It’s Time To Face The Music On Australia’s Flawed Drug Policy

Nov 27, 2018

A few changes could make a real difference.

As a new year begins so does the effort continue to make Australia a safer and more humane country in how we deal with people who use drugs.

Here are five changes that would make a real difference.

1. Decriminalise the personal use and possession of drugs

The levels of harm confronting people as a result of being criminalised for possessing and using small quantities of illicit drugs is extremely disproportionate to the level of harm actually caused. The impact of our current drug laws is staggering: greater risks of HIV and other blood borne viruses, higher incarceration rates and a range of other health and social problems. In contrast, the experience of Portugal, which decriminalised personal drug use in 2001, provides a valuable lesson for other countries. Contrary to the initial fears of some, the results have been reduced drug use, reduced overdose fatalities, reduced incarceration and a range of other positive outcomes.

2. Introduce an early warning system for drugs

Currently in Australia we have no ‘real time’ early warning system to let people know about batches of drugs that are dangerous. Police in Australia send out warnings via media on occasion, but an early warning system where information on drugs is shared in real time between health workers, peer groups and the public doesn’t exist. It would be simple to establish with today’s technology and would also increase the level of safety for individuals and families.

3. Trial pill testing at festivals and venues

Pill testing involves using chemical analysis instruments to determine the content and purity of drugs to be consumed by people at venues and festivals, as well as other locations. Typically, the person about to consume the drug brings it for testing and is provided with an on-site analysis by experts. The person also receives information about the risks of consuming the substances identified and other services available.

The evidence is clear that the results of pill testing are profound and positive. In fact, some people decline to use a drug when a potential for physical harm is presented to them in a clinical manner by experts.

4. Introduce a heroin prescription program

There is clear evidence that methadone and buprenorphine are effective in the management of heroin dependence and they continue to have a central role in reducing injecting drug use and HIV. However, a small proportion of people who use heroin respond poorly to these programs.

International research has demonstrated that some heroin users given access to pharmaceutical heroin injected under supervision show a reduced use of street drugs and improved health and social functioning. The benefits of providing heroin prescription have been confirmed across numerous trials in North America and Europe. Most participants who enter this form of treatment have often lost all family support and are entrenched in a daily cycle of drug seeking and use. Receiving heroin on prescription is a powerful incentive for them to enter the treatment system.

5. Pilot triage rooms

A triage room is a centre specialising in the management and care of intoxicated persons. Its goals are not only improving the health outcomes for people with drug and alcohol problems but to also improve the safety and amenity of people working in hospital emergency departments and other members of the public utilising these services.

Currently, the majority of intoxicated persons discovered by police and paramedics are taken to hospital emergency departments. The environment they encounter often includes a busy setting, strong lighting and long waiting periods as they need to be observed for an extended period of time. This can be the catalyst for poor behaviour including occasional outbursts of violence. The triage room would be established as a stand-alone service in proximity to a hospital yet have a much ‘softer’ environment to assist in de-escalation and retention.

Paying for changes

Even if we ignore the savings that would be made in our law enforcement and health systems as a result of these changes, the question of funding these policy changes and new programs is still a fair one to answer.

So, rather than just decriminalising cannabis use and possession, we could establish a taxation and regulation regime for this market. This has already happened in a number of states in the USA over the past few years and the billions raised from such a regime would not only pay for these changes but also have other added bonuses. These include undercutting the synthetic cannabis market, which only thrives because of the current illegal status of cannabis, and reducing the potential for the millions of Australians that use cannabis being exposed to a black market and the range of other drugs it provides.

Let’s hope 2017 is the year that evidence begins to trump fear in drug policy.

 

Original post can be read here

NCA’s decision on pill testing betrays public trust

Sep 29, 2018

Pill testing at Groovin’ the Moo was deemed a success. CREDIT:ROHAN THOMSON

 

The National Capital Authority has blocked a proposal for pill testing at this year’s Spilt Milk festival in Canberra. It was able to do this because the festival is held on grounds that the NCA’s manages.

