Testing pills is risky and may not cut total drug deaths

The merits of pill testing at high-risk events such as music festivals are debatable. Picture: AAP

We all acknowledge the seriousness of the illegal drugs problem in Australia, but a solution on which we all agree is elusive. Measures to take drugs off the street have been spectacularly unsuccessful. Drug dealers just factor in a percentage loss through confiscation as the cost of doing business. Dealers at all levels who are caught, convicted and perhaps jailed are immediately replaced by others. As we see so regularly, even the death penalty won’t deter those seeking extraordinary profits for so little effort.

Consequently our focus has turned to mitigating the damage caused by drugs. The AMA’s 2017 position paper on harmful substance use, dependence and behavioural addiction stated: “(The AMA) supports the introduction of innovative policy models and trials, in a controlled manner, funded and evaluated appropriately, that might reduce harms and improve outcomes for users and society at large. For example: needle exchanges, pill testing, prisoner interventions and services, novel treatments and degrees of decriminalisation for some drugs etc.”

Unfortunately this vague motherhood statement is seized on by the proponents of pill testing to say the AMA supports such testing when in fact its support is conditional. Simon Tatz, the AMA director of public health, said: “The AMA only supports government-sanctioned pill-testing trials using the latest technical equipment.”

But should the AMA lend its imprimatur to a pill trial simply because it is to be run by a government? The AMA needs to carefully examine the specifics of any trial protocol it intends supporting. Governments are capable of bad science and are prone to act with a view to a political dividend.

The merits of pill testing at high-risk events such as music festivals are debatable, even if the best available technology is deployed. The testing involves an analysis of a scraping from the pill, but illicit pills are unlikely to be homogeneous especially if the active ingredient has been “cut”. Critically the testing for “safety” does not establish the dosage of any psychotropic agents detected in that pill. It cannot establish that even a single pill will not cause life-threatening respiratory depression. That risk increases when the pill is consumed with alcohol or forms part of a cocktail of drugs.

If a pill is tested and found to be unsafe the owner is not obliged to dispose either of it or other pills they have, which they might sell. And if the pill’s owner won’t agree to it being destroyed, the best the testing facility can do is use social media to describe the risky pills.

Of course, supporters may be able to claim that pill testing has reduced drug deaths at music festivals. But what if the pill testing increases the number of drug-related deaths after the festival? Surely some festival-goers will be more inclined to experiment with drugs if they know their supply can be tested and found “safe”. In that way, pill testing could unintentionally encourage more festival attendees becoming addicts.

So the key question remains unanswered: does pill testing at music festivals reduce or increase the total number of drug-related deaths? The toll would need to include both users and any innocents killed by a drug-affected driver.

There is a risk that proponents of pill testing could end up congratulating themselves on fewer deaths at music festivals while remaining ignorant of victims elsewhere.

The pill-testing lobby harnesses the emotional response that “every life saved is worth saving”. Of course every life counts and that is precisely why I have reservations about a trial that cannot answer the key question.

John Allsop is a former doctor who was a member of the AMA.