Drug checking for Victoria – it’s time

This week, I co-led the launch of a public campaign to urge the Victorian government to implement drug checking in Victoria. We launched a statement signed by 77 organisations on the steps of parliament on Monday. The statement was led by VAADA and written by myself and Isabelle Volpe from RMIT University. Harm Reduction Victoria and Students for Sensible Drug Policy also contributed to the campaign, and on the day we also heard from Debbie Warner, from Apod Support representing the family perspective, and Daniel Robinson Croft, youth advocate at YSAS.

The Victorian statement demonstrates support from a wide range of social and community organisations. These include professional societies representing medical and pharmaceutical sectors, such as the Royal Australian College of General Practitioners and the Pharmaceutical Society of Australia.

Isabelle and I also published a longer article in The Conversation on Monday about this campaign and the argument for drug checking.

Following is a selection of the media coverage:

  • Neil Mitchell, Oct 23, 3AW Melbourne, Mornings with Neil Mitchell,  ‘‘Simple and pragmatic approach’: The push for a ‘drug checking’ system in Melbourne’, 8:34am. HTML.
  • Raf Epstein, Oct 23, ABC Radio Melbourne, Melbourne Mornings, ‘Victorian health organisations call for drug testing to reduce deaths’, 8:50am. HTML.
  • Ewa Staszewska, Oct 23, SBS News, ‘Debbie’s son overdosed. She thinks this state’s push for drug testing is a ‘no brainer’’. HTML.
  • Frank Bonaccorso, Oct 23, 2ser 107.3 and The Wire, ‘Health agencies urge Victorian government to implement drug testing’. HTML.
  • Monique Patterson, Oct 24, The Standard, ‘WRAD Health backs call for drug checking system to save lives’. HTML.
  • Will Keech, Oct 26, Geelong Advertiser, Groups in push for drug testing. Bid to stop overdoses, p. 18. Also ‘‘Concerned’ Geelong organisations sign statement in support of drug checking’, HTML.
  • Jenny Denton, Oct 26, Bendigo Advertiser, ‘BCHS lends voice to call for pill testing to prevent overdoses’. HTML.

Special issue of Drug & Alcohol Review – music festivals

As Deputy Editor for Drug and Alcohol Review, I was asked to write an introduction to a virtual special issue collecting papers from the journal published in the last 4 years on this topic. The papers are available for free download here.

The full introduction is reproduced below:

Dance music festivals are typically outdoor events where electronic dance music is performed to large crowds of festivalgoers. These events have emerged as sites of alcohol and other psychoactive substance use, particularly MDMA (or ‘ecstasy’), other stimulants, as well as psychedelic drugs. While some such festivals are single-day events (typically held in urban locations), they are commonly held over multiple days in non-urban locations, with attendees typically camping at the event for 3 to 5 days (sometimes longer). This virtual issue of Drug and Alcohol Review contains 11 papers published in the journal since 2018 on the topic of alcohol and other drug use and harms, and associated policy and monitoring responses, in these festival settings.

Seven of these papers engaged with populations of festival attendees, typically through surveying them to collected self-reported information [1-7]. The typical age of surveyed festivalgoers was young, with median and average ages in the mid-20s across all studies [1-7]. Four of these studies involved in-situ data collection [4-7] – that is, festivalgoers completed the surveys at the festival they were attending – with the remaining three studies conducted through web surveys that asked people to recall and report on their behaviours at previous festival attendances [1-3]. Only one of these studies combined biological measurement with self-report, and in this study, only the use and markers of alcohol consumption were measured [7]. Illegal drug use, and specifically the use of MDMA, was the focus of the remaining 6 studies of festival attendees [1-6]. Event-based measurement – that is, where questions are focused on characteristics of a specific event (usually the current event or the most recent event attended) – was employed among 3 studies [3, 5, 7], while the use of scenarios and measurement of future intended behaviours was employed by 3 studies [1, 4, 6] – all exploring hypothetical responses by festivalgoers to scenarios where drug checking services were available.

