Why pharmacy must support pill testing


green shirt with pill motif

Pharmacy needs to get serious about pill checking and other harm minimisation measures, writes Liam Murphy

I’m just going to get straight to the point: the pharmacy industry and its governing bodies need to step up now and show their support for broadening the scope of harm minimisation to include the implementation of drug checking at festivals in Australia.

After processing that sentence you might be nodding your head, or you might be asking “why?”

To begin to justify this stance, let’s start by acknowledging three key points relevant to this topic:

  1. There are a range of substances/drugs that are illegal in Australia because of the century long “war on drugs”.
  2. Because these substances are illegal in Australia, there is no regulation or quality control with regards to what is going into products consumed. For example, a pill that someone buys at a festival could be made up of talcum powder or it could contain any number of other toxic substances
  3. Regardless of their legal status, these drugs are still being widely consumed by Australians, often with no knowledge about what they are really taking.

So, what exactly is “drug checking”?

Emergency medicine consultant and harm reduction advocate, Dr David Caldicott, describes drug checking, which is also known as “pill testing,”, as “a process that allows a consumer to know what is in their product prior to consuming it.”

It also helps set the scene for alcohol and drug researchers to investigate what Caldicott refers to as a predominantly “invisible cohort of functional consumers”.

The festival scene provides a good testing ground to trial drug checking, but its potential applications are boundless.

Implementing drug checking is not a means of promoting drug use, nor is it about telling people that their pill doesn’t contain harmful additives and then telling them it is safe to use. I see it as a platform for professionals to engage in a non-judgemental discussion with users, ensuring that people are able to make more informed decisions and recommending that people exercise caution and use these substances in a safer manner. 

If we, as pharmacists and trusted health care professionals, really care about creating positive interventions in the community, then this initiative has the potential to create an absolute gold mine for interventions like those outlined above.

There is also the potential to create a whole new breed of pharmacist that can specialise in mental health and harm reduction and apply their knowledge in a previously uncharted way.

I was fortunate to spend the last week involved in the NAPSA congress representing The Roaming Pharmacist with my partner Luke Vrankovich. It is encouraging to see the potential and passion that these students will bring to the profession in the coming years.

It is apparent that there is a sentiment among these future pharmacists that they would like to break the shackles of being designated to traditional ‘community’ or ‘hospital’ pharmacy roles.

Along with the current legal status of some drugs, it is stigma attached to drug use and a lack of political courage that have stifled the progression of harm reduction to expand beyond the successful Opioid Substitution and Needle and Syringe programs already in place.

In NSW, the recently retired Premier Mike Baird was a vocal critic of pill testing. He is on the record as saying, “Don’t do it. That’s the best form of safety. Don’t take pills and you’ll be fine.”

I admit that there is logic in his statement. However, history has shown us that this idealistic approach alone does very little to reduce the wider harms of drug use in the community.

The Australian Greens, spearheaded by former drug and alcohol medical practitioner Richard Di Natale, are the first major party to openly endorse pill testing measures in their party policies.

As drug specialists, pharmacists are practicing under the current Professional Practice Standards set by the PSA, hence harm minimisation should be at the forefront of our practice.

Despite the recent decision to change codeine to a Prescription Only schedule item in Australia, the pharmacy industry was vocal in asserting our abilities to reduce the harms of over-the-counter pain reliever abuse in the lead up to the decision.

Unfortunately, we must accept the unfavourable outcome, but realise that it gives us an opportunity to use this momentum of advocacy to look laterally at how we can diversify and continue to strengthen our impact on healthcare in Australia.

How can we get this done?

Well, I don’t have all the answers, but I do have a few ideas.

Firstly, as Australia’s peak pharmacy professional organisation, the Pharmaceutical Society of Australia should make it a priority to release a position statement on drug checking at festivals. I recognise that there’s a chance I might not like the response, but at the very least it will thrust the issue into the spotlight for further debate.

Secondly, we should encourage our future generation of pharmacists to explore more options relating to harm minimisation in their studies and in their pharmacy practice. There are a range of ways pharmacy academics as well as students undertaking honours projects could utilise their time to contribute to our understanding of the possible implications that this would have.

