Legislative Council Tuesday 13 August 2019
Ms FORREST - Mr Acting President, I move -
That, in order to minimise the harms associated with drug use at Tasmanian festivals and events, this House -
(1) Acknowledges that pill testing is a health-related matter;
(2) Acknowledges that pill testing is an evidence-based health service that reduces the risk of illicit drug harm at music festivals and events;
(3) Acknowledges that pill testing services do not endorse or provide advice on the safety of illicit drug use and there is no research or evidence to support the view that pill testing increases drug use;
(4) Acknowledges the successful results of the two trials in the ACT that demonstrated the effectiveness of pill testing services to change a person's illicit drug behaviour;
(5) Acknowledges that pill testing is supported by national bodies including the Royal Australasian College of Physicians, the Royal Australian College of General Practitioners, the Australasian College for Emergency Medicine, the Rural Doctors Association of Australia, the Australian Medical Association, the Australian Nursing and Midwifery Federation, the National Australian Pharmacy Students' Association, the Pharmaceutical Society of Australia, the Ambulance Union State Council, the Public Health Association of Australia, Family Drug Support Australia, and the Australian Drug Law Reform Foundation and at the local level, by Tasmanian community organisations including the Youth Network of Tasmania, the Tasmanian Aboriginal Centre and Community Legal Centres Tasmania;
(6) Notes that despite there being strong support for the introduction of pill testing services across the Tasmanian community, the Government continues to be resistant to reviewing the evidence and/or exploring how a trial would provide health benefits to Tasmanians, particularly our youth;
(7) Recognises a need for the Department of Health to prepare information and education materials outlining the community and individual health benefits of drug analysis services, to educate and inform the broader Tasmanian community; and
(8) Calls on the Government to commence the necessary steps to explore how a trial of pill testing could occur during the 2019-20 summer festival season.
I will make some overarching and background comments initially and then address each point of this motion separately. At the outset, I will say that taking illicit drugs is not safe and carries a very real risk of serious adverse health outcomes and, occasionally, tragic deaths.
First, there is no safe level of drug use whether we are talking about so-called 'party drugs' or other illicit drugs.
Second, this motion in no way condones, supports or approves of the use of party drugs or any other illicit drugs.
This motion seeks the support of the House to minimise the harm associated with drug use at Tasmanian music festivals and events. I also acknowledge that drug analysis services - what we commonly known as pill testing - is only one aspect of a comprehensive drug policy. Education will always be a critical component of any health-related policy, including drug policy, which is at the core purpose of pill testing.
A zero-tolerance approach denies the reality of historic and current drug use and can be contrary to the effective harm minimisation and drug avoidance strategies and policies. Interestingly, research shows that party drug users are a heterogeneous group of consumers, many of whom are educated, socially and economically stable and who rarely come in contact with the criminal justice system, treatment or support services. Notionally, they do not fit the often‑expressed stereotypical illicit drug user impression.
In his article titled, '"Worth the test?" Pragmatism, pill testing and drug policy in Australia', published in 2018 in the Harm Reduction Journal, Dr Andrew Groves evaluates Australia's National Drug policy strategy and analyses current drug policy literature and research studies. I commend this paper to all members and will reference it during my contribution.
In this paper, the practicalities and application of Australian drug policies are explored, noting that -
At the practical level, problems exist regarding the capacity of policy to recognise and respond to emerging patterns of problematic use, where novel, unknown drugs have entered markets at a time when regular users have increased consumption of more potent forms, such as ice (crystal methamphetamine) and MDMA (3,4-methylenedioxymethamphetamine) …
'Instead', the article continues -
the goal should be to reduce the harms that occur when people use these unknown or more potent drugs, given the serious risks. Notably, despite law enforcement efforts and legislative changes, current harm reduction initiatives have been largely ineffective, evident in monitoring data where certain groups of young people appear to resist social controls by continuing to use party-drugs. As noted in previous studies, this is because many young people see drugs as playing a normative and peripheral role in their lives, revealing an important transition in patterns of use, where party-drugs have become more mainstream, used by a heterogeneous cohort of ordinary young people. This apparent normalisation has occurred alongside a trend where some users are unaware of what they are taking, engaging in 'opportunistic' purchases of drugs at clubs or music festivals rather than prior to events from more trusted networks. Although no use is 'safe', these ad hoc practices substantively increase the risks as suppliers are more likely to be strangers, who may have a greater propensity to adulterate drugs with cheaper and/or alternative substances. Reports have increased of ecstasy pills containing large amounts of methamphetamine and other toxic substances (e.g. rat poison), with others recorded as very high-purity, which could seriously harm users. In combination, the rise in problematic patterns of use, the emergence of novel substances and imbalanced policy highlight the need for targeted and more pragmatic responses to youth drug use.