It made this decision despite the support of the ACT government, including police and health services, widespread community support, and a successful pill-testing service at the Groovin’ the Moo festival earlier this year. The NCA also appears to have made its decision without involving the level of expertise that pill-testing proponents have on their side.

We don’t question the NCA’s power, and right, to make this decision. However, as the only group providing medically supervised pill testing in Australia, we have the right and duty to advise the public of the disservice being done, thanks to what appears to be little more than an ideologically driven impulse. The NCA’s statement suggets it lacks either the willingness or capacity to consider the evidence. To characterise its reasoning as being based on falsehoods would be to critique it kindly – the logic it contained would create benchmarks that would result in the closure of every liquor outlet and pharmacy in the country.

The NCA’s willingness to potentially endanger the health and well-being of the community it supposedly serves is a betrayal of trust. The federal government’s complicity in allowing such a decision to stand, without evening engaging the medical and health professionals providing the pill-testing service, speaks to the lack of due diligence, perhaps even cowardice, in the decision-making process.

Medically supervised pill testing, as it is performed in Canberra, follows guidelines outlined by the European Union. At no time does anyone involved in the pill-testing service advise any patron that it is “safe” to use a drug, or that any particular sample is “good”. Patrons are specifically, and universally, advised that the only way to be 100 per cent certain that they won’t be harmed is to not use drugs. Patrons are advised of the potential adverse outcomes from the substances they are considering consuming (as opposed to what they think they are about to consume); in some cases, we were also able to provide some contextualised medical information. We also stress the importance of seeking help immediately for any adverse reaction and the opportunity to make paramedics aware of the substances they consumed in the event of an adverse reaction.

Is a policy of no contact and no information truly a better way to protect the community’s safety, health and well-being? Perhaps the deaths of a small number of patrons every year is acceptable to act as a disincentive for other consumers?

Pill testing is not a panacea; we never claimed it to be. It does, however, reduce the risk of harm for patrons planning to take an unknown substance.

It is also important to note that there is no legal framework for this issue because the Commonwealth hasn’t put one in place – it is by the federal government’s choice that this situation exists. Legislation and regulation is the business of parliaments, which exist to consider such needs and address such issues on behalf of the communities they represent.

Given that needle and syringe programs were introduced in Australia more than 30 years ago, and the first medically supervised injecting centre more than 15 years ago, one can legitimately ask why Australia has taken so long to allow pill testing. Initial efforts began in South Australia 17 years ago – had they been successful, Australia would be in a far better-informed position regarding our understanding of the evolving drugs market than we now find ourselves in.

The misinformation campaign run by some groups has massively contributed to Australia’s inability to institute pill-testing programs, despite evidence and its successful implementation in Europe for decades. Young festival-goers are more than capable of arriving at the truth themselves.
Governments across the country need to acknowledge publicly that our health and law-enforcement systems have worked, and can continue to work, effectively together in the grey areas of life. No one wants to see young people, or any people, harmed from drug use. But to simply believe that we have the ability to prevent supply and prevent drug use is at best fanciful and at worst tragic. Quite simply, harm reduction must always be a part of any real-world response to drug use.

Dr David Caldicott and Gino Vumbaca are members of the consortium that delivered Australia’s first officially sanctioned pill-testing program earlier this year in Canberra.

 

Original article can be read here 

By Dr David Caldicott and Gino Vumbaca

Drug Reform series – At last, a government sanctioned pill testing program

Aug 8, 2018

We are finally seeing in Australia the first signs of a recognition by government of the important public health benefits of sanctioned pill testing programs.  Law enforcement alone will never overcome the problems that can arise from drug use. Much like needle and syringe programs, pill testing is a real-world response which is evidence based and rightly treats harm reduction as one of the primary objectives of drug policy.

April 2018 saw the first ever sanctioned pill testing program take place at a music festival in Australia

The pilot program at Canberra’s Groovin the Moo Festival was the culmination of years of advocacy by many, particularly Dr David Caldicott who has led the charge on this key public health initiative for over a decade in Australia.