If you are a pharmacist, student or a member of the public that has a spare hour and wants to learn more, then simply type “What’s In My Baggie?” into Google and follow the featured YouTube link for a fantastic documentary on an underground movement for pill testing in the United States.

 

Liam Murphy is the founder of The Roaming Pharmacist.

Image: Fish Taco

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26 Comments

  1. Greg Kyle
    01/02/2017

    OK, so assuming that the pill testing occurs, all the police need to do is to set up near the testing van (or whatever is used) and they have a captive market and arrest everyone who comes along. All this will do is stop people getting anything tested and we’re back to square one.
    I know there will be a huge cry against this comment saying that the police would need to keep away, but these are illegal drugs, so why should they? It would be the same argument as having someone testing car speedometers on nominated stretches of public road and telling the police to stay away.
    The drug is legal or not (separate debate to this thread) – and laws get enforced. If people want to take risks around such rules (laws) , they are PERSONALLY liable for the consequences of their voluntary choices and actions.

    • Andrew Roberts
      01/02/2017

      While I can see where you’re coming from, you fail to realise that regardless of what laws are in place, they’re going to be broken by a number of people taking these substances. Looking at the bigger picture rather than just what happens to these people, unsafe substance abuse puts an added strain on emergency health services, the friends and family of the users, etc etc. Even if you don’t see the value in preventing harm at a user-level, you can’t deny the benefit to the wider community (and at the very least, the budget.) Where these things have been successfully implemented, its clear that it’s worthwhile.

    • Andrew
      02/02/2017

      Hi Greg,

      “Clients of the needle and syringe program in NSW remain at risk of prosecution for possession of prohibited drugs, but police officers are directed to ‘be mindful not to carry out unwarranted patrols in the vicinity of needle and syringe program outlets that might discourage injecting drug users from attending…..The needle and syringe program therefore provides a model for how police discretion could operate in relation to drug checking services. Note that needle and syringe program outlets could also be potential sites for co-location of drug checking services, which would entail continuation of normal police practice in the vicinity.”

      http://www.unharm.org/drug_checking_brief

      “NSW Police Service also considered it unlikely that a person who provides a testing facility could be found guilty of the offence of aiding or abetting the possession or use of a prohibited drug. It is believed that for a person to be aiding and abetting the offence they must be ‘linked in purpose’ with the drug user and that it is also necessary for the person to engage in some action or encouragement which makes the offence more likely to occur.”

      http://www.aph.gov.au/~/media/wopapub/senate/committee/acc_ctte/completed_inquiries/2004_07/aosd/submissions/sub16A_attach1_pdf.ashx

      • Ronky
        03/02/2017

        False analogy. The primary aim of the needle exchange program is to prevent blood borne disease from spreading through the community. Testing illicit drugs on behalf of intended users is a totally different situation.
        This is one of the Green Party’s more insane ideas, and that’s saying something.
        The whole idea is based on an abysmal ignorance of science. These idiots think that it’s possible for someone in the back of a van to do a chemical/toxicological/pharmacological analysis of an unknown sample and identify everything in it and their effects, within five minutes. Oh and no doubt they want it done at no or minimal cost to the client, maybe paid for by the long-suffering law abiding taxpayers.
        As for the even more insane idea that pharmacists should be involved in it, can you imagine drug users saying “take this pill, it’s been checked by a registered pharmacist!”.
        And just try asking your professional indemnity insurer if it will consider covering you for such activities!

        • Andrew
          03/02/2017

          Hi Ronky,

          >>>>>This is one of the Green Party’s more insane ideas, and that’s saying something.

          The UNODC have recently come out in favour of pill testing – it’s a non-partisan public health issue (or at least, should be). Those not in favour are either ideologically opposed or unaware of the evidence base. Happy to send you some reading if you like.

          >>>>>These idiots think that it’s possible for someone in the back of a van to do a chemical/toxicological/pharmacological analysis of an unknown sample and identify everything in it and their effects, within five minutes.

          All of those things are totally possible, today Reagent testing is the less preferred option; HPLC, MS. GC, LCMS are far more sensitive and experience from Europe shows that they can test 100-120 samples per night. Handheld Raman spectroscopy is an emerging technology with better transportability and higher throughput.

          >>>>>As for the even more insane idea that pharmacists should be involved in it, can you imagine drug users saying “take this pill, it’s been checked by a registered pharmacist!”.

