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If pill testing can save lives, what are we waiting for?

15 January 2019 No Comment

by ROSS FITZGERALD

There’s been another death of a young woman caused by consum­ption of illicit drugs at a music event, this time in western Sydney.

Yet despite some impassioned opposition, including letters to this newspaper, the debate about pill testing in Australia appears to have reached a tipping point.

It now seems more a matter of when rather than if trials will commence across the country. Indeed the family of the 19-year-old woman who died on Saturday have come out begging NSW Premier Gladys Berejiklian to allow a pill testing trial.

Every year about 19,000 Australians die from smoking, 5000 from alcohol and 2000 from illicit and prescribed drugs.

So are we right to be so concerned about the five deaths that have occurred in the past six months after young people have taken drugs at a music event?

The answer is a definite yes if any of these young people is among your loved ones.

Of course you would have wanted everything done to protect them, and would now want to protect other young people from succumbing to a similar fate.

But even without a personal connection, a majority of Australians supports pill testing.

In fact, the benefits of pill testing seem to be worthwhile while the risks appear to be minimal.

Why has this debate reached its present intensity? First, many Australians have come to the conclusion that the present policy simply isn’t working well enough. Too many young, healthy Australians are dying after taking drugs at music events every summer, despite all the police and sniffer dogs.

Second, many people have come to the conclusion that more than a few of these deaths might have been prevented if pill testing had been readily available.

Although there is a strong case from more than two decades of experience in Europe, we will never know for certain whether that is also true here unless we evaluate pill testing in Australia.

Sound familiar? It should. We have had much the same debate every time a new drug harm-­reduction intervention has been proposed. One side argues that the existing policy is working quite well and that people who are prepared to use illicit drugs get what they deserve. If no one took drugs at a music event, they say, then there would be no deaths.

The other side argues that young people have always experimented with drugs. A decade of just saying no to drugs has had minimal effect on behaviour.

Older and more experienced generations have a duty to protect younger and less experienced people. This includes being open-minded about possible benefits of new and improved technologies.

The debate about pill testing is very similar to previous debates about proposed harm-reduction interventions, including methadone treatment for heroin dependence, needle and syringe programs to slow the spread of HIV, medically supervised injecting centres to reduce overdose deaths, and condom promotion to reduce teenage pregnancies and sexually transmitted infections.

These were all essentially debates about pragmatism versus abstinence: the world we actually live in versus the world that some people would like us all to live in; compassion versus indifference: evidence versus intuition; valuing incremental benefits versus demanding perfect but probably unachievable results.

Despite claims to the contrary, pill testing doesn’t send a green light to young people considering taking drugs at a music event.

Many young people enjoy going to these events where some of their friends have already decided to buy and take drugs. Rightly or wrongly, most young people will be influenced by the behaviour of their friends. So the question then becomes: is a tested drug safer than an untested drug? Testing does not eliminate all risks but tested drugs will always be safer than untested drugs.

Pill testing can never be a silver bullet that protects everyone taking drugs at a music event from all possible harms. Nor do advocates for pill testing claim it to be any silver bullet. But if saturation policing and sniffer dogs were a silver bullet, then this debate would not be taking place.

Some opponents have claimed pill testing inadvertently assists drug traffickers by providing a false promise of safety. The evidence suggests pill testing at an event discourages sellers to ply their less risky products, lest disappointed and angry customers start demanding their money back.

But one expert says pill testing has serious flaws that should be considered. John Lewis, an academic associated with the Centre for Forensic Science at the University of Technology Sydney, said in a letter to The Australian last week that there are “issues” that counter arguments for public testing.

He says it is “not possible” for any equipment to identify all of the hundreds of synthetic cannabinoids, benzodiazepines, amphetamines and opiates used in recreational drugs.

It has also been suggested that pill testing could be a Trojan horse for drug decriminalisation. But what is the aim of policymakers? Is it to try to keep every young person attending a music event alive and well, or is it to make sure that drug policy doesn’t change?

Pill testing doesn’t imply that taking illicit drugs is safe.