I firmly believe that none of us in this place wants to see young lives lost even if these individuals are engaging in risk-taking behaviour. We see every generation engage in risk-taking behaviour, particularly during adolescence and early adulthood - as all of us have been adolescents, we can and should reflect on that. We might have engaged in risky behaviour related to alcohol, to drugs, to sex, to driving and other recreational activities, just to name a few. We obviously all survived and for some of us that may have been more by good luck than by good behaviour as measured by general societal standards.
Many of us have also raised adolescent children and know the anxiety and challenges of this important role. Some of us have experienced the adverse impact of some of the risk-taking behaviour our children have engaged in. For some, that is yet to come. It is a worrying time.
Regardless of these risky behaviours, young people do not deserve to die. I believe young people do not intentionally take risks that may result in harm to themselves or their friends. They generally believe they are 10-foot tall and invincible. If members remember, you probably thought the same of yourself. Sadly, this is not the reality for some young people.
We acknowledge and respond to this reality in our approach to road safety. We take a safe systems approach to road safety because we acknowledge that while we cannot prevent every crash, we can minimise the damage done, even when a person may have broken the law in their driving behaviour and participated in risky behaviour. I challenge anyone in this place to say they have never broken the law while driving; even if it is only driving a few kilometres over the limit.
Pill testing is a similar measure and should be considered from a harm minimisation, health and wellbeing framework that fits within our drug policy area alongside other existing law enforcement activities. Law enforcement in the areas of manufacturing, supply and trafficking of illicit drugs at music festival events is, and will continue to be, a vital aspect of law enforcement.
This harm minimisation approach is well recognised and has been adopted with beneficial impacts to intravenous drug users through needle and syringe exchange programs and safe injecting rooms. These measures were not fully supported when first introduced, predominantly because drug policy was a political tool for which zero-tolerance principles flourished and education programs and messaging focused on a 'Just say "no"' approach, or a 'Do not make bad choices' and a 'Don't do drugs' approach.
This approach stems from the lasting legacy of the twentieth century when the drug problem was seen as a war to be won, where winning the war aligned with increasing anxiety about crime generally and attempts to create fear in society of the harms of drug-taking. This outdated approach ignores reality and the culture of generations. Every older generation complains about the youth of today.
Prohibition simply does not work at a society level. Education and support is, and will continue to be, needed. Pill testing provides targeted opportunities to educate and counsel a group of people who can be difficult to engage in education about drug use.
At a moment in time when a young person has the opportunity to act, it may be the only time to have an opportunity to act and interact with a health professional.
The recent deaths of young Australian music festival attendees from party drug overdoses have added to the debate regarding the effectiveness of Australian drug policies. The most recent deaths are currently before the New South Wales Coroners Court, with findings expected later this year. Because of that, I will not be referring specifically to these tragic deaths.
Some may suggest we should wait for the coroner's findings to be released before we consider this motion. I suggest this is completely avoiding an issue we know has resulted in a number of tragic deaths in other jurisdictions. From the evidence in the public arena already from the coroner's investigation, it is highly likely harm minimisation measures such as pill testing will be required in such events in the future.
This is a pragmatic motion that does not call for the implementation of pill testing. It does not even call for the implementation of a pill-testing trial. I will say more on this in point (8) of the motion, which calls for the Government to investigate what steps would be needed to actually undertake a trial. It only calls on the Government to explore what steps would be needed to facilitate a trial before the summer music festivals.
I encourage members to approach it from that perspective. Let us be on the front foot and be prepared to engage in a process that will educate our young people through a proven harm minimisation approach - save lives and also build on the research and data already there. That is what this motion is calling for.
According to the research paper by Andrew Groves -
However, notwithstanding the tragic loss of young lives, what is concerning is that these fatal overdoses, and several 'near-misses', may have been avoided through more pragmatic and amoral drug policy and practice.
Australia has been and is widely lauded for its harm minimisation approach to drugs. However, research suggests over the last 30 years these policies have been fragmented, sometimes inconsistent and contradictory. Much of the experience from other countries suggests there is a need in Australia for drug policy reform and there is an opportunity to learn from international studies that have shown promising findings in the reduction of harm of party drug use and its harm through the application of pill testing services.
Before addressing each point of the motion, it is important to know the limitations and gaps in the research in this area. In doing so, I note pill testing trials and other research in this area will add to the growing body of evidence needed.
