Toxicologists throw support behind pill testing ahead of major festival weekend

Doug Hendrie

19/07/2019 3:57:23 PM

Australia’s forensic and clinical toxicologists say testing could save lives at music festivals.

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Will pill testing tell users what’s in their party drug?

The move comes as the national debate over pill testing is set to reignite this weekend as key pill testing advocate Dr David Caldicott demonstrates the technology and approach at the Splendour in the Grass festival outside Byron Bay.

The issue has shot to renewed prominence after a NSW coronial inquest began into the pill-related deaths of seven young people at music festivals across the state over the last two years.

The Deputy State Coroner overseeing the pill-death inquiry will reportedly watch Dr Caldicott’s demonstration at the popular festival, which attracts around 50,000 patrons.  

President of the Forensic and Clinical Toxicology Association (FACTA), Dr Dimitri Gerostamoulos, told newsGP his organisation supports pill testing.

‘We support the notion of pill testing, and that’s true for most forensic toxicologists. We are not advocating that illicit drug use is OK, but we support the notion that pill testing is effective, not only here but overseas,’ he said. 

‘There’s plenty of evidence that pill testing does save lives. Why wouldn’t we be in support?

‘But pill testing has limitations, and we recognise that too. At a pill-testing site or in a laboratory, you will not be able to detect every single substance out there. So we’re seeking to define those limitations and improve those by providing a better scientific understanding.’

The move comes after Dr Caldicott spoke at the FACTA conference in June.

Dr Caldicott, an emergency doctor, led Australia’s first trial of pill testing sanctioned by a state or territory government in Canberra last year, which was considered a success after testing 85 pills and finding two that contained lethal substances.

FACTA will now offer Dr Caldicott’s organisation, Pill Testing Australia, access to their expertise in drug analysis.

‘We feel it’s important. We want to give [Dr Caldicott] objective measures as to how good these tests are and what’s coming,’ Dr Gerostamoulos said.

He added that mobile laboratory conditions are never as good as laboratory conditions, but do have the advantage of speed. 

‘We know [patrons] don’t want to sit there for a couple of hours. Rapidity of testing, getting the results quickly and increasing capacity at a mobile location is not easy. But as the technology improves, so does the capacity of these instruments to do that,’ he said.

‘But even in labs, we know we’re unable to see all these new synthetic drugs.’

Dr Gerostamoulos said it would be entirely possible to convert a truck into a mobile laboratory and staff it with forensic toxicologists and illicit drug chemists to get laboratory-like results.

‘It’s possible. It’s just a question of resources and support,’ he said.

A key challenge, however, is the question of government involvement in pill testing.

‘Often, it’s governments who control forensic labs. So there’s a question over whether they will provide such services and what the legalities are when you’ve got a state funded laboratory issuing results in regards to illicit drug taking,’ Dr Gerostamoulos said.

‘The reluctance of government comes because what happens if testing is done and a person dies of a drug not identified by the tests. That’s where FACTA comes in, where we can lend advice.’

Dr Gerostamoulos said that a major benefit of pill testing is the fact that a prospective drug user could have a conversation with a doctor before taking the drug.

‘It’s not simply reliant on the detection of a drug. Even if you do detect a drug you think is dangerous, half will take it,’ he said.

‘So it’s much more important to have that discussion with an emergency doctor about the dangers of drugs.’

Dr David Caldicott has advocated for pill testing for almost 20 years.

Dr Caldicott told newsGP that he came away from the Adelaide conference feeling that the ‘overwhelming majority’ of forensic toxicologists believe pill testing not only could be done, but should be done.

‘That’s where the expertise lies. Never mind the health profession – the actual analytical chemists are now in favour,’ he said.

‘The [pill testing] demonstration [at Splendour in the Grass] will be an example to the coroner of how medically supervised pill testing would work, and the importance of doing so in such a way that can provide immediate feedback to consumers.

‘Pill testing is not like getting a ticket from the delicatessen and shouting out the result once it’s known. What we do is we sit down with the patron, tell them the result and put that result in context. Everyone is told, if you want to stay safe you should probably not use illicit drugs. Everyone is asked what they’ve already consumed.

