Pill testing as harm reduction – a return to pragmatism in Australian drug policy

A recent article in Harm Reduction Journal explores the history of Australian drug policy, and argues that pill testing may have a role to play. In this blog, author Andrew Groves discusses further this important issue.

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There is growing evidence in Australia and around the world that hard-line, zero tolerance approaches to illicit drug use are not effective and, in fact, may be contributing to (or even causing) a range of equally severe harms for drug users and the community.

So are we asking the right questions and taking the right approach, in building programs, networks and legislative action under the National Drug Strategy? The short answer is “not quite…”

This is an important discussion for not only government policy-makers and law enforcement agencies, but also medical experts, the media and everyday citizens, given the recurrence of drug-related harms experienced by individuals, their families and the wider community. An all-too-clear example was observed in Melbourne in January this year, where nine young party-goers were “lucky they didn’t die on the spot” (ABC News, 2018), with this near-miss nonetheless having serious implications for the users affected, as well as their friends and families.

So are we asking the right questions and taking the right approach, in building programs, networks and legislative action under the National Drug Strategy? The short answer is “not quite…”

Australia’s Drug Policies: Pragmatic and Successful?

Australia’s National Drug Strategy (NDS) is grounded by the principle of harm minimization and comprises three pillars targeting supply, demand and harm reduction. It seeks to prevent the manufacture or importation and sale of drugs through seizure, arrest and other law enforcement practices (e.g. raids, customs checks, etc.), reduce the need for drugs by educating and informing the community, and limiting the harms for the community by providing drug diversion, treatment and rehabilitation programs/services.

The NDS is a longstanding, national framework that since 1985 has shaped several important initiatives in response to the use of drugs (illicit, as well as misuse of alcohol and medications), as well as led to the development of strong networks between drug and alcohol clinicians, policy-makers, police, academic researchers and treatment/support services.

Talking about drug use and how the community should best respond to this phenomena is not new. For example, the introduction of Needle Syringe Exchange Programs in 1986 and the Medically Supervised Injecting Centre in 2001, both in Sydney, Australia, represent pragmatic responses to concerns surrounding heroin and drug-injection practices that have been widely successful and continue today.

Getting Tough

…it is clear that current punitive, zero tolerance policies are not working to limit drug use or the impact of its harms.

However, such is the dynamic, shifting and politicized nature of the drug landscape, that the effectiveness of legal and policy responses can be limited or forgotten, particularly when constrained by media-driven community attitudes and populist policy-making. Despite an overall focus on harm reduction, often the drug debate is framed as a ‘problem’ of deviance, criminality and, in particular, youth. This is because, in reality, much of the effort, resources and political action has focused on ‘get tough’ policies and policing young drug users, which has served to criminalize and expose them to stigma, shame and community condemnation, often pushing them away from protective welfare and treatment services and social networks.

This is the situation we now face in Australia where, as further evidence of the failed war on drugs, it is clear that current punitive, zero tolerance policies are not working to limit drug use or the impact of its harms.

If we look to current trends and patterns of use, recent reports reveal young people at dance parties and music festivals continue to use drugs like ecstasy and methamphetamines, often in more potent forms (i.e. ‘MDMA’ and ‘ice’), exposing themselves (and others) to the dangers related to consumption of high-purity, adulterated or poor quality substances.

A Return to Pragmatism?

Pill testing then offers a return to pragmatic and evidence-informed policy, as a complement to existing harm reduction strategies, as a way of strengthening Australia’s response to drugs by increasing what we ‘know’. Pill testing involves party and festival-goers having a sample of their drugs tested on-site by scientists, who can then provide information to the user about what they are taking so they can make a more informed decision.

As found in several international studies in countries such as The Netherlands, Portugal and Austria, when harmful or unexpected substances were identified through testing, most users chose not to consume their drugs and would share this warning with their friends. In addition, in these contexts pill testing encouraged positive help-seeking behavior (i.e. rehabilitation or counseling), monitoring of drug markets and interaction between users and healthcare services, as well as increased overall awareness about drug-related risks and levels of support from both formal and informal social networks. Pill testing can, and does, work if used as part of a larger harm reduction strategy.

By no means is pill testing intended to be a stand-alone “solution”, nor does it condone the use of illicit drugs. Instead, the argument is that we need to change the language of drug use from deviance and criminal justice labels to pragmatic notions of harm and public health, where any policies or programs implemented seek to reduce the harms associated with drug use.

There are examples of such pragmatism in policy and practice in Europe and even in our own history, which we must learn from and apply in Australia if we are to implement better drug policy. Put simply, it is about building knowledge to ensure prevention, education and cultural values of social inclusion so that we can reduce the harms associated with party-drug use and save lives. Pill testing is a part of this process, so it is definitely worth the test.

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Jagdeep Kaur

I deeply appreciate your thoughts. Trust often facilitates successful treatment outcomes.

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