The pilot pill testing program in Canberra took significant and intensive negotiations with the ACT Government’s Ministry, Health and Police Departments, Cattleyard (festival promoters) and the University of Canberra (festival grounds landowners). The pilot was also delivered at no cost to the ACT Government or promoters by the STA-SAFE Consortium – which consists of Harm Reduction Australia, Australian Drug Observatory (Australian National University), the Noffs Foundation, Dancewize (Harm Reduction Victoria) and Students for Sensible Drug Policy Australia.

Given needle and syringe programs were introduced in Australia over 30 years ago, and the first medically supervised injecting centre over 15 years ago, it is quite legitimate to ask why the pill testing pilot program was so long in the making in Australia. And to ask why there is such a continued lack of understanding within some key decision-making bodies on how well public health programs can exist side by side with law enforcement.

In short, the reasons pill testing has taken so long to introduce in Australia, are multiple, but primarily lie with an unfortunate and misguided belief in prohibition policies on drugs in some governments in Australia – the most recent example being from South Australia.

The misinformation campaign run by some groups can also not be underestimated in its contribution to Australia’s inability to institute pill testing programs despite the evidence and its successful implementation in Europe for decades.

Coupled with some of the appalling commentary and reporting of drug issues in this country at times – such as ice users gouging their eyes out and eating them (since proved wrong) – it is understandable why some governments are too scared to change their commitment to policies. They see fighting a war on drugs as a vote winner despite knowing it will fail. The seemingly high levels of cognitive dissonance amongst people in power who can privately express an understanding of the evidence but publicly advocate otherwise is extraordinary. The growing line of former politicians, senior police and others that publicly express support and advocate for change in drug policies is an indicator of how people who know the evidence also understand what we really need.

Governments across the country need to publicly acknowledge that our health and law enforcement systems have worked, and can continue to work, effectively together in the grey areas of life. No-one wants to see young people (or any people) harmed from drug use but to simply believe that we have the ability to prevent supply and prevent drug use is at best fanciful and at worst tragic. Quite simply, harm reduction must always be a part of any real-world response to drug use.

The misinformation campaigns that make such pragmatic and evidence-based responses difficult to implement in Australia are generally reliant on some key and common falsehoods.

“It will send a message to young people that using drugs is acceptable”

This is an oft used argument against many harm reduction programs. It ignores the evidence that health professionals engaging with people using drugs often results in lower levels of drug use, lower levels of harm and increased access to treatment and other services for people in need of such help.

The alternative is to send a message of don’t use drugs and if you do we will punish you – a message that lacks compassion, honesty and an understanding of human nature and behaviour.

“Young people will be told that it’s safe to use drugs after testing and be at greater risk of harm”

This is just not true. At no time are patrons attending pill testing programs advised that it’s safe to use drugs. The evidence is clear that people are more likely to discard their drugs after testing than consume at harmful levels.

“Pill testing cannot take into account individual physiological conditions making any advice inaccurate”

This is true but it is hardly reasonable to withhold information on the contents of a product that is about to be consumed by a member of the public on the basis that a full medical check must also be provided to individualise every piece of advice. It is unclear why such concerns are not raised about the information provided when alcohol, tobacco, over the counter pharmaceuticals, junk food etc. are sold to members of the general public.

“The pill testing equipment used is not the same as that used in forensic laboratories”

Again, this is true but the equipment used and operated by qualified technicians is of a far higher standard and quality than the reagent testing kits legally available and used by members of the community. Any field-testing equipment will be of a lesser standard than that available in multi-million dollar laboratories but again it could be raised why such concerns are not raised with the technology of hand-held random breath and drug test equipment operated by police when compared to the laboratory equipment available.

“There is a liability on governments if someone uses the pill testing service and comes to any harm”

One can only assume that the most harmful drugs in our society, alcohol and tobacco, are somehow exempt from such liability for the manufacturers and retailers of these drugs and the governments that earn significant revenue from their sales. The protocols in place around pill testing can never claim to prevent all harms despite our best efforts, such is human behaviour. However, it certainly reduces the likelihood of harm.

 

Gino Vumbaca is President of Harm Reduction Australia and a member of the STA-SAFE Consortium.