‘Around the world, we see as many as half of consumers change how they consume a drug [after testing] in ways that make it less likely to overdose.’

Dr Caldicott said that in places like Europe, pill testing is well established, while the approach is gaining momentum in Australia, with support from the drug and alcohol sector and many medical groups.

He said opposition now stemmed not from technical concerns but from politics.

‘It’s been nearly two decades since I first got involved in this. Those who stand against pill testing are now almost exclusively political,’ he said. 

‘If you look at the polling, the Australian public supports pill testing. But there’s a conservative rump who doesn’t like same-sex marriage and doesn’t believe in climate change. That’s fine. They’re entitled to their opinion. But we don’t allow people who don’t believe in blood transfusions to determine transfusion policy, or people who don’t believe in vaccinations to determine immunisation policy.

‘This is a war of harm minimisation versus prohibition, a war of science versus politics. It’s a lot closer to the climate change debate, to be honest. But there’s change in the air. People have had enough.

‘There are vast sums of money invested in the edifice of prohibition. We’re not addicted to drugs so much as we’re addicted to our war on drugs.’

His comments come after a medical expert who helped the NSW Government draft its music festival guidelines told the pill-death inquest that the nation is ‘stuck in a war on drugs’.

The controversy around the topic will not be far away at the festival, with Dr Caldicott to sit on a Q&A-style panel alongside outspoken Federal Liberal MP Andrew Laming, an ophthalmologist, who has argued that current proposals for pill testing at festivals do not provide exact information on purity or dose of the drugs. 

Speaking ahead of the panel, Mr Laming told newsGP that festival pill-taking was ‘spurning risk in search of euphoria’.

He warned that legal issues would plague pill testing.

‘Currently [pill] testers claim to be indemnified, but it is obvious that the risk is completely borne by the ACT government [in the trial last year],’ he said. 

‘Inevitably, a festival-overdose will involve a tested pill, leading to civil action against testers, organisers and sky-rocketing indemnity. Then what?

‘Before leaping to test pills that combine sub-standard equipment, unreliable results and intoxicated clients, we need to be sure there isn’t a better way … Pill scrapes can miss the active ingredient, struggle to detect more than three substances, miss many new drugs and much of what is less than around 10% of the sample. Unlike purity, these tests can’t determine dose, and it is dose that kills.’

Mr Laming claims law-enforcement agencies across the nation hold reservations about onsite testing.

‘Trading accuracy for speed and ease in festival tents opens a world of uncertainties. That is why I prefer slower but accredited laboratory HPLC [high performance liquid chromatograph] testing before and during festivals,’ he said. 

‘Results and counselling onsite would follow police-checks and a buccal-swab illicit drug screen. Given testing is around $100 per sample, the cost of staffing, laboratory time, couriering and indemnity could add $50 to ticket prices.

‘Last summer’s tragedies taught us that the real enemy is not the untested pill, but double-dropping [taking two pills at once] and polypharmacy, which is refractive to pill-testing. Decades of safe-sex campaigns remind us though, that choices can change over time with education. Untested pill-taking is just as stupid as unprotected sex, and the state simply can’t be everywhere when these choices are made.

‘That is why Australia’s peerless public health profession should stand behind strategies that incorporate the highest quality testing available. We can afford it, and those relying on such information deserve it.’

Mr Laming raised a series of questions he believes have not yet been answered by Pill Testing Australia, such as whether testing undermines supply reduction.

‘Music festivals, like all public places, should be drug free. So how do clients get pills past police sniffer dogs at entry and into tents without what happened in the ACT; a collapse in drug-related violations. That is why having supply reduction and harm minimisation collocated is so fraught,’ he said.

‘We either adopt a permissive approach with police ignoring sub-threshold supply and possession, or police apply the laws of the land consistently. Doing both risks panicked ingestion of drugs that patrons were intending to test; the worst of both worlds. Abandoning policing is not a price the community will accept, just to allow pill testing.’