          I can’t think of anyone better than society’s nominal drug experts to provide advice and support on these issues. Maybe a special type of health practitioner, somewhere between a pharmacist and D&A clinician?

          • Ronky
            03/02/2017

            Oh I’m sure one can do some sort of “test” in five minutes. But not one that guarantees that a pill is safe. And certainly nothing that a responsible health professional would sign up to, least of all pharmacists, who know better than anyone the dangers of misuse of chemical substances.
            It’s not the Government’s or pharmacists’ responsibility to try to protect you from the inevitable consequences of acts which you willingly and stupidly choose to do, contrary to all responsible advice from health professionals and governments.

          • Andrew
            06/02/2017

            >>>But not one that guarantees that a pill is safe.

            No more so than the little green man says that it’s safe to cross the road – you still might get skittled but it’s less likely.

            >>> who know better than anyone the dangers of misuse of chemical substances.

            MDMA is safer than horse-riding, driving a car, general DIY – the list goes on.

            >>>>I note you ignored the question of who’s going to pay for the high-tech tests you refer to.

            I believe UnHarm and some other associated groups have arranged such funding for their testing. Private funding, which should eventually be moved to public spending under the public health banner.

            >>>It’s not the Government’s or pharmacists’ responsibility to try to protect you from the inevitable consequences of acts which you willingly and stupidly choose to do

            Uh, yes it is.

          • Ronky
            06/02/2017

            Wow, nicely proved my point. Thanks for your honesty, which is otherwise pretty rare among extreme neo-Marxist Green Party ideologues such as yourself who demand that taxpayers fund their pet ideologies and who accuse anyone who dares question them of being “ideological”.

          • Andrew
            06/02/2017

            Thanks Ronky, happy to help.

            I’m just trying to clarify the issues in this often confused topic. The gap between community/practitioner perceptions and the actual evidence in this area is stark – the potential for reducing community harm along with the many secondary benefits should be its own advocate.

        • Jarrod McMaugh
          09/02/2017

          Ronky, I have read the back and forth between you and Andrew, and your stance seems to be very misguided. Not sure if you actually work in harm minimisation, but it doesn’t seem like you have the temperament for it.

          Two points you raised that I want to address:
          1) pill testing ISN’T about telling someone that their pill is safe – it is only telling them what is in it. To be technical, we can’t tell any person that the tablet they take is safe… But that’s muddying the water

          2) your comment on the listenability of music…. please see this comment from Bill Hicks. https://youtu.be/nOHjhYyCJbE

          • Ronky
            09/02/2017

            May I suggest that you and Andrew not only don’t have the temperament for harm minimization, but don’t seem to even understand what it is.
            1) of course, what the tester actually says is “the results say that this pill contains X,Y and Z and does not contain A, B, or C”. But if you know anything at all about drug users (or even human behaviour in general) you would know that what the user hears is either “this pill is safe” or “this pill is not safe”.
            2) You do realise Bill Hicks is a comedian, right? (Oh and no thanks for the lack of a profanity warning.) In any case his “argument” if you can call it that, is that drug abuse helped some songwriters to write good songs. It’s got nothing to do with the necessity to be high on drugs to be able to appreciate a song.

          • Evie Paragalli
            18/03/2017

            Jarrod,
            Do you know much about the pill testing method itself. Correct me if I’m wrong, but it won’t tell anyone what is in the tablet. It will only look for compounds that will react with suitable reagents.
            It will not pick up new synthetic agents, glass, battery acid or other dangerous compounds.

    • Evie Paragalli
      18/03/2017

      Hi Greg,
      Those are all valid points.

      I am concerned about the methodology behind the testing. The tests can only identify what the reagent(s) can react with… What about other dangerous (and sometimes unknown) substances that cant be identified through this method. As a future health professional, I don’t feel comfortable handing drugs back to people without knowing what is in them. It’s also not a reliable quantitative method. Perhaps I am missing something but I have never seen these points addressed or even mentioned before.

  2. Marina Santiago
    01/02/2017

    Great article. I agree that harm minimization is the key here. If we like it or not, many people will take drugs… doesn’t matter if legal or not, if people/family agree or not. It would be great to have students learning more about harm minimization. And for the comment bellow about police setting up next to the test place I have two comments: first NSW police force supports and operates within the principles of harm miimisation and second have you ever seen the police setting up around a needle and syringe machine or clinic?