Groves, in his article acknowledges this need -
Like most debates about policy reform, a key question in the rationale for pill testing is whether it 'works'. The literature is complicated and, to date, no studies have fully tested in a controlled way, whether pill testing reduces harms. Most evaluations concern attitudinal change (e.g. what people would do), legal issues and the integrity of various analytic procedures, with others describing program features or contextually relevant praxis, so although not within the scope of this paper, a large, multi-site systematic review of testing practices is needed. Nevertheless, part of the paradox of pill testing comes from expectations of drug policy and practice generally, where effectiveness is often measured in language of abstinence. As a robust body of literature has shown, however, abstinence is a goal that displays ignorance of reality. A much broader definition is needed, which demarcates effectiveness more pragmatically, as any strategy shown to improve public health or reduce the prevalence or severity of drug-related harms. For example, connecting users with support services, increasing education and awareness, monitoring market changes and encouraging avoidance of dependence are strategies shown to be effective in Europe. Despite this, like in the UK, Australian policy-makers have appeared to take limited account of these findings.
This supports the approach of including pill testing as part of a comprehensive drug control policy - not limiting it to this alone but introducing and trialling it alongside ongoing research to determine what measures are effective.
I will address each point of the motion.
(1) Acknowledges that pill testing is a health-related matter;
Pill testing is first and foremost a medical intervention that provides education and health information from qualified medical and health practitioners to patrons who are considering consuming an illicit drug or substance, generally at music festivals.
In the ACT trial, qualified chemists, nurses, emergency department doctors and counsellors volunteered their professional skills and time to deliver the pill-testing services. The interactions between the festival patrons and the health professionals are conducted within a health service delivery model based on evidence from research related to trials and experiences in other jurisdictions.
Qualified staff conducted a chemical analysis of samples bought by patrons then interpreted the results and provided advice and information about the risks associated with consumption. Regardless of the results of analysis, all patrons were advised that there is no safe level of drug use and were encouraged to dispose of their drugs in the amnesty bin provided, which was later collected and disposed of by ambulance staff.
I repeat: one of the biggest myths is that this condones pill taking. Regardless of the results of the analysis of the pill testing, all patrons were advised by health professionals that there is no safe level of drug use and they were all encouraged to dispose of their drugs in the amnesty bin provided.
This motion in no way condones illicit drug use. It may be the only opportunity a person in that situation has to reconsider their decision.
Pill testing stations are always located within the medical precinct of festivals or events and work cooperatively with health and ambulance staff on site and the festival organisers. While pill testing is not the only health intervention that should be provided to minimise the potential harms associated with illicit drug use, it is an important and effective measure to reduce harm and provide important health information to patrons. It may be the first time they have ever heard any information about the risks from a health professional.
(2) Acknowledges that pill testing is an evidence-based health service that reduces the risk of illicit drug harm at music festivals and events;
The prevalence of illicit drug use at music festival is very high. Most patrons at pill testing stations are often young, first-time or very naive and occasional drug users. To suggest it is not happening or not happening frequently is completely wrong and completely naive.
I have had messages from parents. Their young adult children have told them they have taken the pills, and it horrifies them. The risk of death or serious injury is very high, as we have seen by the six deaths at New South Wales and Victorian music festivals over the 2018-19 summer period. Pill testing is an evidence-based harm reduction strategy used internationally. It is also known as drug checking or adulterance screening. It commenced in the early 1990s in the Netherlands, where it is part of official national policy.
Dr Groves' article describes the process -
Testing involves dance-party and music festival attendees volunteering a sample of their drugs for analysis by scientists, who provide information concerning composition and purity. In Europe, this is typically undertaken in mobile facilities located near or inside venues to allow timely feedback to users (approx. 30 min). ... These practices are possible through partnerships between event promoters, healthcare services and local police and a strong harm reduction philosophy
Pill testing is now commonplace at music festivals in Europe and has been proven to drastically reduce or eliminate deaths in some countries. In addition to the Netherlands, pill testing services are routinely available in Switzerland, Austria, Germany, Spain, Portugal and France. It has been recently legislated for in Iceland and recently New Zealand passed legislation.
Since the introduction of pill testing, Portugal has had zero deaths at music festivals and research from pill testing in Austria found 50 per cent of those who used the drug testing service believe the results influenced their drug-taking behaviour, which means they may have taken fewer drugs or not taken them at all.
Recent evaluation and pill testing in the United Kingdom showed two-thirds of patrons who had their pills tested decided not to consume the drugs. Two-thirds did not take them. Those who took them anyway consumed significantly less than they had planned and said they would warn their friends of the inherent risk, so there is a flow-on benefit.