Mr Laming claims it is ‘irresponsible’ for Pill Testing Australia to link lower death rates at European festivals with pill testing.

‘The dehydration risks at [festival] Defqon’s 30⁰ Sydney days are very different to 15⁰ in Amsterdam,’ he said.  

He also raised concerns around what happened to discarded drugs, and whether angered patrons would go looking for the supplier in the event the tested drugs had no psychoactive substances, seeking ‘refund, replacement or in worst case, retribution’.

Mr Laming’s colleague, forensic toxicologist Andrew Leibie, has previously raised concerns around the efficacy and safety of pill testing, with concerns around deaths from heat injury and a false sense of safety.

Dr Leibie disputes Dr Caldicott’s claim that the majority of forensic toxicologists agree with pill testing.

‘I’m a forensic toxicologist and I’m quite certain I have the overwhelming support of my peers on this point,’ he said in an email to newsGP.   

RACGP President Dr Harry Nespolon has given his personal support for pill testing as part of ‘harm minimisation’.

Dr Hester Wilson, Chair of the RACGP Specific Interests Addiction Medicine network, has previously told newsGP that ‘pill testing saves lives – that’s the bottom line’.

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Sophia Feeney-Nesire   19/07/2019 7:23:01 PM

Why is it that politics and politicians are roadblocking something that has the potential to save their own sons and daughters? Actions speak louder than words, Australia has recognised the issue and its time to act on preventative measure rather them remedial.

Dr Peter j Strickland   20/07/2019 11:09:47 AM

This whole concept of recommending pill testing is a 'cop-out' for recognising the problem here. It opens the door to allowing illicit drugs being sold and peddled by drug dealers to susceptible individuals, and who apparently cannot enjoy a music concert , or night out without taking potentially fatal doses of these drugs.
To stop deaths at these music concerts there should be trained sniffer dogs and police employed by the promoters; those carrying drugs, or seen peddling these drugs, should be arrested and charged, lose their privileges of financial assistance for work and/or education at schools and universities, and all made to do some sort of national service in the community for a minimum of 2 years. Anyone over the age of 18 years is considered an adult, and they should take total responsibility for what they consume or inject. I think of 16-18 yo men and women of the past who went to war for Australia, and were mature and never would consumed something potentially lethal

Dr. Patrick McSharry   20/07/2019 4:09:33 PM

I agree with Dr. Wilson. "Pill Testing" saves lives. In the US (where I practiced in 3 States ), harm reduction measures such as this (along with more responsible prescribing , PDMP 's and Mentoring and easier access to addiction services (Direct from the GP or provided by the GP - which I was fortunate to be involved in ) are credited with the 1st reduction in Opioids Related Accidental Overdose Deaths since 1999!
However , I totally agree with the Opthalmologist (Mr. Laming ) on many points . I particular , the "permissive" opinion of many of my colleagues (that I worked alongside in North America and Europe) , example are decriminalization of Drugs etc.
Mr/Dr Laming is correct when he says "supply reduction and harm minimisation collocated is so fraught" .The same debate raged about Naloxone.
The CDC (2016 ) and the Canadian Opioid Prescribing Guideline of 2017 were credited for both increase in Illicit Fentanyl deaths and reduction in Presribed Opioid Deaths so "go figure".

Marshall Donnelly   20/07/2019 8:05:45 PM

This is a no brainer the evidence is clear irrefutable harm minimisation is the key
Our children are going to take these drugs , let’s give them the best education and equip them to make the best decision , if pill testing is part of that then I’m with the toxicologists
Do it !

Dr Jitendra Natverlal Parikh   20/07/2019 9:21:56 PM

If it saves one lifeand it does then make a start All these opinions from respectd colleagues need to be addressed successfully as a process of progress

Andrew Laming   26/07/2019 1:54:23 PM

As of my article in the Australian yesterday - there is NO official forensic toxicology position on pill-testing. Just wait for their ‘clarifying statement.’ Next step I will take on the RACGP and then the AMA for their ill-informed non-evidence based positions. Stay tuned.