospitalisations from ecstasy use have almost doubled in the period between 2010 and 2015, from 413 to 814 [11]. If pills are tested and discarded if found to be adulterated, drug-related hospitalisations would reduce, lives would be saved, and young people can be educated about safer drug use. Another comparison point is that of police drug dogs. Currently, Australians spend $1 million per jurisdiction to maintain drug dog programs [12], yet these programs have been found wanting. In 2014, there were 14,869 searches across NSW as a result of a drug dog indicating the presence of illicit substances on a person. Three quarters of those searches, or 11,043, turned up no drugs [13]. This is a waste of time and resources. A pill testing program is less than one tenth of this cost [14] and, as this article outlines, has had a positive impact where it has been introduced.

From a research perspective, pill testing can provide invaluable information about the emergence and decline of certain substances present on the drug scene [15]. This is important, particularly given the increase in new, untested psychoactive substances such as synthetic forms of MDMA, cannabis and LSD, which are marketed to mimic the effects of mainstream drugs but whose effects are unknown and could be far more dangerous, as they are packaged and sold with no indication of their contents [16]. Data from pill testing can contribute to an enhanced monitoring of these substances, and increase the effectiveness of governments’ response by providing them with accurate knowledge from which to create warning campaigns around new, potentially lethal substances [17].

Pill testing does not condone drug use

Critics will say that pill testing sends the wrong message by deeming some illicit substances “safer” than others, and that harm reduction advocates should be focusing on prevention in the form of providing resources about the health risks associated with recreational drug use. However, advocates have repeatedly stressed that pill testing does not condone drug use, that the overarching aim is to reduce the negative impacts associated with drug use by creating awareness about drug effects and side effects, whilst recognising that people will take drugs regardless of the laws in place to criminalise them. Moreover, many young recreational drug users do not access traditional drug care services [18] making it hard to directly convey health risks to them. Pill testing programs tap into this demographic by establishing a direct presence within the context of drug use - festivals and clubs. Crucially, there is evidence to suggest that pill testing does not increase incidents of drug use, and may actually reduce it [19].

Towards a future of harm reduction

Harm reduction services such as drug checking do not inevitably lead to legalisation [20] and can exist alongside both the current prohibitive drug policies in Australia and any future amendments towards regulation. Pill testing is not the ultimate solution, rather one part of a harm reduction strategy. And it has shown to be effective. In Austria, one study showed 50% of those who had their drugs tested changed their consumption choices based on the results [21]. The ideal would be to have a number of harm reduction measures in place at a festival, including pill testing. Advocates would like to see pill testing as part of a routine approach to safety at festivals [22], and hope to achieve it as soon as possible. Another important aim of a legitimate pill testing service is having it work in collaboration with a multitude of other organisations, such as research institutes, hospitals and policymakers [23], to create stronger drug policies and safety strategies.

Given the inevitability that people will use drugs, regardless of their legal status, and that the responsibility of governments and police is to ensure the safety of the community, regulating drug use must go hand-in-hand with harm reduction. If Australian governments are serious about reducing the amount of drug-related deaths at festivals, they must support a proper exploration of harm reduction strategies. In the case of pill testing, a comprehensive trial to assess its benefits would allow society to make a fully informed decision about its merit.

[1] Project Know. Jagged Little Pill (Retrieved from here
[2] Hunt, M. 'Don't ban music festivals. Pill testing is the way to stop drug overdoses'. Sydney Morning Herald. 28 October 2015. (Retrieved from here
[3] EMCDDA. 2001. An inventory of on-site pill-testing interventions in the EU. (Retrieved from here)  
[4] Ritter, A. 'Six reasons Australia should pilot 'pill testing' party drugs. The Conversation. 12 November 2014. (Retrived from here
[5] NSW Bar Association. 2014. Drug Law Reform: Discussion Paper. (Retrieved from here)  
[6] Haylen, J. 'We need a drug summit because we're losing the war'. ABC News. 18 February 2016 (Retrieved from here
[7] Benschop et al. 2002. Pill Testing, Ecstasy & Prevention: A Scientific Evaluation of Three European Cities. (Retrieved from here)
[8] Ritter, A. 'Six reasons Australia should pilot 'pill testing' party drugs. The Conversation. 12 November 2014. (Retrived from here
[9] 'Six Dead, Countless Overdoses: Why Has Australia's Music Festival Culture Turned Deady?' Tone Deaf. 7 December 2015. (Retrieved from here
[10] Alcohol and Drug Foundation. 2 October 2018. New psychoactive substances. (Retrieved from here)
[11] Haylen, J. 'We need a drug summit because we're losing the war'. ABC News. 18 February 2016 (Retrieved from here
[12] Savulescu et al. 'We have a moral obligation to allow drug analysis at music festivals' The Conversation. 14 September 2016 (Retrieved from here
[13] Haylen, J. 'We need a drug summit because we're losing the war'. ABC News. 18 February 2016 (Retrieved from here)
[14] Savulescu et al. 'We have a moral obligation to allow drug analysis at music festivals' The Conversation. 14 September 2016 (Retrieved from here
[15] Long, C. 'Pill testing at festivals has hidden benefits that could reduce drug taking'. ABC News. 23 July 2018. (Retrieved from here)
[16] NDARC. Emerging Psychoactive Substances (EPS). (Retrieved from here)
[17] TEDI. 2011. Factsheet on Drug Checking in Europe. (Retrieved from here
[18] EMCDDA. 2001. An inventory of on-site pill-testing interventions in the EU. (Retrieved from here)  
[19] TEDI. 2011. Factsheet on Drug Checking in Europe. (Retrieved from here
[20] Ritter, A. 'Pill testing doesn't undermine the law, it supports it'. The Ethics Centre. 4 December 2015. (Retrieved from here
[21] EMCDDA. 2001. An inventory of on-site pill-testing interventions in the EU. (Retrieved from here)  
[22] Brown, A. 'Advocates call for pill testing at Spilt Milk music festival'. Canberra Times. 26 November 2016. (Retrieved from here
[23] TEDI. 2011. Factsheet on Drug Checking in Europe. (Retrieved from here
 

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