As noted in Dr Grove's article -
Several studies and the 2013 NDSHS report suggest many Australians see little value in punitive sanctions (e.g. imprisonment, increased fines) for drug use. Instead, referral of users to treatment or education programs appears the preferred response (approx. 45%), with only drug manufacture and distribution perceived to warrant harsh penalties. Drawing from a large (n>2300) internet survey of young Australians, Lancaster and colleagues report the majority back the implementation of pill testing (82.5%), as well as other harm reduction initiatives (NSEPs 76%, 'chill-out zones' 65.6%). An even greater level of support was reported in a survey conducted at a major Australian music festival in 2016, where most participants (86.5%) believed testing services could help to reduce harm for users. These findings describe a cohort that values information and seeks to engage in safer practices, regardless of whether they use drugs. Notably, many youth also appear to translate this drug knowledge into behavioural change, with an Australian study finding more than three-quarters of regular ecstasy users would not take an 'unknown pill'. A similar result was identified in a more recent sample of users at Australian dance-parties or music festivals, where 90% reported seeking information about drug contents in the last 12 months. Most of these respondents (60%) had encountered unexpected substances or problems with drug purity during this period, which motivated them to alter their behaviour with more than half warning friends (51%), many deciding not to consume their drugs (39%) and more than a quarter reducing the amount they consumed (28%). Most respondents also reported they would use a form of self-testing (94%), onsite event testing (94%) or a fixed-site (i.e. 'drop-in') service, and valued services that provided comprehensive, individual feedback rather than only when dangerous results were found. This reinforces previous claims that young people can be persuaded to make rational decisions and are willing to use testing services, which may elicit positive behavioural change at the time of use, reducing some drug-related harms.
These people have already usually arrived at the festival with their pills or they may buy them onsite with the intention of taking them. We can see here that when they have that intention, this alters behaviour and can reduce harm.
These are pretty compelling statistics. An additional benefit to pill testing occurs through increased publicity for support services, advocacy, public health campaigns and opportunities for monitoring and research. A pill testing trial in Tasmania - should it be conducted - would add to this body of knowledge and ongoing research into the effectiveness of these trials and the associated educational programs delivered as part of them.
While it is noted in the article -
These positive outcomes have also served to extend discussion beyond notions of individual criminality and morality to encompass social, economic and welfare debates, challenging conventional thinking about concepts like harm, risk and social responsibility …
It continues to be important -
to emphasise that drug use is dangerous and cannot be conceptualised as risk‑free, nor is pill testing a 'silver bullet' …
It is important to continue to come back to that. Another myth is that it is the be-all and end-all or it does not work at all. It is supposed to be part of a comprehensive program and an opportunity for those engaged in the process to be informed or to be actively informed that drug taking is dangerous and is not without risk.
Quoting from Dr Groves' article again -
Instead, this article argues that pill testing needs to be viewed through a lens of pragmatism, where for certain users in certain settings, it is about providing young people with information about drugs and their use so they can make more informed choices to limit the associated harms, as well as making important practical changes to the settings in which drugs are used.
I feel compelled to reiterate: allowing young people to make informed choices is in no way condoning drug use. We all tell our kids not to drive in a dangerous manner because of the obvious associated risks. We do the same with sex. We do the same with alcohol. While driving is legal and alcohol is legal, driving your car over the speed limit, drinking and driving, and using your phone while you are driving are not legal.
This is first and foremost about allowing young people to make informed choices about the risks of drug use because we are naive to think that telling people to say no actually works. In some cases, it can make them more likely to do it.
Another approach - one delivered in an accessible, non-judgmental and confidential manner - is critical. Dr Groves' article highlights the need to share responsibility when dealing with risky behaviours. His article highlights -
… the need to share responsibility for tackling drug use across the community, given that drug-related harm intersects with criminal justice issues, health, vulnerability and various social problems - complex challenges faced by young people that require interdisciplinary and comprehensive responses.
It is not something on its own but part of a whole package. Dr Groves refers to the introduction of the Illicit Drug Diversion Initiative in 1999, which 'officially signalled the utility of an operational relationship between police, health and support agencies'.
He also describes another policy collaboration I mentioned earlier - the introduction of needle syringe exchange programs - NSEPs - and the Medically Supervised Injecting Centre in Sydney.
Dr Groves acknowledges that -
there was conflict between police and health workers linked to these initiatives, legislative reforms and changes to NSW police operating procedures encouraged police to 'exercise discretion; work collaboratively and develop a positive relationship with local NSEPs; and promote the legal operation and positive outcomes of NSEPs to the wider community'.
Such harm minimisation approaches can result in improved outcomes. It is important to note -as the article does - that making assumptions about the value of pill testing based solely on the introduction of the needle syringe exchange programs and safe injecting centres is inappropriate as the driving factors are not the same and there are specific conditions that led to their introduction. Primarily, the motivation of these initiatives came from general concerns regarding public health and the threat posed by HIV and the need to avoid an HIV epidemic, but we know people were reusing their needles and syringes to inject illicit drugs. While it might have been to prevent HIV spreading, it also allowed people to continue to inject safely from the point of contracting a potentially lethal virus.
Dr Groves acknowledges there are examples of pragmatic responses that sought to reduce drug‑related harms as well as foster cross-sectorial partnerships, just as this motion calls for.
(3) Acknowledges that pill testing services do not endorse or provide advice on the safety of illicit drug use and there is no research or evidence to support the view that pill testing increases drug use;
We have heard quite the contrary in my previous comments.