    • Andrew
      02/02/2017

      The use of sniffer dogs is proof enough that NSW Pol have no interest in harm-minimization. In fact the methods used by NSW Pol are as close to harm maximisation as possible – outright refusal of pill testing, arbitrary searches in public, the list goes on.

      • Ronky
        07/02/2017

        You are confusing harm-minimization with legalization. We should minimize the harm caused by illicit drug abuse AND enforce the laws against it. It’s not an either/or question. Not sure what your problem is with sniffer dogs which have been a fantastic success in NSW and around the world.

        • Andrew
          07/02/2017

          Hi Ronky,

          >>>>We should minimize the harm caused by illicit drug abuse AND enforce the laws against it.

          Totally agree – the evidence says it’s an either/or situation though.
          Full enforcement of current drug laws would criminalise half of the Australian population (lifetime incidence of illicit drug use), which in turn creates more and worse criminals because as we know any exposure to the criminal justice system increases the risk of re-offending. So assuming we could logistically deal with 11.5 million offenders, how many of those would go on to escalating crimes as a consequence of their initial exposure to criminal justice? Some….and that’s too many. This is not harm reduction, either for the individual or the community.

          >>>>enforcing the laws helps with harm minimization and proper and well-thought out methods of harm minimization helps in law enforcement.

          Any evidence for that?

          >>>>Not sure what your problem is with sniffer dogs which have been a fantastic success in NSW and around the world

          My interest in this was sparked when I was sniffed and searched in full public view at a Sydney trainstation on a visit last year. A group of coworkers saw this happen, the embarrassment was awful, my boss had questions, and to top it off one of the police threatened my job based simply on the suspicion that I was carrying drugs (which I wasn’t – I don’t use them).

          As far as sniffer dogs being a success….they’re not. NSW Pol’s own stats say that 3/4 of all detections are false-positives, and that of those 25% of detections that are legitimate only 2% of this cohort go through the court system to record a conviction. Furthermore most positive detections are for cannabis…hardly a dangerous drug. A success rate of less than 1% is hardly a “fantastic success” and doesn’t justify the cost of a dog squad and six support officers.

          Can you name any other jurisdiction in the world that uses sniffer dogs in the same way, or evidence to back your assertion that it’s a successful strategy?

          • Ronky
            07/02/2017

            Nice strawman Andy, I never said we should throw the book at everyone who’s ever had even one puff of a joint even if it was 50 years ago and in another country. In Australia thank goodness our authorities get the balance pretty right for drug and other crimes – first (and even second) time offenders for minor offences get off without a conviction or often without even a prosecution or even with just a warning and/or with referral to treatment services in the case of drug abuse.
            Obviously you get embarrassed very easily. I don’t know of any jurisdiction in the developed world which doesn’t use sniffer dogs.

          • Jarrod McMaugh
            09/02/2017

            I’ve been in a similar situation

            I was at a rock festival recently with 3 friends. We’re all pushing the late 30s.

            As a result of out age, poor fitness, and the summer heat, we headed inside to the beer pavilion and literally napped on the concrete floor.

            About 20 minutes in to the nap we were awoken by some people who accused us of being affected by drugs, and that we should be ashamed at our age etc. turns out they were out of state police officers, otherwise I’m sure they would have been exerting their authority on the situation. Instead they received some polite invitations to spend some “quality time” with themselves, plus many other colourful phrases. I was acutely aware that had these guys been policing the event, rather than attending as patrons, their attitudes and behaviour would have meant the interchange would have gone the other way …. And I definitely would not have had the moral high ground.

          • Andrew
            09/02/2017

            Pretty similar attitude to what I experienced.

            Seems like there’s a police blitz on puffing, red, fat old blokes. Down with this sort of thing.

          • Ronky
            09/02/2017

            Seems like the off-duty cops were doing some very responsible harm minimization. And they apparently got roundly abused for their trouble by you and your ignorant mates. Are you suggesting that the cops should have just assumed everything was OK and ignored you? No doubt they could see the potential headlines the next day “Man dies of OD at rock festival – callous cops saw him passed out on the floor but did nothing to help.”
            And if at your age you need to have a nap on the floor in a public place, I suggest you’re more than just unfit, you seriously need to see a doctor. That’s just not normal.