Staff are instructed to avoid giving any guarantee a tested pill is free of risk. Alex Wodak, president of the Australian Drug Law Reform Foundation, argues that these days pill testing with high-quality equipment even in temporary facilities at a music event is almost as accurate as it would be if it were conducted in a hospital laboratory. In the case of NSW he argues persuasively that if “this Premier doesn’t introduce pill testing then the next one will. And if the next premier doesn’t, then the premier after that one will.”

As is the case throughout Australia, pill testing seems to be merely a matter of time. Keeping people alive so that they can try well-established programs such as Alcoholics Anonymous and Narcotics Anonymous is surely something to be welcomed.

Ross Fitzgerald is emeritus professor of history and politics at Griffith University.

The Australian, January 15, 2019, p 10

PILLS WILL KILL, BUT TESTING THEM IS NOT YET THE ANSWER

The notion of testing illegal pills to see if they are safe is gaining momentum in the wake of a spate of deaths of young people at music festivals around Australia.

Ross Fitzgerald argued in support of it yesterday.

But it won’t work and is fraught with dangers. What if we don’t know what we are testing for? New psychoactive compounds are being developed all the time. In any case, is the drug we’re testing for consistent throughout the pill? We could easily miss it by scraping a little from the surface. And perhaps the deadly threat lurks in ­unidentified contaminants.

There is much to be considered — maybe first is the fact no forensic toxicologist I know recommends pill testing or believes it is practical.

Years ago, most people were happy taking amphetamine, ­cocaine and occasionally LSD in ­addition to alcohol; in the past few years novel psychoactive subs­tances have become a clinical and forensic nightmare. These drugs include synthetic cannabinoids, such as PB-22, cathinones (stimulants related to the khat plant that mimic the effects of methylamphetamine and cocaine) and a number of synthetic benzodiazepines drugs (related to diazepam).

Consider this: in 2010 there were about a dozen synthetic “spice type” cannabinoids; by 2011 there were about 40; in 2012 there were 60. In 2015 four Australians died from PB-22. By 2016 there were about 125 synthetic cannabinoids, more than 20 cathinones, 20 synthetic benzodiazepines, and by last year about 18 highly potent fentanyl derivatives were found in the US. There have been reported deaths because of the synthetic ­cathinone MDPV in Italy and carfentanil-laced heroin in Britain. Carfentanil is a fentanyl-like substance 10,000 times as potent as morphine and has been deemed responsible for inadvertent overdoses by regular heroin users. It is estimated that a lethal dose of this drug may be as low as 20 micrograms. Local authorities have ­already seized shipments of carfentanil. These highly potent substances are mixed with regular benzodiazepines or ecstasy.

Fitzgerald states the risks of pill testing appear to be minimal. That is curious. In a ­recent toxicology publication, a leading forensic scientist reported there was great concern in the US that these novel illicit substances typically are outside the scope of routine drug testing by hospitals and laboratories or below the sensitivity levels for detection. If major forensic facilities have difficulty in identifying these subs­tances, it stands to reason that on-site pill testing could not adequately identify most of the potentially lethal components in a pill scraping.

In another recent publication, Australian forensic laboratories noted there were about 740 new psychoactive substances ­reported to the UN Office on Drugs and Crime from 2009 to 2016.

Again, leading Australian forensic institutions using high-resolution mass spectrometry struggle to keep up with ever-increasing variations in synthetic substances. Pill testing may identify some of these within the time and scope of the on-site facility, but the risk of an adverse or fatal episode ­remains with several hundred substances not detected.

Fitzgerald reckons there is a strong case from more than two decades of experience in Europe, but that’s ignoring the exponential increase in deadly adulterants.

The issue of pill testing should be decided on forensic science. The ability to identify a wide range of components in a compound ­depends on the ability to test a ­representative portion of the substances, and that representation is incumbent on the pill being ­homo­geneously mixed when produced. If the pill has not been manufactured to ethical pharmaceutical standards then there is a risk of the pill tester missing the more toxic ingredients of the substances.

If pill testing were trialled, you would need sophisticated instrumentation such as high-resolution mass spectrometry to rapidly analyse the contents of the unknown substance. Such instrumentation is not amenable to on-site music festival venues. Crit­ically, operators of the instru­mentation would need to ensure their database of compounds is up to date. As newer synthetic drugs are regularly ­entering the market, forensic laboratories are struggling to obtain appropriate and ­expensive analytical reference material to identify unequivocally all ingredients in a pill.