 

Original article can be read here 

The Rejection Of Drug Testing Is A Hard Pill To Swallow

Aug 26, 2016

It is a case of the demand for perfection stifling any progress.

GETTY IMAGES. Making more arrests will not solve the real problem.

In their efforts to defend the ‘just say no’ approach to pill testing, government officials often highlight what they believe is a major problem. Basically, that there is the potential for a misunderstanding of the results by individuals because pill testing cannot provide a full individualised statement on the exact physiological effects the chemicals will have on the person taking the drug. Something that is not possible to do without a full medical history and examination.

However, while criticising comprehensive testing regimes because they don’t include a full medical assessment for every person, they allow the availability of less reliable do-it-yourself pill-testing kits. Apparently it is more acceptable for safety conscious people to buy a less reliable alternative than to have access to a properly regulated pill-testing regime operated by public health and welfare officials — many of whom would gladly volunteer their time to prove the case.

It is a case of the demand for perfection stifling any progress.

We tragically saw the loss of young people’s lives from overdose during the 2015 festival season. The tragedies prompted many to ask the obvious question — how do we make sure this never happens again? Or, perhaps more realistically, how do we reduce the chances of this happening?

The response of the public health community, youth advocates, festival organisers and many others was an evidence-based and pragmatic one. It involved a call for the introduction of pill testing or drug checking, as it is also known. It’s a harm-minimisation response that has been effectively operating for years in many countries around the world.

Instead of supporting a pill testing trial, many governments publicly focused on a view that it would send the wrong message and there should be more sniffer dogs and police at the festivals, even going as far as threatening to shut down festivals. One has to wonder what message we send to people when we say that we would rather arrest you and have you risk overdose than make sure you are safe.

Arguments that pill testing would serve to support the drug dealers’ business model are also repeated as an excuse for the rejection of pill testing. Again, the evidence is ignored. One of the consequential outcomes of existing pill-testing regimes around the world has been a consumer-led safety movement on the quality of drugs being sold and consumed.

As is the case in most markets, information became a powerful consumer tool. Poor test results quickly put sellers on notice to make their products safer. It also gave cause for more thought by the people taking the drugs. More importantly, existing pill-testing programs typically offer a range of support services that extend well beyond testing drugs. The effect is not dissimilar to the engagement we see at needle and syringe programs and drop-in centres where people have an opportunity to talk about their drug use and other issues with health and welfare professionals. For many, it is their first engagement with these professionals and services and an opportunity to receive information about how to minimise risks and be educated about what the test results mean.

If it is one of your children or family attending a festival and considering taking a pill, which would you prefer; an engagement with health professionals, or reliance on an over-the-counter or internet-ordered test kit?

Everybody wants to ensure that people attending festivals and other events return home safely. Parents, if asked, would prefer that their children didn’t take drugs, but many would also understand that youth risk-taking and experimentation occurs despite our best efforts and fears.

We all know that there is no magic solution to eradicating drug use from this world. Drug use has always occurred, and always will. What the punitive approaches have achieved to date are more people being caught up in the criminal justice system, bigger profits for organised crime and a scale of global political corruption we struggle to comprehend.

How governments respond to the public becoming increasingly aware that less reliable pill-testing kits are already legally available will be an indication of how important they believe it is to reduce the vulnerability of our children to the dangers of unsafe drug use.

By Gino Vumbaca

President and co-founder of Harm Reduction Australia

Original article can be read here 

What is ‘drug checking’ and why do we need it in Australia?

Dec 1, 2015

This weekend saw the tragic death of a young woman after she took an unidentified tablet at the Stereosonic music festival. Drug-related deaths of this type are not uncommon in Australia, and this raises the question of whether our approach to harm minimisation needs reform.

Ten years ago the Australian Medical Association passed a resolution backing research on testing illicit drugs in Australia to see what they actually contained, in an attempt to reduce consumption, overdose and death.

Previously called “pill testing”, “drug checking” gives a consumer the opportunity to know what is in their product prior to consuming it. It also allows alcohol and drug researchers to access what is largely an invisible cohort of functional consumers.