          • Jarrod McMaugh
            22/02/2017

            You clearly haven’t been to a 14 hour rock festival.during 40.degree heat.

            It is exhausting, and it is very common for people to rest between sets for the band’s they want to see.

            So to break it down, off-duty police from another state decided to interrupt our very common behaviour of resting during a long hot day just because they thought everyone around them was on drugs. That isn’t reasonable. Even if it was, the method to use would be to enquire about our well-being, not accuse us of drug use with no evidence or provocation.

            Your response shows that you aren’t interested in real discussion here – you just want to tell everyone they’re wrong.

          • Ronky
            22/02/2017

            I’ll ignore your parting insulting and plainly false accusation and continue rationally discussing the issues.
            If I was silly enough to willingly spend 14 hours out in 40 degree heat (and pay for the privilege!) I wouldn’t be boasting about it.

            I can certainly understand resting during a long hot day. But you didn’t say you were just resting, you said you “literally napped on the concrete floor” of a public bar (despite the continuing extremely loud music from the bands that you didn’t like).
            It is personally reasonable behaviour on seeing someone in such a situation to wake him up and enquire what if any drugs he has taken. In fact would be unreasonable NOT to do so. You don’t wait for any other “evidence or provocation”. If you claim to be unaware that illicit drug abuse in such situations is extremely common, you are unbelievably naïve.

            More likely it seems you have an irrational prejudice against all police who you seem to think can’t ever possibly do anything right, even in off duty Good Samaritan situations. I repeat, harm minimization does NOT mean legalization of drug abuse or pretending that’s it’s legal. Nor does it mean demonizing people (and even animals!) who are enforcing the law.

  3. David Bryant
    02/02/2017

    Does anyone think that after having purchased a pill for $20-50 and then having it tested,the tester tells them it contains a number of possibly toxic compounds will the person dispose of this pill safely or will they take it nonetheless? The people making these pills care about one thing, money! If they can take short cuts, they will, after all they are criminals. Even after having the pill tested I would guess that many will still take it, even if they were advised against it. The only possible “benefit” of pill testing is that the “quality” of the pills may improve and the price will go up. I’m all for evidence based harm minimisation and we need more evidence that pill testing will reduce harm.

    • Andrew
      02/02/2017

      Hi David,

      >>>>Does anyone think that after having purchased a pill for $20-50 and then having it tested,the tester tells them it contains a number of possibly toxic compounds will the person dispose of this pill safely or will they take it nonetheless?

      There’s plenty of evidence showing what people actually DO;

      “…..when presented with a ‘bad result’, two thirds of people say they will not consume the drug and will warn friends”

      http://www.emcdda.europa.eu/html.cfm/index1577EN.html

      “……a test indicated an ‘unknown’ substance found that 76% reported they would not take it”

      http://www.sciencedirect.com/science/article/pii/S0955395906001058

      >>>>>after all they are criminals

      First and foremost they’re business people. If you’re selling a low-quality product your consumers are unlikely to shop again and you’ll make no money.

      >>>>>The only possible “benefit” of pill testing is that the “quality” of the pills may improve and the price will go up

      I’m not aware of any evidence showing price changes in response to pill testing – do you have any?

      There is literally no excuse for opposing pill testing – especially from a public health and utilitarian perspective. “Play stupid games, win stupid prizes” is tacitly approving of our young dying from a wholly preventable cause.

  4. Campbell Gradon
    06/02/2017

    Here are a few points to consider from the pro testing camp.

    The legal status of drugs has little bearing on people’s tendency to take said substance. If the legal status of heroin was switched to be decriminalized then usage would not shoot up otherwise Portugal would now be worse off than pre decriminalisation, instead it’s now lower.

    MDMA as a recreational drug causes less harm than alcohol.

    Pill testing causes reduced consumption of pills and improves consumer safety. If the only end result is that dealers sell better quality pills then public safety is the winner.

    Pill testing would have prevented the death of the pharmacist at stereosonic in august 2015.

    Pharmacists are most likely the best health care professional to offer pill testing and be able to address the results.

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