There is misinformed concern that pill testing services could leave people with a false sense that the make-up of the substance or pill is safe. This is not the case. The onsite staff at pill testing stations are qualified health professionals who do not endorse drug use or promote any illicit drug use as being safe. The inherent risks involved in drug taking are discussed with those using the service in a nonjudgmental, confidential and safe environment. The 10 to 15 minutes while an individual is waiting for the results of the analysis provide a rare opportunity for health professionals to discuss drug use, risks and harm reduction strategies at a critical moment in time. This rare opportunity for a brief intervention should not be undervalued. It is possibly the most important aspect of the whole system. You have 15 minutes with a health professional who is telling you it is not safe to take the pill. Here is your chance.
Pill testing stations target people who have already purchased illicit substances and have already taken significant risks by bringing them to the music festival and thus they are fairly committed to taking them. The pill testing station staff do not judge the individual, nor do they chastise or lecture. That is not the role of pill testing services. That is left to the parents, if the young people get to go home.
Pill testing stations offer a last and perhaps lifesaving opportunity for someone to be informed about the serious risks of, and change their mind about, drug consumption. To describe this process I wish to read from a summary provided by Gino Vumbaca, co-founder and president of Harm Reduction Australia, at a workshop in March this year facilitated by the Alcohol, Tobacco and Other Drugs Council of Tasmania for Tasmania's major music festivals. Pill Testing Australia was run under the auspices of Harm Reduction Australia and delivered the two pill testing trials held in the ACT. I quote from this information sheet they provided to explain how it is done so that there can be no misinformation as to what actually happens -
How does a pill testing service work? There are five key stages to the process.
1. Patrons entering a pill testing station are greeted by a counsellor or peer worker who talks them through the process. The patron signs a waiver form and hands over their mobile phone (no photos are allowed within the pill testing station to ensure confidentiality).
2. The patron provides a sample, a scraping of their drug, which is provided to the chemist, who uses mobile drug analysis technology to assess the contents of the drug.
3. Once complete, the patron speaks to a medical professional, for example a GP, who will talk them through the substances identified in the drug and the risks associated with consuming the drug. Never at any stage does a medical professional tell the patron the drug is safe, or condone drug use.
4. The patron is offered the opportunity to take a wrist band with a number that corresponds to their drug analysis results. In the case of a serious medical emergency paramedics can take this wrist band to the pill testing station and access information on what substance the patron has consumed or may have consumed.
5. The patron then speaks one final time to the counsellor or peer worker who provides the patron with additional information on the risks of drug use. Advises them where the amnesty bin is, if the patron chooses to dispose of their drug, and provides them with the information on what to do in the case of an emergency.
I cannot see how this condones drug taking.
This is important because we know that a key reason someone may not seek medical advice is because they are afraid of getting in trouble with the police. There has been a lot of conjecture recently in regard to sophistication of the technology of pill testing that Pill Testing Australia uses, including concerns that it will not provide accurate readings or it will not identify every illicit substance in the sample.
I have been informed by Pill Testing Australia that its technology is the most sophisticated and mobile testing equipment available. Pill Testing Australia will be down here again in September with this equipment if anyone wants to view it. The equipment has the capability to identify more than 30 000 chemical compounds and substances, including synthetics.
If a substance is identified not within the database, the substance is immediately categorised as highly dangerous. Regardless of whether all substances are identified, it only takes the identification of one substance for it to be considered dangerous out of 30 000 known substances. Any not known are immediately labelled as extremely dangerous or highly dangerous and that feeds into the advice given to the patron.
Ms Armitage - If it is considered there is something dangerous in it, is it given back to the person and told it is dangerous or binned?
Ms FORREST - I will get to that.
As I mentioned, staff in the pill testing stations never tell patrons a drug is safe because pill testing is first and foremost a medical intervention that provides education and information to patrons considering consuming an illicit drug. All patrons are encouraged to dispose of their drugs in the amnesty bin, but they cannot and will not be compelled to. That may answer the member for Launceston's question.
It is also important to note the concerns raised by some members of the community that pill testing technology enables testing for the purity of substances like ecstasy and will provide false messages these drugs are safe to take. This is categorically incorrect and impossible given that Pill Testing Australia's technology does not test for purity. If any illicit substance is found - ecstasy or otherwise - the patron is informed of the risks and encouraged to dispose of the drug.
There is also no evidence to support the view pill testing increases drug use. Research shows pill testing positively changes attitudes to drug use and reduces the likelihood of the drug being taken at all, and if it is, it is taken in lower quantities, as I referred to research earlier.