To date, analytically trained ­experts have yet to explain ade­quately ­the complexity of attempting to test pills reliably and quickly at an on-site venue to be reasonably confident they can eliminate minute amounts of ­potentially lethal ingredients such as the deadly carfentanil.

In any case, the greater difficulty is in figuring out where in the pill, whether purportedly ­ecstasy or methylamphetamine, might lie the adulterants. Only forensic analysis can ­determine the concentration of adulterants in pills. For many of these substances, there is no known toxic concentration. When combined with other substances, adverse effects including respiratory depression leading to coma can occur at any level.

Before moving ahead with a policy to trial pill testing, we need some sobering facts. The efficacy of pill testing is best left to forensic scientists, while the value of pill testing as a means of harm ­reduction is the domain of ­researchers into behavioural patterns of users and their potential for risk-taking. A 2004 study by the National Drug and Alcohol Research Centre into risk factors and risk perceptions found that those who perceived the possibility of getting caught or being ­involved in accidents were less likely to drive while impaired. Conversely, the perception of not getting caught or having an ­adverse reaction contri­buted to their drug-taking behav­iour.

While one cannot draw a direct correlation between drugs and driving and taking of ­unknown pills at a music festival, it is clear from recent events that many ­attendees at these events do not perceive the dangers and non-­forensic pill testing may well provide attendees with a false sense of security.

John Lewis is honorary associate at the Centre for Forensic Science at the University of Technology Sydney

The Australian, January 16, 2019, p 10.

Pill testing may save a few lives but where does it fit in an overall strategy that categorises drugs as dangerous and illegal (“Injecting pioneer seeks pill tests trial”, 15/1)? It seems to me pill testing at music festivals is like saying to BASE jumpers, “BASE jumping is dangerous and illegal. However, if you let us know what you are planning we will arrange to have a paramedic unit on standby in case something happens. We won’t arrest you but please understand we do NOT condone your behaviour.”

P eter O’Brien, Kiama, NSW

We have injection rooms for an illegal drug and now there’s talk of pill testing for illegal pills. So what’s next, a drunk driver’s-only lane on our highways?

The Australian, January 16, 2019, p 11.

No guarantee on pills

People should listen to John Lewis (“Pills will kill, but testing them is not the answer”, 16/2). I guess that, in testing a pill, it is necessary to render it useless for the purpose for which it was purchased. Given that the pills are probably cooked up in a pan in the back of a dirty garage, what guarantee is there that all the pills in a given batch will be the same?

Anyway, governments should not accede to demands that they assume responsibility for guaranteeing the safety of ingesting what is the product of a pattern of criminal behaviour.

Frank Pulsford, Aspley, Qld

Don’t blame teachers

There are several causes for student misbehaviour (“Teachers hardly to blame for disorder in the class”, 16/1). In many cases, misbehaviour is to conceal inability to do the work set. In other cases, it stems from the need to be noticed, at the heart of which is the need to be loved. Then there is the fact that many students have no idea what school is for or why they are there. They haven’t yet internalised the value of education.

But the main reason is that society has spent 40 years moving away from belief in personal responsibility to belief in every misfortune being, if not someone else’s fault, the fault of the power structure. This is where the modern demand that teachers “engage” students comes from.

Teachers can certainly learn better techniques of behaviour management, but unless we embrace personal responsibility, misbehaviour will continue to be explained as the fault of the teacher, the education system or the patriarchal, capitalist state.

The push for pill testing, which will succeed, tells us society is still not ready for individuals to bear responsibility for their own actions.

Chris Curtis, Hurstbridge, Vic

The Australian, January 17, 2019, p 11.

John Lewis (Pills will kill, but testing them is not yet the answer. The Australian, January 16, 2019, p 10.) makes a good case for continuous improvement in the forensic science of pill testing; but he does not make the case that today pill testing combined with information and education does not reduce harm.  As Ross Fitzgerald (If pill testing can save lives, what are we waiting for? The Australian, January 15, 2019, p 10) notes, for pragmatic evidence-based risk management the perfect will always be the enemy of the good.  

Dr Peter Smith, Lake Illawarra, NSW


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