Wed Apr 27

Pill testing really does reduce the risk of harm for drug users

Written by: David Caldicott, Senior lecturer, Australian National University

Days out from the event, festival goers for Canberra’s Groovin the Moo festival were told the event would no longer be offering a free drug checking service ^[1] after Pill Testing Australia, which provides the testing service, had public liability insurance withdrawn, without explanation from insurers.

Pill testing in the Australian Capital Territory was hard fought and won, and this represents a setback for an intervention that can reduce the harms of drug consumption.

A history of pill testing in Australia

In Australia, the ACT has been ahead of other states in applying innovative drug policies. In 2018, it gave permission for Australia’s first trial of pill testing at a music festival. Pill testing, or “drug checking” as it’s often called internationally, is a harm reduction intervention with clear benefits.

Acknowledging a “drug-free” Australia is magical thinking, and that some people will always use drugs, pill testing provides consumers with information about the actual content of their chosen substance, so they might make better decisions about consumption. It also gives us access to an otherwise invisible group of “functional” drug consumers.

Advocates have been working to have pill testing made legal in Australia since the early 2000s. And while there was apprehension in the ACT in 2018, it was deemed a huge success ^[3] at its first trial there.

Colleagues in other states have followed progress in the ACT with interest, but several proposals have stumbled as a consequence of political or ideological objections by conservative elements.

Pill testing trials in Australia have been deemed a huge success. Shutterstock

Pill testing reduces drug harms

Since 2002, several ^[4] studies ^[5] have clearly shown pill testing has never been associated with increased drug use, or drug-related harm – no matter how much opponents of pill testing would have you believe.

Work conducted by colleagues from the ANU shows quite clearly ^[6] a deep trust by those using the service and in broader health services providing services to drug users.

Research increasingly confirms ^[8] pill testing does influence the behaviour of people who use drugs, especially when pill testing results show unexpected results, or drugs of concern. From our own work in Canberra, we have also found consumers spaced out doses, reduced doses, or even disposed of their drugs, following conversations with those providing the service.

These general findings have been corroborated by several coronial inquests ^[9] in Australia into music festival deaths and a special inquiry ^[10] commissioned by the New South Wales government.

Both recommended, independently, further trials of pill testing in those jurisdictions, as have subsequent coronial inquiries in Victoria ^[11]. The Australian Medical Association also officially supports ^[12] calls for medically supervised, ethically approved pill testing.

Such has been the success of the festival-based testing in Canberra, a fixed site is now on the cusp of opening, ensuring a service that functioned only at music festivals, and for the demographic groups that attend them, can now be extended to benefit a broader group of consumers over a longer period of time.

Multiple inquiries have recommended pill testing. Amy Harris/AAP

There is no research comparing festivals that did or did not deploy pill testing – it would be quite the design challenge to try to conduct controlled experiments in the chaos of a music festival. But we can follow the behaviours of those who participate in the pill testing process, and when we do, most early indications suggest those who use drugs change their behaviour in such a way as to be less likely to result in harm.

What has to happen to ensure pill testing goes ahead?

In this recent instance, the issue was not with government, but with private insurers. We cannot say what made them pull out, but the fact a private entity determined the course of public health policy is a disappointment and should not be allowed to happen again. Given the manner and timing in which this was done, it suggests the prevention of pill testing was the intended outcome.

Governments could address this by requiring insurers to provide the actuarial basis for any decisions they make about insurance. They might also consider their insurance options when choosing insurance providers, selecting those prepared to support evidence-based health care.

Pill testing, now established in the ACT, is not going away. It is only a matter of time before other jurisdictions find a way to introduce their own systems in their own way.

Insurers should be trying to win customers with ethical and evidence-based policies. Harm reduction is insurance, not just for people who use or who have used drugs, but also for people who love the people who use drugs. Between those two groups, that represents a lot of Australians – all of them who have choices as to where to source their insurance products.