Of the 7 articles reporting research with festival attendees, 4 studies were measuring patterns of alcohol and other drug use [2, 3, 5, 7]; in particular, higher-risk behaviours and harm reduction practices. Two papers confirm that double dropping – taking two (or more) MDMA pills or capsules simultaneously – is prevalent among Australian festivalgoers, with Grigg et al. [3] reporting 48% of festivalgoers (who used MDMA) double dropping at the last festival they attended (data collected 2016) and Healey et al. [5] also reporting 48% double dropped (or intended to do so later in the day) at the festival event where they were surveyed (data collected 2019-2020). Healey et al. also reported on the practice of preloading: consuming all of their drugs prior to entering the (single-day) festival. Of the festival-goers who reported drug use during the festival, 33% reported preloading. This behaviour appeared to be related to how the festivals they attended were policed. Those who agreed that knowledge of or anticipation of police or police dog presence at the festival had altered their drug use patterns were at over double the odds (adjusted odds ratio 2.2) of reporting preloading their drugs before entering the festival. While double dropping practices may be based on past experiences of MDMA pills being relatively weak in Australia, with the rise of high strength pills and capsules, double dropping is much more likely to result in MDMA toxicity. Healey et al.’s findings that preloading with drugs prior to events is commonplace and is a response to policing practices is concerning and should spur more urgent action to overhaul such the relatively heavy-handed policing practices that occur at music festivals in Australia.

The web survey of an international sample of festivalgoers (primarily from Spain, USA and Australia) reported by Fernández Calderón et al. [2] focused on harm-reducing practices, such as avoiding mixing depressants (69%) and limiting the quantities of drugs consumed (62%). Overall, fewer adverse health events were reported by respondents who also took harm reducing measures. Norman et al.’s [7] study used multiple measures of alcohol drinking over a prolonged drinking event, finding that a diverse set of 4 measurements contributed unique and valuable information. Importantly – while only conducted with 14 participants – this study demonstrates feasibility of continuous alcohol monitoring and the use of unobtrusive biological techniques among the festivalgoer population.

The remaining 3 papers that engaged festivalgoer populations were focused on how people might respond to a drug checking service [1, 4, 6].  Taken together, in the Australian context where drug checking has been formally available at only two single events in the ACT [8], these studies indicate a strong desire to use drug checking services if available, with an on-site service (94%) somewhat more popular than a fixed-site or off-site (external to the festival) service (85%) [1]. Lack of support for drug checking from government and police was a considerable barrier, with 94% reporting that they would not use a service if there was the possibility of arrest [1]. One political barrier to drug checking introduction has been the contention that drug checking services would increase the use of MDMA among this population, by ‘giving the green light’ to use drugs. Two of these studies provide data to refute this contention [4, 6].  Hollett and Gately [6] found that both people who had never used MDMA and people with MDMA experience reduced their MDMA risk across on-site and fixed-site drug checking scenarios; however, they noted that people with MDMA experience were less likely to reduce risk than MDMA naïve participants in some situations, for example, when the hypothetical drug checking result showed a high strength MDMA pill or a pill substituted with PMA/PMMA. It may be that certain risks (higher strength; PMA/PMMA) may be perceived as less concerning to those with more experience then to those who are MDMA naïve. Murphy et al. [4] report that neither group (MDMA experienced and MDMA naïve) reported an increased intention to use MDMA in scenarios were drug checking was available. Subjective norms (e.g. items like “Most of my ecstasy-using friends tell me that I should test/check the content of my pill before I use ecstasy” [9]) were associated with intended use of both on-site and fixed-site drug checking services. These studies also found that festival goers were willing to co-pay for a drug checking services – $12 [6] or $10 [1] for an on-site test.

