A fixed location pill testing site run by a pharmacist was among several options considered during a recent inquest into six deaths at music festivals
The inquest investigated the deaths of six patrons of NSW music festivals: Hoang Nathan Tran, Diana Nguyen, Joseph Pham, Callum Brosnan, Joshua Tan and Alexandra Ross-King. All died over the 2018-19 summer music festival season, across five different events.
In the case of each victim, post-mortem toxicology results showed an amount of MDMA in their blood at a toxic level, and in one case, that of Callum Brosnan, mixed drug toxicity – MDMA and cocaine.
Deputy State Coroner Magistrate Harriet Grahame said that “To fully understand why Nathan, Diana, Joseph, Callum, Joshua and Alex died it has been essential to learn as much as possible about their drug use at music festivals and to place that use in a broader context”.
“The illegality of MDMA and other drugs sometimes consumed at music festivals means that open discussion of these issues is often difficult or even impossible.
“It can be hard for the community to grapple with some of the underlying issues when drug use is illegal and drug users are stigmatised. It is difficult to properly explain the potential risks to young people if our only permissible message is ‘just say no’.
“While we continue to hide the true extent of drug use, it remains inherently more dangerous.”
Ms Grahame said that it was clear, given the evidence prevented, that more could be done to prevent MDMA deaths, including “a need to reframe our main priority from reducing drug use to reducing drug death”.
“There is no single solution, but there is strong evidence to support a range of initiatives, including drug checking and drug monitoring, strengthening peer support organisations, changing the way festivals are currently policed and improving the safety of the environments where festivals are held.”
The coroner noted that each of the five relevant festivals had been held over the summer period, some in extreme hot temperatures.
One consultant in clinical toxicology, clinical pharmacology and addiction medicine gave evidence to the inquest saying that one of the probable factors causing users to take large doses of MDMA in a single session was potentially the presence of police and police dogs.
While this presence does not do a good job of deterring young people from bringing drugs to festivals, there is evidence it can make people engage in such risky drug-taking behaviours, he said. Ms Grahame noted that this presence may be doing significant harm.
Ms Grahame also made observations about drug checking or pill testing, which she said “would seem to fall squarely within the government’s harm reduction policy framework and requires close consideration”.
“At the simplest level substances can be tested at home using a colour reagent test purchased from a pharmacist or sourced on the internet,” she noted. “These tests can be used by anyone and give only the most basic information.”
She said that it was interesting that these were currently popular and widely used.
“This appears to indicate a real interest in consumers to find out more about the substance they are planning on taking.”
Observing the current paucity of Australian data given only two small trials have to date been conducted (at the last two Groovin the Moo festivals in the ACT), she noted the commitment to the strategy on the part of harm minimisation proponents.
She cited evidence given by Dr David Caldicott, emergency consultant at the ACT’s Calvary Hospital and member of Pill Testing Australia, who said the aim of pill testing was to ensure that festival patrons are not harmed or killed by taking substances, and that with the information such a service can provide, the way potential consumers use their drugs can be changed – including, in some cases, deterring them from taking the substances at all.
“Dr Caldicott stated the trials demonstrated that drug checking can reduce the quantity of drugs consumed by individuals and the number of drugs consumed in a session, both of which are risk factors for overdose and death,” the coroner noted.
“In keeping with the overseas experience Dr Caldicott stated that the Australian pilots were demonstrating that there can be behavioural change when people are provided with accurate advice.”
He stressed that patients were never advised that a drug was safe, she observed.
“It became clear listening to the evidence that one of the most important aspects of drug checking, as it is conducted all over the world, is the possibility of providing a brief harm reduction intervention to the person who is intending to use drugs,” Ms Grahame noted.
As well as testing at music festivals, the inquest also heard about fixed site drug checking in international locations, including in the Netherlands, and the UK.
In the latter example, the first sanctioned drug checking service in the UK was set up as a small pilot earlier this year, in partnership with drug and alcohol service Addaction, with some training support from the LOOP UK.
“It was a limited trial, operating for four days over a four-week period between February to March 2019,” the coroner observed.
“The testing was performed on-site by pharmacist Dr Amira Guirguis, and her small team. Following identification of the sample content, the pharmacist and a health worker from the Addaction team would carry out a tailored harm reduction advice and undertake necessary interventions.
“Dr Amira Guirguis gave evidence that by undertaking drug checking in an existing drug and alcohol service, it attracted a broad range of people and a much wider level of support. Appropriate referrals were possible. Addaction staff could link people up with local support groups and tell them about the different activities and services that Addaction offers.
“People were able to get support from other organisations like mental health, housing, employment and social care because the staff are familiar with the area and what is available.”
Fixed drug checking services, potentially in community pharmacies, have been suggested in the recent past by a number of stakeholders.
The only interested party who indicated opposition during the inquest to a drug checking trial was the Commissioner of Police.
The Commissioner’s “vehement and sustained” opposition included an assertion that there was a lack of scientific evidence to prove pill testing would drive changed behaviour or reduce harm, and that there was a lack of interest in uptake.
The Commissioner also said the intervention occurred too late, when the patron was already committed to taking drugs.
“At the end of my reflection, I am in no doubt whatsoever that there is sufficient evidence to support a drug checking trial in this state (both on-site and fixed),” Ms Grahame said.
“In my view the evidence is compelling. Of course drug checking is not a magic solution to these tragic deaths. Of course its introduction will not guarantee further deaths will not occur.
“Drug checking is simply an evidence -based harm reduction strategy that should be trialed as soon as possible in NSW.”
She recommended that NSW permit a pill testing pilot at music festivals during the summer of 2019-20, as well as the establishment of a permanent drug checking facility.
She also recommended that the NSW Department of Health research and support evidence-based strategies to maximise the chance of reducing harm and saving lives when it comes to drug-related illness at music festivals, and that NSW Police remove drug detection dogs from festivals.
The Take Control campaign responded to the findings by urging the NSW Government for immediate reform to prevent deaths over the summer.
Take Control spokesperson and Ted Noffs Foundation CEO Matt Noffs said, “The Premier now has overwhelming evidence for pill testing and for a major health intervention in drug policy. It’s now her responsibility to do everything she can to save lives over the summer.”
Former federal police commissioner and Take Control spokesperson Mick Palmer said governments must start treating drug use as a health issue if they want to reduce harm.
“Locking people up who actually need healthcare doesn’t get the drug issue under control. If we are to help people, we need to rethink our approach. The coroner has presented a compelling fact-based argument for a different and more effective approach,” said Mr Palmer.
“Heavy police presence at music festivals does not prevent drug use. It only makes individuals less likely to exercise caution. Today’s findings confirm this and map out a path to safer drug laws.”
Meanwhile in Victoria on Tuesday, the Victorian Ambulance Union has made its own recommendations, which according to the Herald Sun are meeting those who are against pill testing – including the Victorian Government – “halfway”.
Rather than having patrons bring their drugs voluntariy to be tested, and receive a health intervention, this plan would involve testing seized drugs and then alerting other patrons if dangerous substances are tested.
The national campaign for safer, saner drug laws Take Control has welcomed the Victorian Ambulance Union’s support for pill testing but warns against removing the health and safety advice component.
Take Control criticised this approach.
“Delivering health and safety advice to young people in the pill testing tent is the most important part of the process. It’s that advice that can save lives and change behaviour,” said Mr Noffs.
“We welcome the support of the ambos who are on the frontline of our failed drug laws and look forward to discussing the details of a Victorian trial that can provide health and safety advice direct to young people.”