Victorian coroner recommends drug checking

Today the Coroners Court of Victoria released its findings into a cluster of five drug-related deaths that occurred across Melbourne between July 2016 and January 2017.

The five young males, aged between 17 and 32, were all found to have consumed an unusual combination of two new psychoactive substances, 25C-NBOMe and 4-FA. Most of the deceased thought they were taking MDMA.

Coroner Paresa Spanos has recommended the Victorian government implement a drug checking service as a matter of urgency. This is a service where people could find out the content and purity of drugs alongside a meeting with a health-care worker to talk about their drug use and test results.

She also recommended Victoria implement a drug early warning network. Data from the drug checking service could be cross-checked with other information we have about what drugs are out there, triggering alerts to warn people if an unusually dangerous substance is circulating.

As an expert witness to the coronial inquest, I argued that more timely communication about the dangers of this drug combination to the public may prevent tragedies like these in the future.

Read the rest of my commentary at The Conversation.

I am available for media inquiries on 0407778938. Please leave a text message if I don’t answer immediately.

Some of the suspected NBOMe/4FA capsules photographed by an anonymous community member, January 2017
Images of the suspected NBOMe/4FA capsules provided to me by an anonymous community member, January 2017

What might a completely digital research project look like?

In the last 6 months, many researchers (including research students) have had to adapt their research designs to make them COVID compatible. For many this move has been to digitise their methods. Can we interview people via Zoom calls? How can we recruit if we can’t actually enter the target setting, like the hospital or the public space?

As someone that has been working in primarily digital spaces for the bulk of research career, I don’t really need to do this pivot! Mostly, my work is already fully COVID compatible. (Although, ironically, I had just had a project approved in November 2019 that did involve in-person data generation, and now am having to change this to online workshops!).

I draw on my experiences doing digital social science research for nearly 20 years, with a focus on illegal drugs, mainly but not exclusively with people who use drugs recreationally.

Digital technologies provided a way of reaching this population. They are considered hard to reach because they do not typical come into contact with health, justice, and social services. In the 2000-2010s, web forums were a popular location for group discussions either directly about drug use or more tangentially in relation to settings of use, like dance music festivals or nightclubs where drugs are typically consumed.

In the early 2010s, the first darknet markets emerged, where drugs are traded in ebay like marketplaces accessible through anonymising software, e.g. Tor. These spaces not only functioned as marketplaces but also had web forums which hosted discussion between market participants who typically were also people who consumed drugs. Drug use and harms discussion also takes place in these settings, in addition to discussions about the marketplaces themselves.

In the later 2010s and into 2020, the digital ecosystems within which we are living in have shifted such that big tech companies – Facebook, Google, Twitter – are major players in how people can discuss drugs and associated issues in digital spaces.

Here I wanted to reflect on three different aspects of my digital research practices that may assist people facing this COVID methods pivot.

Cross-sectional transnational anonymous web survey
During the last 6 months, at Global Drug Survey, we decided to launch a special edition of the annual survey that focused on how drug use may have changed over the period of lockdown – in our survey this was Apr-May-June of 2020. We just released findings last week, here’s an Australian findings summary. You can read more about how we do GDS here. To summarise, the GDS survey is anonymous, the GDS organisation is independent (so can be nimble in responding to new drug trends), and we rely on partnerships with media and community organisations to promote the survey and return findings to those organisations rapidly.

I’m also part of the Global Cannabis Cultivation Research Consortium. Just this month we launched our second global anonymous survey of cannabis cultivators (if you are, or if you know, a cannabis grower – do check it out!). The first one was conducted in 2012-2013 when the policy landscape of cannabis was quite different to 2020. We have written about the specific challenges of transnational digitally mediated survey research here.

Text chat qualitative interviews
During my PhD in 2008, I used text chat programs to do qualitative interviews with young people who were involved in online forums where drugs were discussed. They were typically also engaged in the dance music and clubbing scenes. You can read more about that method here. Back in 2012, my conclusions were that people who use drugs found online interviewing to be “an acceptable and convenient way to contribute to research” and that “[w]ith adequate preparation to develop technical and cultural competencies, online interviewing offers an effective way of engaging with young people that is worthy of consideration by researchers in the alcohol and other drug field”.