The remaining 4 papers that did not report on festivalgoer populations all focused on the topic of drug checking at music festivals, and included: a representative survey of the Australian population measuring attitudes towards drug checking at music festivals [10], two policy analysis papers on the topic of drug checking in the Australian jurisdictions of NSW and the ACT [11, 12], and one paper from Italy reporting descriptive drug sample data from an operational drug checking service [13]. Through these papers we learn that almost two-thirds of the Australian public (64%) support “pill testing at music festivals” while 22% are opposed, 14% neutral and 1% did not answer. Political affiliation was associated with support, with voters for the two main Australian conservative parties the least likely to support this initiative [10]. The two policy analysis papers utilised document analysis to create detailed timelines of critical policy and advocacy events, utilising news coverage, transcripts of television specials on the topic of drug checking, parliamentary transcriptions and reports [11, 12]. Ritter’s analysis of the debate in NSW synthesises the narratives used by those in favour and those opposed to drug checking, finding that both sides appeared to share a basic goal of ‘saving lives’ but as the beliefs and values underlying this goal differed, the debate continued to remain polarised [11]. Sommerville et al. compared one jurisdiction who had successfully supported drug checking (ACT) with one that had failed to do so (NSW) using the Advocacy Coalition Framework [12]. The key difference identified was that the dominant coalition in ACT was health-led, whereas the dominant coalition in NSW was led by law enforcement. For policy change on drug checking to occur in NSW, both core and secondary beliefs of the dominant law enforcement policy required shifting, a shift that rarely occurs [12]. The final paper in this special issue reported on an active drug checking service in Italy in the festival and party context, focusing on the drugs detected and the use of a Raman spectrometer in the field [13]. Raman instruments are often used for policing application (e.g. the “TruNarc”) and are rugged, field-deployable, are not required to touch the drug sample directly and provide fast results. However, the Raman fails to identify substances when present in low quantities or when a novel substance was not available in its spectral library [13]. Raman instruments are likely to be useful among a suite of analytic tools used in drug checking services, rather than as a stand-alone instrument.

This collection contains only 2 papers from outside of Australia – but it should be noted that Drug and Alcohol Review has also recently published Canadian papers on drug checking (just not in a festival context) [14, 15] as well as papers related to similar drug use practices but within the nightclub setting, e.g. in New York City [16-18].

This showcase of festival-related research provides some pertinent information relevant to advocates and policy makers. It demonstrates that the lack of drug checking in most parts of Australia cannot be blamed on a lack of evidence or on a lack of public support. Indeed, the lack of uptake of drug checking may be much more associated with a clash of values and the location of where the most political power currently lies, that is, within coalitions of partners aligned with law enforcement. As festivals begin to emerge again after the easing of pandemic restrictions on large gatherings, we may see further pushes for policy reform, especially in the event of deaths that could be prevented by service provision as well as public drug alerts derived from checking services.