Its origins lie in the European dance music scene, with the emergence of counterfeit and contaminated pills. Consumers often feared something in the products they were consuming could be dangerous to them. But with no regulation, there was no way to find out.

A decade ago, when we conducted research at the Enchanted Forest “raves” in South Australia, that was what we were concerned with too. But a decade is a lifetime in drug-market years. We are now faced with the most dangerous drug market in years.

Novel compounds previously undescribed in human toxicology, and MDMA (methylenedioxy-methamphetamine, or, ecstasy) of a purity and dose never seen before, are all available through the internet and untraceable cryptocurrencies. From what I’ve observed as an emergency physician, this has been one of the worst starts to the music festival season ever, in terms of harm from overdoses.

Drug checking as process and intervention

One of the best examples of a drug-checking program is in Zurich, under the banner of “Saferparty”. In conjunction with University of Bern, researchers bring a shipping container of state-of-the-art forensic equipment to one of the largest dance festivals in Europe, Street Parade.

Knowing what’s in the drugs is just as important as talking to the people taking them. Chris Breikss/Flickr, CC BY

Setting up in the early hours of the event, forensic chemists, doctors and teams of experts are ready to test drugs in their mobile laboratory. Chemists are looking for drugs they know to be particularly dangerous, or drugs in dangerous doses.

Patrons queue up from the time the doors open to submit a scraping of what they intend to consume during the day. Law enforcement are aware and tolerate the program, acknowledging its benefits to public, and the fact that they will also have access to a de-identified data source that would have otherwise been unavailable to them.

Festival-goers are provided with a unique code that corresponds to their submission, and then wait for their results. This can take 20-40 minutes, in which time there is ample opportunity for a dialogue between consumer and tester.

Attendees are frequently functional users, meaning their drug use is not problematic and does not prevent them from leading a normal life. This means they’re otherwise invisible to routine survey techniques. While many might think establishing the identity of the drugs is reason enough to conduct drug checking at music festivals, it is this opportunity for dialogue that presents one of the most compelling justifications for this sort of program on-site.

At venues where drug checking occurs, we see patrons modify their behaviour, and mitigate potentially more dangerous behaviour that might result in harm. In our on-site labs from the early 2000s, as many as two-thirds of those surveyed wouldn’t take their drugs if they found them to contain something other than what they were expecting. There are few other interventions that demonstrate this strength of effect in this environment.

This has now been rolled out across dozens of European countries, and has its own best-practice guidelines.

Why not in Australia?

There have been many opponents to drug checking in Australia over the last decade, largely from conservatives from the Howard-era “tough on drugs” movement.

Some arguments are philosophical, such as the charge that it sends “the wrong message” to users or wider society. This was articulated in the mid-2000s by then Minister for Ageing Christopher Pyne, who stated at the time that I, along with other supporters, were part of:

… a long line of medical people who treat drugs as a health issue, rather than the self-harm and criminal offences that they are …

and that pill testing represented:

… dangerous views, which if allowed to become mainstream, would undermine the government’s policy of being tough on drugs.

There are those who feel the process underscores some sort of capitulation in an already failed War On Drugs. On the contrary – by providing a medical and toxicological context, we can “nudge” the behaviour of consumers in a far more persuasive manner than by the mere threat of criminalisation. In their eyes, the law is something to be eluded; death and permanent impairment is a much more serious prospect.

Against the charge that it might encourage drug consumption, we would agree – if it was our plan to deploy the intervention outside supermarkets, or primary schools. But the intervention deliberately targets the highest of the high risk, the venues where patrons have already chosen to consume illicit drugs. It’s not possible to encourage them any more – only to persuade them to moderate their ways.

At no stage are users ever advised that what has been tested is “safe” – the only way to be completely safe from drug-related harm is to not take drugs.

Prime Minister Malcolm Turnbull has called for a “nimble”, “imaginative” and “innovative” Australia. We applaud this, as it’s precisely what we will need if we are to stop more avoidable deaths at dance festivals this season.

 

Emergency Medicine Consultant, Australian National University

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original article can be read here >