Since then I’ve supervised students and have led an NHMRC funded project which employed these methods successfully. Dr Jodie Grigg used encrypted chat interviews with a similar population in 2016, Michala Kowalski used encrypted chat interviews to interview people who bought drugs from darknet markets in 2018, and Robin Van Der Sanden is currently interviewing people who report buying or selling drugs using social media apps or platforms in 2020. Jodie, Michala and Robin are all utilising the wickr platform, as unlike any of the alternatively, wickr does not require that the interviewer have the phone number of the interviewee. This makes it possible to conduct truly anonymous interviews.

Digital engagement with research sites and/or communities
Back in the 2000s doing my PhD about online forums where drugs were discussed, I noted that there were very different reactions by online communities to research. It ranged from actively welcoming, to supportive, to neutral, to actively opposed! I’ve written about my experiences engaging with these digital communities here.

Increasingly, the data generated by individuals in digital spaces becomes the data that can be utilised for research. We need to ask some important questions though. Who owns the data? Who should we be engaging here? My approach has typically involved an active engagement of people and groups: I’ve written about this approach with my colleague and friend Dr Alexia Maddox in this paper. As just one example, the approach of the digital community is outlined here and here.

A paper decades in the making

The following questions are posed in our article “Coming Out”: Stigma, Reflexivity and the Drug Researcher’s Drug Use, published today in Contemporary Drug Problems. Download the accepted version here.

Should drug researchers who have direct personal experience of taking illegal drugs discuss these experiences in their work?

Are experts at least partly impaired in their understanding of drug use if they do not have that key component of expertise — personal experience?

Should researchers be open about their own personal experiences of drug use and the role these experiences have played in shaping their own research?

Why might it be important for drug researchers to publicly disclose their own drug use when it comes to engaging with policy makers and with the public at large?

Is it possible that by widening the concept of who uses prohibited substances we can break down the othering that occurs in public discourse and in public policy?

Conversely, by staying quiet about our use of prohibited substances, do we not perpetuate a false dichotomy between the researcher and the researched?

What are the implications of privilege and intersectionality for decisions about whether and how to disclose drug taking and drug use identities?

In short – Are we ready to come out?

In announcing the publication of this journal article today in Contemporary Drug Problems, I’d like to thank a few people. My co-authors, Anna, Judith and Gary, with whom I have had the pleasure of discussing this topic and nutting out a shared position for around 4 years now. My husband and family, for supporting my engagement with this topic and supporting this rather unusual career of mine. A much wider network of colleagues and mentors who have supported my work. And you, the readers, with who I look forward to further discussion once you’ve had a look at what we have written.

Are blogs even a thing anymore?

I began this blog in 2010, when the internet looked a little bit different to today. But I’ve just gotten a new job at RMIT University (hello again Melbourne!) and I’ve decided there is still a role for the humble blog. I’ve even renamed this website from the quaint sounding ‘Drugs, Internet, Society’ to ‘Drugs in Digital Society’. Perhaps in 5 years I’ll just say ‘Drugs’. Perhaps we are already so embedded in the digital that it almost ceases to be a thing that we speak of – it’s more like the air we breathe these days. (See The end of cyberspace).

I look forward to sharing more of my stuff with you in the months to come!

Pill testing is still a great idea, if we use the right equipment

Andrew Leibie (Pill testing sounds like a great idea, but there’s a catch, Sydney Morning Herald, 20/1) argues that pill testing is flawed. The technology is not accurate or reliable. It can’t detect all ingredients in pills, including some of the new drugs that are active in micro-doses. It can’t provide data on dose or concentration. He also argues that the evidence from countries where pill testing is conducted shows that it doesn’t work. He concludes that “the reality is that pill testing kits will never be able to detect all the illicit drugs entering the community”.

Many of the statements Leibie makes are factually correct. The problem is that he makes a number of assumptions about what pill testing is and how to evaluate it.