Dr Monica Barratt
Senior Vice Chancellor’s Research Fellow, RMIT University, Melbourne Australia
and Deputy Editor for Drug and Alcohol Review
References
  1. Barratt MJ, Bruno R, Ezard N, Ritter A. Pill testing or drug checking in Australia: Acceptability of service design features. Drug Alcohol Rev 2018;37:226-36.
  2. Fernández Calderón F, Díaz Batanero C, Barratt MJ, Palamar JJ. Harm reduction strategies related to dosing and their relation to harms among festival attendees who use multiple drugs. Drug Alcohol Rev 2019;38:57-67.
  3. Grigg J, Barratt MJ, Lenton S. Double dropping down under: Correlates of simultaneous consumption of two ecstasy pills in a sample of Australian outdoor music festival attendees. Drug Alcohol Rev 2018;37:851-5.
  4. Murphy S, Bright SJ, Dear G. Could a drug-checking service increase intention to use ecstasy at a festival? Drug Alcohol Rev 2021;40:974-8.
  5. Healey A, Siefried KJ, Harrod ME, Franklin E, Peacock A, Barratt MJ, et al. Correlates of higher-risk drug-related behaviours at music festivals in New South Wales, Australia. Drug Alcohol Rev 2021 [Epub ahead of print]. https://doi.org/10.1111/dar.13404
  6. Hollett RC, Gately N. Risk intentions following pill test scenarios are predicted by MDMA use history and sensation seeking: A quantitative field study at an Australian music festival. Drug Alcohol Rev 2019;38:473-81.
  7. Norman T, Peacock A, Ferguson SG, Kuntsche E, Bruno R. Combining transdermal and breath alcohol assessments, real-time drink logs and retrospective self-reports to measure alcohol consumption and intoxication across a multi-day music festival. Drug Alcohol Rev 2021;40:1112-21.
  8. Olsen A, Wong G, McDonald D. ACT Pill Testing Trial 2019: Program Evaluation. Canberra, ACT: Australian National University; 2019.
  9. Davis AK, Rosenberg H. Using the Theory of Planned Behavior to predict implementation of harm reduction strategies among MDMA/ecstasy users. Psychol Addict Behav 2016;30:500-8.
  10. McAllister I, Makkai T. The effect of public opinion and politics on attitudes towards pill testing: Results from the 2019 Australian Election Study. Drug Alcohol Rev 2021;40:521-9.
  11. Ritter A. Making drug policy in summer—drug checking in Australia as providing more heat than light. Drug Alcohol Rev 2019;39:12-20.
  12. Sommerville K, Ritter A, Stephenson N. Pill testing policy: A comparative analysis using the Advocacy Coalition Framework. Drug Alcohol Rev 2021 [Epub ahead of print]. https://doi.org/10.1111/dar.13352
  13. Gerace E, Seganti F, Luciano C, Lombardo T, Di Corcia D, Teifel H, et al. On-site identification of psychoactive drugs by portable Raman spectroscopy during drug-checking service in electronic music events. Drug Alcohol Rev 2019;38:50-6.
  14. Borden SA, Saatchi A, Vandergrift GW, Palaty J, Lysyshyn M, Gill CG. A new quantitative drug checking technology for harm reduction: Pilot study in Vancouver, Canada using paper spray mass spectrometry. Drug Alcohol Rev 2021 [Epub ahead of print]. https://doi.org/10.1111/dar.13370
  15. McCrae K, Tobias S, Grant C, Lysyshyn M, Laing R, Wood E, et al. Assessing the limit of detection of Fourier-transform infrared spectroscopy and immunoassay strips for fentanyl in a real-world setting. Drug Alcohol Rev 2020;39:98-102.
  16. Kelly BC, Vuolo M. Nightlife scene involvement and patterns of prescription drug misuse. Drug Alcohol Rev 2020;39:888-97.
  17. Palamar JJ, Barratt MJ. Prevalence of reagent test-kit use and perceptions of purity among ecstasy users in an electronic dance music scene in New York City. Drug Alcohol Rev 2019;38:42-9.
  18. Palamar JJ, Le A, Acosta P, Cleland CM. Consistency of self-reported drug use among electronic dance music party attendees. Drug Alcohol Rev 2019;38:798-806.

Help inform harm reduction in the EDM space

We need your help!

Harm reduction group Energy Control – famous for their international and local drug testing services – have collaborated with Australia’s DanceWize to do some research into safer drug use practices. We will see how drug use patterns and safer use practices differ between Spain and Australia, countries with quite different policy settings.

If you have been to festivals or dance parties recently, please complete the survey and help harm reduction groups understand what’s really happening!

http://partyanddrugs.infoinnova.es/

Rainbow Serpent Festival
Rainbow Serpent Festival

The drug’s in the mail

Last week was a week of firsts for me: first time mentioned in The Age, first time a photo of me was printed in The Age, first time I have spoken on radio (3AW) and first time I’ve appeared on national television (The Project, Network Ten). As regular readers of this blog will know, I’ve done a bit of media training but haven’t had much of a chance to put it into practice. Now at least I’ve done these things once, I’ll have a better chance of preparing and understanding what’s required for next time 🙂

Journalists who tackle drug stories often get a bad rap – they are often accused of sensationalist, one-sided reporting. I want to congratulate the journalists I worked with on these stories as I feel they represented my views accurately. While there is always a dose more ‘drama’ in these stories than I am comfortable with, I don’t think these stories were over sensationalised and they were largely accurate in their reporting. So, thanks to the journalists involved. Looking forward to working with you again in future.

Read The Age article: original link, archived link.

Listen to the 3AW radio segment: original link, archived link.

Watch The Project: original link (it’s after the ‘global news’ segment), archived link.