Dr Groves' article provides the following on this -
Most notably, pill testing has been shown to positively affect users' behaviour, contradicting claims often used as the rationale for criminalisation that 'soft' options encourage increased uptake and use, particularly among youth. Evaluation of the chEckiT project in Austria reported approximately half of users whose drugs were tested indicated that information about quality/purity would influence their decision to take them. If presented with a negative result, two thirds reported they would not consume their drugs and would also warn friends against consumption. This corresponds with research from the Netherlands, which revealed no increases in the use of most party-drugs (or poly-drug use) because of pill testing and provision of drug information. This also supports evaluations of the reforms in Portugal, where pill testing, as part of a wider public health approach, in fact reduced problematic use, related harms and burden on the justice and healthcare systems.
Evaluation of pill testing stations ,which has been operating in Europe for almost two decades, showed that people make different choices based on the results of the testing. Some choose to put their drugs in the amnesty bins while others choose to take significantly less than they planned to. There is no evidence to support the view that pill testing increases drug use.
An article by Professor Alison Ritter, from the University of New South Wales and published in The Conversation in 2014 and updated in 2018 adds to the argument supporting pill testing.
First, pill testing has been shown to change the black market. Products identified as particularly dangerous that subsequently became the subject of warning campaigns were found to leave the market.
Research also showed the ingredients of tested pills started to correspond to the expected components over time. This suggests pill testing might be able to change the black market in positive ways.
It is important to acknowledge those points. Even though drug use may continue, you are not likely to see adulterated pills being sold because the word gets out.
I wish to reiterate an important point: Professor Ritter also explains -
Visits to pill-testing booths create an important opportunity for providing support and information over and above the testing itself. They enable drug services to contact a population that is otherwise difficult to reach because these people are not experiencing acute drug problems. Indeed, the intervention has been used to establish contact and as the basis for follow-up work with members of not-yet-problematic, but nevertheless high-risk, groups of recreational drug users.
Finally, pill testing means we can capture long-term data about the actual substances present in the drugs scene. And it creates the potential for an early warning system beyond immediate users. This is becoming all the more important as new psychoactive substances that may be used as adulterants are appearing more frequently.
There is a range of positive benefits here in terms of harm minimisation, acknowledging at every stop that there is no safe way to take illicit drugs and that this motion does not condone the use of illicit substances.
(4) Acknowledges the successful results of the two trials in the ACT that demonstrated the effectiveness of pill testing services to change a person's illicit drug behaviour;
The results of Australia's first pill testing trial at the Groovin the Moo festival in Canberra in 2018 proved the merits of pill testing. Of the 128 festival-goers who had their drugs tested, five disposed of their pills in the amnesty bin provided after receiving the test results and 42 per cent of those who had their drugs tested said their drug-taking behaviour would decrease as a result of the testing. Also at the 2018 Canberra trial, drugs belonging to two festival attendees were found to contain n-ethylpentylone, an often-lethal substance responsible for mass overdoses in Europe in recent years. Both these attendees disposed of their pills immediately.
From the second pill testing trial held in Canberra in April 2019, initial figures highlighted that of 171 samples tested, seven tested positive to the deadly n-ethylpentylone, with all seven pills being voluntarily discarded into the amnesty bin. Evidence from the trial showed that patrons desperately wanted to know more information about what they planned to consume and valued both the chemical analysis and the counselling offered by medical staff at the pill testing station.
These results from the ACT are quite compelling. The trial was the result of extensive consultation with ACT ministers and the ACT government, and the development of an advisory committee focused on establishing a supportive environment to facilitate the trial. Additionally, extensive consultation was undertaken with the ACT police minister and the Commissioner for Police regarding how it would be implemented on the ground. Having police involvement and support for a trial of pill testing is crucial. The pill testing trial in the ACT was fully supported by other organisations within the medical precinct; especially ACT ambulance staff and services and ACT festival organisers were ready and eager to proceed.
These actions are similar to those of point (8) of the motion, with a call to see pill testing trialled in Tasmania or to take the steps necessary. Some of those steps have been described in what I have just said. Tasmania's major music festival organisers are firmly on board. Festival-goers want to see it available, predominantly people younger than most of the MPs in this parliament, and the technology is available. We need the Government to take the steps and work with Tasmania Police, health professionals, the Alcohol, Tobacco and Other Drugs Council of Tasmania and Harm Reduction Australia.
This is laying out a framework for what needs to happen if we are going to put in place a trial, which I will get to in point (8) of the motion.
(5) Acknowledges that pill testing is supported by national bodies including the Royal Australasian College of Physicians, the Royal Australian College of General Practitioners, the Australasian College for Emergency Medicine, the Rural Doctors Association of Australia, the Australian Medical Association, the Australian Nursing and Midwifery Federation, the National Australian Pharmacy Students' Association, the Pharmaceutical Society of Australia, the Ambulance Union State Council, the Public Health Association of Australia, Family Drug Support Australia, and the Australian Drug Law Reform Foundation and at the local level, by Tasmanian community organisations including the Youth Network of Tasmania, the Tasmanian Aboriginal Centre and Community Legal Centres Tasmania;
I note that the Youth Network of Tasmania speaks for Tasmania's youth and most of us in this place are well beyond our youth so we need to take advice from those this directly affects, speaking for myself particularly.
