MDMA has a reputation as a culprit in overdoses and harmful drug use. This is because MDMA is too often conflated with ecstasy, the street name for a drug which may contain MDMA but which may also contain a number of other unknown substances, making it far more harmful. As we have seen in this article series, the actual chemical compound MDMA has a long history and sections of the medical and recreational drug-using communities are very familiar with its effects. On the other hand, it is difficult to predict the effects ecstasy will have on an individual, given that a substance sold as ecstasy could contain any number of unknown substances.
However, people continue to use this "street" ecstasy, regardless of the opinions of their parents, governments and the media. It is time for policymakers to admit that no amount of punitive enforcement will stop people taking ecstasy and that, regardless of their opinions on the morality of using drugs, the most important thing is to ensure the safety of individuals and the community.
This is where pill testing comes in. It is one component of an overall harm reduction strategy, and has plenty of high profile support . Evidence from Europe shows that pill testing has saved lives , and has influenced people who use drugs to make safer choices regarding their use .
As manufacture and distribution of ecstasy is strictly prohibited, its production is clandestine and unregulated. This means there is no control over how the pills are made, and what goes into them. At present, most pills and capsules marketed as MDMA often contain other chemicals, and may not even contain MDMA at all . Some of these chemicals, such as PMA and PCP, are highly toxic and can cause dangerous side effects when ingested.
There is no way of telling what is in an ecstasy tablet or capsule just by looking at it. The problem with consuming pills marketed as MDMA is that it is a gamble - any number of unknown chemicals may be contained within the pill, causing other side effects not documented amongst the common side effects of MDMA consumption . The prohibition of ecstasy and the lack of regulation over how it is manufactured puts users at greater risk of harm .
In Australia, recent festival deaths have highlighted the consequences of risky drug use. Australians have the highest rate of ecstasy consumption on Earth , and Australian ecstasy is arguably the most harmful. Our ecstasy is the highest in unknown ingredients including PMA/PMMA, a highly toxic compound linked to a number of deaths in Australia and overseas. One study found that out of a selection of countries, PMA was most frequently observed in Australian ecstasy . Ecstasy is the second most commonly used illicit drug in Australia after cannabis, with most recent figures putting the proportion of those who have ever used the drug at 10.9% .
Given these facts, it is negligent that Australia hasn’t taken better steps to prevent the consumption of potentially harmful, unknown chemicals. Current law enforcement measures already fail to prevent people consuming drugs, and without pill testing there is no way lawmakers can determine what people are consuming. Arresting a handful of people and repeating the message that drugs are bad will not stop the manufacture of adulterated pills, and it won’t save lives.
While prohibition remains the status quo, users and distributors of ecstasy will be criminalised under the guise of government concern for the health risks to individuals. However, there is widespread agreement amongst legal scholars that Australian drug laws were not made out of concern for the documented health risks .
Rather, a combination of factors can be attributed to our current drug policy, including cultural and social fears, economics, and politics. The prohibition of MDMA in Australia was influenced largely by international attitudes to ecstasy  - specifically, ecstasy-related moral panics in the United States and United Kingdom.
While the risks associated with ecstasy are very real, these moral panics, born out of the intense media coverage of several high profile ecstasy-related overdoses, failed to distinguish between the effects of ecstasy and MDMA, as well as the external factors that can influence an overdose more than the drug itself . The prioritisation of criminalising ecstasy use over a harm reduction approach reflects the desire of governments to maintain a ‘tough on crime’ approach, and leaves little room for discourse on how all drug use can be made less harmful for young people.
There are concerns across the population about the spate of deaths at festivals and electronic music parties in Australia in recent years, believed to be related to ecstasy use [13,14,15]. These concerns are held by both older and younger generations, as well as governments and lawmakers.
Considering five people died of suspected drug-related overdoses at festivals in 2016, in an environment that should be more about enjoyment rather than life-threatening risk, these concerns are well-founded. However, the debate over how to solve the issue of risky drug use is constantly overshadowed by ideological morality.
There is no question that pill testing works. A significant body of evidence from Europe demonstrates pill testing is an effective harm reduction strategy, and many European music events see long queues at drug checking stations . As many as half of European festivalgoers who get their drugs checked say they would dispose of a substance if it wasn’t what they thought it was.
According to studies in Austria, a third of people decide not to take a substance after having it checked . This further proves that pill testing does not result in increased drug use.
One Swiss study found that a pill-testing service is often the first contact with social support systems for many users, and that by offering such a service, it is easier to motivate individuals to participate in a consultation about informed drug use . The study also found that, contrary to the usual claims from critics, pill-testing services did not result in an increase in the frequency of most party drugs, and that the information offered by these services even resulted in restricted consumption amongst ecstasy users.
In Australia, pill testing has the support of health experts, academics, sections of law enforcement, and various politicians [19,20,21]. Far from promoting drug use, a pill testing program here would not instruct a potential drug user that their substance is “safe” or “unsafe”, rather, it would give the individual more information about the nature of the substance, so that they may then make an informed decision about whether or not to consume it.
As for young people, research shows they care strongly about their welfare and safety. A 2013 survey of 2,300 young Australians by the Australian National Council on Drugs found more than 82% support the introduction of pill testing as a harm reduction initiative . This is evidence that young people are aware of the dangers presented by illicit drug consumption and want to make more informed choices about the drugs they take.
The war on drugs has done nothing to quell the demand and supply of illicit drugs. Instead, it has pushed drug manufacture and trade underground, and contributed to the increase in use of emerging psychoactive substances as people look for cheaper, legal alternatives . If nothing else, this shows that individuals’ desire to use drugs will not be stifled by prohibitive laws, yet such laws create a riskier environment for drug use.
Pure MDMA has far fewer documented adverse health effects than legal drugs such as alcohol and tobacco . However, the manufacture and consumption of ecstasy continues unregulated, with a higher chance that users will get an impure product cut with unknown, potentially much more harmful chemicals.
In Australia, ecstasy remains the second most commonly used drug. Recreational drug use will never be without risk, and there will always be sections of society with a moral stance against drugs who will continue to campaign in favour of prohibition. This, however, is largely irrelevant when it comes to ensuring the health and welfare of young people.
Pill testing is an effective preventative measure, helping to curb the consumption of harmful chemicals and encouraging young people to take control of their activities and make informed decisions.
Pill testing should be implemented in Australia because it works, and because harm reduction should always be the number one priority in preventing the adverse consequences of drug use.
Even if it only saved ONE life, who can argue with saving just one life?