Dangerous, manageable or hard-core?

The unfortunate death of a 20-year-old Sydney woman in 2007 provided a catalyst for my analysis of how online drug-using communities defined PMA and ecstasy. PMA or para-methoxyamphetamine is structurally similar to the phenylethylamines (MDxx) and mescaline. It is a hallucinogenic stimulant with a low threshold for overdose, making it definitively more dangerous than pure MDMA. Most, but not all, use of PMA is inadvertent, as the users believe they are consuming an MD derivative when they buy pills sold as ‘ecstasy’, but the pill actually contains PMA.

Annabel Catt’s death in 2007 followed her ingestion of ‘ecstasy caps’ which were later found to contain PMA. Her friends did call an ambulance but Annabel died later in hospital due to overheating and respiratory failure.

There were a range of public responses to Annabel Catt’s death. Police warned the public about the dangerousness of all illicit drug taking. Toxicology results were released indicating PMA in Annabel’s system and police released the testing results from seized capsules and pills indicating that there were PMA batches in circulation at the time.

Bluelight.ru and Pillreports.com issued warnings to their users about how to deal with pills sold as ecstasy and PMA. Australian Bluelight moderators wrote an email on the topic which was also distributed across many of the forums I was monitoring. The re-posted email generated much discussion across these different groups.

I identified three different discourses around ecstasy and PMA in these responses, as indicated in the title of this post: dangerous, manageable, and hardcore.

The first discourse ‘A dangerous drug’ is a familiar, dominant discourse that positions all illicit drug use as inherently aberrant. This discourse underpins prohibition and it disrupts attempts to reduce harm by denying any possible lower-risk drug use. The ‘dangerous drug’ discourse is problematic because within it, the notion of pleasure is absent, and all drug use, regardless of context, is positioned as problematic. This discourse was found mainly in the media and police public responses to Annabel Catt’s death.

The second discourse ‘harm reduction’ recognises that people will continue to use drugs, that some drug practices are riskier than others, and that people who use drugs can and should act to reduce risks. Drug-related harms are seen as manageable. The harm reduction discourse draws on notions of neoliberal self-responsibility; that is, individuals must look after themselves and ‘do the right thing’, especially in relation to keeping themselves healthy. There was also a communitarian ethic present in the harm reduction discourses around taking responsibility to look after your friends. The harm reduction discourse was the dominant discourse in the drug-user online settings involved in this project.

The third discourse redefined the ‘dangerous drug’ or ‘manageable risk’ as ‘fun’. Rather than being a reason to avoid PMA, the fact that it was described as a ‘strong psychedelic stimulant’ was seen as a positive or as a challenge. For the drug users employing this discourse, pleasure and fun were privileged above risks and harms. In fact, pleasure and fun may indeed derive directly from the riskiness of a drug practice. For these individuals, defining PMA as ‘fun’ or ‘hard-core’ can be seen as an act of health resistance and using PMA intentionally can be seen as an act of defiant consumption, and the rejection of neoliberal values and the health imperative. The ‘PMA sounds fun’ discourse was present in the responses to the Bluelight email re-posted to the numerous dance music forums involved in this project.

These three discourses illustrate that drugs are more than their pharmacology: their effects and meanings are under construction and online settings are one place where that ongoing negotiation of meaning occurs. The implication for drug policy is that we cannot assume that if people were ‘better informed’ they would choose not to use drugs. Pleasure and fun may be more highly valued than health in some cases. We need to think further about how to include people who are actually attracted to danger in our frameworks, rather than assuming that everyone is determined to look after themselves.

At the APSAD in Hobart, I presented a paper from my PhD called ‘PMA sounds fun’: Negotiating contested meanings of PMA in online settings. You can view the 15 minute vimeo here. This article is a shorter summary of this work: I am working on the full paper which will be submitted for peer-review in the next month. This article has also been reproduced at Global Drug Survey, where I am now part of the international advisory committee.

Communities and Technologies presentation

I’ve just presented at #comtech2011

Here is the Prezi – which you can use/edit yourself if you like.