The organisations listed in point (5) of the motion are significant and broad; they represent health bodies and bodies supporting and speaking for young people. The Government should not reject this united show of support.
Since putting the motion on notice, the national body, Forensic and Clinical Toxicology Association - FACTA - is now in support, and the Alcohol, Tobacco and other Drugs Council of Tasmania continues to be a leading voice in this matter. The Hobart City Council has confirmed its support for a trial and other councils are also looking at doing so.
Pill testing services are utilised effectively in a range of countries to assist in reducing illicit drug use and harm and, as I mentioned earlier, New Zealand became the most recent country to join the growing number of countries to introduce pill testing services following the passage of amendments to its Misuse of Drugs Act. This act will now give New Zealand police discretion to take a health-centred approach, a move in response to a large number of deaths caused by dangerous synthetic substances and drugs.
It is time the Tasmanian Government showed a more open approach and actively engaged in conversations with organisations that have already shown their support for this health-related harm minimisation measure, and supported the establishment of a framework to facilitate a pill testing trial.
As a health service focused on harm minimisation, if we can prevent even one death or serious adverse outcome, the action will be justified.
No-one deserves to die for making an ill-advised choice and when we can minimise that risk from a choice generally made prior to presenting to the pill testing station, we should.
As I stated, evidence suggests that such a service does not increase drug use nor does it normalise illicit drug use. It provides an opportunity to engage with a cohort of young people who can be difficult to reach through more traditional measures and who often have not come to the attention of law enforcement, the justice system or even the health system.
Point (6) of the motion -
Notes that despite there being strong support for the introduction of pill testing services across the Tasmanian community, the Government continues to be resistant to reviewing the evidence and/or exploring how a trial would provide health benefits to Tasmanians, particularly our youth;
The Alcohol, Tobacco and Other Drugs Council of Tasmania, alongside Pill Testing Australia, previously offered to brief the Government on the evidence behind the merits of pill testing services.
The former Health minister, Michael Ferguson, was unwilling to be briefed and did not accept an invitation from Harm Reduction Australia - HRA - to attend the ACT's pill testing services forum, an invitation extended to all state and territory health ministers in April 2019 ahead of a second pill testing trial in Canberra's Groovin' the Moo festival.
I do not understand the Government's reticence to act or even to consider the available evidence. There is broad community support, and support from almost every national professional medical and health body. A number of other countries have also acted.
It is interesting listening to the media and reading the Government's media releases put out on this matter, because it seems Mr Ferguson continues to be the spokesperson. He is not the minister for Health, the minister for Mental Health and Wellbeing, the minister for Police or the minister for Justice. I am not sure why he is the spokesperson; the Leader may be able to enlighten me as to why he seems to be calling the shots.
In an article in The Conversation by Dr David Caldicott from the Australian National University, and a member of HRA, titled 'We can't eradicate drugs, but we can stop people dying from them', he describes what occurs in other countries and the non-evidence based approach taken on some drug policy approaches -
The European Union continues to roll out drug-checking programs (where party drugs are tested for strength at music festivals and other sites where they are consumed). In April, the United Nations General Assembly special session on drugs policy is considering decriminalising personal drug use.
I am not suggesting that here, Mr Acting President. I am just quoting from Dr Caldicott's article.
In the midst of this, Australia plods on with its punitive and prohibitionist ideals, despite the rest of the world moving on. Whether it's the use of sniffer dogs at music festivals (which an ombudsman's report found was ineffective in detecting drug dealers) or roadside drug testing (for which there is no evidence it prevents crashes), we seem happy to adopt interventions that have little evidence behind them, instead of those that do.
The most fundamental shift on drugs policy worldwide has been from moralising about use to focusing on keeping young people safe. More people are beginning to accept that nowhere will ever be 'drug free'. Now over a decade old, US drug policy expert Marsha Rosenbaum's Safety First: A Reality-Based Approach to Teens and Drugs tells parents to replace 'Just Say No' with 'Just Say Know'.
Taking an approach that ignores the reality of youth culture does not assist those most at risk. We must take our heads out of the sand and accept that although we may personally abhor illicit drug use, it is a reality for some young and occasionally not-so-young people. We all take risks but I do not believe we deserve to die as a result of taking those risks, when death is not the intention.
I am certain that as a community we are not willing to continue with this serves-you-right mentality for those harmed. I hope that is where we are at.
Dr Caldicott mentioned the negative impact that the Ombudsman found of having sniffer dogs at festivals. The associated evidence is that people tend to see the police with the dog and then take all the pills to get rid of them. I think more will come out on that in the coroner's report. That is a real risk and it has not been proven to be effective.