Image: Energy Control

First, let’s start with a summary of what we are talking about. ‘Pill testing’ (or drug testing) is a service that invites ordinary citizens to anonymously submit samples of illegal drugs for forensic analysis, and provides individualised feedback of results and counselling as appropriate. This kind of testing service has been operating in some form for 50 years across multiple countries around the world, with the longest running services operating in Austria, the Netherlands, Switzerland and Spain.

Leibie assumes that ‘pill testing’ involves colour reagent test kits. But pill or drug testing services acknowledge that testing kits as a main testing tool are poor technology. They only use test kits as their main tool when they don’t have access to better technology, due to lack of funding or government resistance to their operation.

Fully funded pill testing services use proper laboratory equipment. Mobile laboratories in Switzerland and Austria can determine contents and purity comprehensively in less than 30 minutes, with a minority of samples that require additional analysis sent to the main laboratory. In the UK, infrared spectrometers are used in the field, [edit: alongside other techniques, thanks Fiona Measham!] providing indicative results in less than one minute. Reagent test kits may be used to determine which next test to conduct. A suite of tools is needed depending on the drug, its form and whether there is evidence of multiple drugs.

Although testing services acknowledge the limitations of using test kits as the only analysis method, there is still important information that can be gleaned for consumers under specific conditions. For example, in the case of a pill sold as ecstasy or MDMA, the use of a Marquis kit can definitely tell you whether or not an MDMA-like substance is present can definitely tell you when there is no MDMA-like substance present and can be used to rule out MDMA as a possible component [edit: thank you to Earth Erowid]. For the consumer who is not interested in consuming anything but an MDMA-like substance, a negative result on the Marquis will prevent the use of the unknown substance. In many surveys of people who use drugs, including a recent survey that I led of 800 Australian festivalgoers (paper under review), the vast majority say they would discard a drug in this scenario. This decision could save their life if the drug they were about to consume was high dose NBOMe or PMA.

Yes, I agree with Leibie that there are scenarios where the use of test kits alone is problematic. One such scenario is where Ecstasy/MDMA is combined with another potent drug, like an NBOMe, as mentioned by Leibie. In this instance test kits would indicate an MDMA-like substance, leaving the consumer in the dark about the NBOMe. Another scenario is a pure MDMA pill that is high dose, with reagent kits unable to provide purity or dose information. These flaws underscore the importance of governments supporting the use of more sophisticated laboratory equipment in the field. They are not an argument against pill testing altogether.

Leibie also implies that testing has to be fast in order to be acceptable to the target group. We asked festivalgoers in our survey how long they would be willing to wait. Most were willing to wait half an hour, and many were willing to wait days or even weeks to find out what is in their drugs. A testing service does not just have to be stationed at a festival. It can also be available through fixed site booths, as it is conducted in the Netherlands, where people can have drugs tested in the late afternoon in preparation for their activities that evening or the next weekend.

It is absolutely true that reagent tests are not comprehensive. And this is why we need to fund access to laboratory-grade equipment to find out quickly what is contained within particularly lethal batches. A rapid turn-around of information from a credible source can make a difference. For example, in the Netherlands, a pill was identified through their testing service with high dose PMMA in late 2014, just prior to New Year’s Eve. Dutch services distributed warnings widely and no deaths were reported. Unfortunately the UK did not have a similar warning system and recorded 4 deaths due to consumption of this same pill.

Which leads me to the most inaccurate part of Leibie’s piece. His depiction of the UK is nonsense. Firstly, the UK did not have a pill testing service in 2015. Secondly, even now, the UK has one service, The Loop, which conducts testing at a handful of events. It is nonsense to try and evaluate the effectiveness of The Loop by pointing to one statistic about the number of NPS related deaths across the whole country a full year before any testing had been conducted in that country.

The technology is available for an Australian testing service to test samples and disseminate accurate information that could help people avoid harms and help health workers treat people more effectively. There should not be a need in this country to use old technology to provide a substandard service, unless governments continue to ignore the needs of people who use drugs in our community. Until that point, test kits and online reports will be the best information people have, with all their flaws.