Here is the video I made for my dry run yesterday on Vimeo.

Thanks C&T – it’s been a fantastic experience, and I’ve met some amazing people and have definite plans for future collaborations.

More on that after my Qld holiday!

Video of 6DYP conference presentation

I recorded the audio of my presentation on 4th May at the 6th Drugs and Young People conference, and now I have recorded it alongside the Prezi into a movie. Please ignore the beginning with 12 seconds of black screen. My video editing skills are novice but I’m hoping to continue this kind of thing so all presentations I do in public will be recorded and disseminated on my Vimeo channel at http://vimeo.com/tronica

Drugs, Internet, Censorship from Monica Barratt on Vimeo.

Drugs, the internet, and the internet filter #6dyp

I’m presenting this today. In case you can’t be there, or were there and want to follow up any of the points I made, here’s the presentation! Remember to press ‘full screen’ 🙂

All comments warmly welcomed!

LINK

Australian Drugs Conference 2010

Today I attended Day 1 of the Australian Drug Conference 2010. The conference focus was ‘Public health and harm reduction’. I certainly felt at home in this environment: where public health, human rights, harm reduction, law reform and the involvement of people who use drugs in policy and practice were emphasised.

We have had some recent successes in Australia that were celebrated today: including the NSW state government’s decision to lift the trial status of Sydney’s supervised injecting centre. Other innovative harm reduction measures, such as peer-administered naloxone to prevent death from heroin overdose (Chicago, and in many other parts of the world), the ‘unsupervised’ provision of buprenorphine-naloxone substitution therapy (USA, France) and the decriminalisation of illicit drugs for personal use (Portugal), are yet to find acceptance in Australia despite positive results in other parts of the world.

I was particularly interested in the session called I found it online. Johnboy Davidson (Enlighten Harm Reduction) spoke about the proposed internet filter and what it might mean for online harm reduction, Cameron Francis (Dovetail) discussed the challenges of responding to new or emerging drugs using mephedrone as an example, and Stephen Bright (Peninsula Health) provided an overview of so-called legal highs and the law in Australia.

Some of the messages I took from this session include:

  • The censorship laws as they stand today could be applied to websites hosted in Australia, but generally at not enforced. Even so, websites disseminating instructions on safer injecting could be taken down if the laws about refused classification were actually enforced.
  • We need a workable early warning system to detect new and emerging drugs quickly. None of our current systems are quick enough to help people who use drugs and the people who work with them better understand new drugs: ways of reducing harm, specific risks, etc.
  • New drugs are quick to arise and quick to disappear – in part this is due to the legal roundabout whereby new ‘legal highs’ are marketed/used in Australia, then they are discovered by law enforcement, analogue laws are used/enforced, and the cycle begins again. (Or markets are driven by trends in larger countries like the UK, where the UK enacts legislation to ban the new substance, which precipates another new substances, and we begin again…).
  • Legislative approaches to controlling emerging drugs should be examined carefully. Are drug laws themselves fuelling the problem on both the demand and the supply side?

Some of my thoughts on these issues are that:

  • The internet facilitates and accelerates the process of new drugs emerging, but the internet is not the causal factor, and suppressing access to drug related information on the internet (as would happen under the proposed internet filter) will not necessarily reduce this facilitation. The consequences of the internet filter for drug users and drug markets needs some more careful thought: one scenario is that seasoned drug and internet users will still be able to find and share information in a clandestine fashion (using virtual private networks or peer-to-peer traffic) but the novice user casually searching google for information will not have access to important information for drug harm reduction. Yet, they will definitely still have access to websites selling ‘legal highs’ because these can keep changing their name/location as required…
  • People really need to look at the demand side of emerging drugs: addressing only supply will never change the desire to use drugs. We should ask the hard questions, like: ‘Is spending money/time reducing supply/purity of MDMA pills necessarily a good thing for public health?’ If we find that people displaced from ecstasy use decide to use emerging and mainly unknown drugs as substitutes, should we not reconsider the wisdom of this?

Thanks to everyone I chatted to today and I hope you all enjoy tomorrow’s sessions!