Two perspectives on pill testing

Does pill testing work or will it do more harm than good? We ask both forensic science and public health experts to give us their take on the debate. Their opinions may surprise.

The public health expert – Daniel Demant

In the first week of 2019, 115 people were hospitalised as a result of ecstasy use. Most of these were young people and as a result, many public health experts, including myself, have called for the introduction of pill testing to reduce harm, mortality, morbidity and to educate the public.

Pill testing is not a new concept. It was first introduced in the Netherlands in the early 1990s. Many other countries have followed suit, either introducing it as part of their national drug policies or by allowing non-for-profit organisations such as The Loop which is based in the UK, to offer such services in controlled environments. 

In NSW, Premier Gladys Bereijiklian and her government went full Helen Lovejoy in the debate, seemingly unable to resist The Simpsons’ character’s good old pity plea: “Won’t somebody please think of the children”. But such remarks serve only to divert the conversation about pill testing away from the evidence and push it into the realms of morality.

Testing helps ensure that pills with dangerous fillers are identified, and young people have increased knowledge of safer drug use and the consequences of drug use.

Daniel Demant
Lecturer, Public Health

Among politicians, particularly conservative ones, other common arguments are that pill testing provides a false sense of security and promotes drug use, leading to a higher prevalence of illegal drug use. Combining these claims could lead one to think that pill testing will create an entire generation of drug-infested zombie-like children.

These arguments are not new and were presented in every debate on drug use and harm minimisation over the past 30 years. If we look at needle exchange programs, for example, these were originally perceived as dangerous and promoting injecting drug use. Today, they’re well-established and heroin use has declined dramatically in most western countries, while the percentage of those engaging in safer forms of injecting drug use has increased. A similar story can be told about injecting drug rooms.

When it comes to the pill testing debate, it should be noted that almost all illicit drug users who died or were admitted to hospitals in the first week of 2019 were adults, not children as some might suggest. When I think about pill testing, I think about 20-something-year-olds at music festivals making sure their pills are safe and getting educated about drug use. I don’t think about pill testing in Sydney primary schools.

Furthermore, the evidence from countries with established pill testing programs such as the Netherlands, France and Germany is clear – it works. Testing helps ensure that pills with dangerous fillers are identified, and young people have increased knowledge of safer drug use and the consequences of drug use. In addition, the quality of drugs has improved with the introduction of testing. This is because the pressure on the black market has made drugs safer, even for those who didn’t use pill testing. There’s also 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.

Pill testing will not solve all our problems and will definitely not prevent people from taking drugs. But it does offer a new harm minimisation tool. In the end, we have to remember that public health authorities don’t have the right to tell people what to do. Our mission is to promote evidence-based harm minimisation strategies and provide information that enables people to make informed decisions about their own health behaviours. And pill testing is one of the ways to do this.

Daniel Demant is an epidemiologist and Lecturer of Public Health in UTS’s Faculty of Health.

The forensic science experts – Marie Morelato, Shanlin Fu, Claude Roux

Substance misuse is a significant health problem in Australia and the world. The widespread use of drugs in our society is, at its heart, a public health issue that has led to drug use disorders, incidents of HIV and overdose deaths. Both Australia and our global neighbours now face an additional wave of dangerous synthetic drugs – new psychoactive substances (NPS), 800 of which have  emerged in the illicit drug market in the past decade. More worryingly, the toxicological effects of these drugs are not widely known making them especially dangerous.

This is why the spate of recent deaths and hospitalisations of young people from illicit drug use at festivals in Australia has prompted debate around the introduction of pill testing.

Pill testing, both on-site and off-site, has been conducted in several European countries for a number of years and, on the whole, it’s resulted in better-informed users. While Australia is recognised for its harm minimisation approach to illicit drug use, it has failed to introduce pill testing.

Opponents to pill testing argue that it doesn’t guarantee the safety of the product or protect a person from potential harm and, as a result, consumers may feel a false sense of security. Critics also identify the technical limitations of testing, such as the lack of sensitivity of field-deployable instruments or the concern that not all minor pill ingredients can be detected.  

In general, on-site testing is less sensitive than lab testing. However, in recent years, available on-site testing technologies have advanced significantly. There are now a number of portable techniques that can identify the composition and dose of the pill and warn if unexpected compounds are present. These technologies have been successfully used in pill testing in many European countries such as the Netherlands, Austria, Switzerland, Portugal and Spain.  

Scientists at our Centre for Forensic Science have developed a number of sensitive and specific colour tests for rapid and accurate detection of novel synthetic drugs such as cathinones (sometimes marketed as ‘bath salts’) which have strong central nervous system stimulant effects, and NBOMe substances, a class of potent hallucinogens.

These tests have the potential to detect drug classes even if the exact chemical entities or structures of the drug are unknown; this is particularly advantageous as different novel synthetic drugs are constantly emerging and are difficult to detect even by laboratory-based methods.  

While testing does not make recreational drugs safer, it certainly helps mitigate some of the risks associated with it. We believe the benefits of pill testing outweigh the disadvantages.

Marie Morelato, Shanlin Fu, Claude Roux
School of Mathematical and Physical Sciences

Resources permitting, some sensitive and sophisticated testing techniques such as chromatography coupled with mass-spectrometry can also be set up on a mobile platform and used for pill testing.

While testing does not make recreational drugs safer, it certainly helps mitigate some of the risks associated with it. We believe the benefits of pill testing outweigh the disadvantages. In our opinion, the main value of pill testing is to not only inform users about the substance’s content but to also obtain a strategic overview of the substances that are being consumed at festivals. This then helps guide the preventive messages authorities broadcast at that event or at future festivals.

For instance, if many pills are found to contain high doses of MDMA or an unexpected toxic substance, it could be brought to the attention of users by sharing information through social media. This would provide users with immediate knowledge of the issue.

The bottom line is that pill testing is consistent with the Australian harm minimisation policy, which recognises the risks of consumption and the need for users to be better informed. So why not go one step further and introduce testing to reduce the incidence of drug-related harm and ensure both users and our community are better protected.

Claude Roux is Distinguished Professor of Forensic Science and the founding Director of UTS’s Centre for Forensic Science.

Shanlin Fu is Professor of Forensic Toxicology at UTS’s Centre for Forensic Science.

Marie Morelato is a Chancellor's Postdoctoral Research Fellow at UTS’s Centre for Forensic Science.