(7) Recognises a need for the Department of Health to prepare information and education materials outlining the community and individual health benefits of drug analysis services, to educate and inform the broader Tasmanian community;
There is a need for the Department of Health to be on the front foot in any health matter. It does a very good job in many areas. Part of bringing this motion on for debate was also to add to that public commentary and to make factual information public about what pill testing is and what it is not.
Much information is available to assist the Department of Health to prepare information and educational materials outlining community and individual health benefits of the drug analysis services to educate and inform the broader Tasmanian community. I suggest the Government has a moral obligation to undertake public education in this area. You do not have to condone an activity to take action to inform the public of its risks. This should include the health benefits of drug analysis services. We must not deny the reality facing families with young adult children and the young people themselves, whose voices are often not heard in debates or matters that directly relate to them. It needs to be available in all settings relevant to young people.
There is a clear need to educate and inform the community about the realities and risks of illicit drug use. Part of this must be a discussion about evidence-based information regarding harm minimisation, just as we have in other areas of public policy. I have mentioned those already.
(8) Calls on the Government to commence the necessary steps to explore how a trial of pill testing could occur during the 2019-20 summer festival season.
This motion does not call for them to undertake a trial though you could infer that is where it is headed. I suggest that is the case, but it is asking the Government to take the steps necessary to be prepared and to know what they would need to do.
The first step in this process is, as has happened in other jurisdictions, to establish a drug analysis advisory committee. This committee should consist of a representative from Tasmania Police; the Department of Health; Ambulance Tasmania; the Alcohol, Tobacco and Other Drugs Council; Harm Minimisation Australia; Tasmanian music festivals; and a GP with experience in drug addiction as nominated by the Royal Australian College of General Practitioners. They are the people you want around the table looking at what would need to happen.
Tasmanian festivals such as Dark Mofo, Falls Festival and Party in the Paddock all support a trial at the upcoming 2019-20 Tasmanian summer festival season. They are committed to working with the Tasmanian Government to explore a trial should the Government commit or agree.
The Alcohol, Tobacco and other Drugs Council Tasmania has repeatedly offered to independently chair this committee. It will be eminently suitable to do so.
Before providing my concluding comments, I acknowledge pill testing has its limitations. I have alluded to that previously. I quote from Dr Groves' article -
Another concern relates to the threats posed by new psychoactive substances (NPS), which have emerged in Australia following rapid rises in Europe and popularity at dance-parties and music festivals. These substances, also known as analogues or synthetics, are designed to mimic established drugs and often comprise new, untested chemicals used by drug manufacturers to replace others either in short supply or banned through changes to possession, production and importation laws. This means their contents and effects are unpredictable, placing users and the community at further risk of harm due to an ever-increasing number of 'unknowns'.
This is why a targeted and comprehensive education program remains a key aspect of drug policy. The article goes on -
This risk is demonstrated in recent findings from the USA and Canada, where several studies identified the introduction of fentanyl in the illicit drug market. Specifically, evidence suggests a wide range of pills (e.g. MDMA) and other drugs (e.g. methamphetamine, cocaine) have been laced with fentanyl, highlighting the potential danger of relying solely on existing practices and technologies, as often local laboratories or other facilities (e.g. hospitals, police) do not have capacity for fentanyl testing or detection of new analogues.
As I said previously, if they detect a substance they cannot identify from the 30 000 in the database, it is immediately labelled as highly dangerous.
This confirms my previous statement that drug use cannot be and is not conceptualised or promoted as safe. Greater knowledge of these substances will arguably improve policy and treatment options and add to the body of knowledge that we can apply to appropriate and effective drug policies.
Although no Australian deaths have been confirmed as linked to fentanyl, 10 drug-affected youths did present in one night at the Royal Perth Hospital in 2013 demonstrating the devastating consequences of new batches of unknown substances.
These events support the call for pill testing as it can provide an additional mechanism to understand what new substances are out there, keep up to date with shifts in drug use trends and contribute to more effective prevention and treatment.
This knowledge can also assist law enforcement officers in addressing the very serious crimes of drug trafficking and other illicit drug trade crimes, adding to the harm prevention. It is not instead of, it is as well as.
In conclusion, I reiterate the broad community and key stakeholder support for pill testing trials at musical and other festivals in Tasmania. I also reiterate the fact that there is no safe way to take illicit drugs. Pill testing is not a panacea. Rather, it is part of a solution and an important part of a harm minimisation health-related matter that can be successfully delivered in harmony with law enforcement, as demonstrated in the ACT.
Another article by Professor Alison Ritter from the University of New South Wales was published in The Conversation in 2014 and updated in 2018; it provides a good summary of the support for positive impacts and limitations of pill testing -
A 2010 survey found more than 11% of 20- to 29-year-olds and 7% of 18- to 19‑year-olds had taken the drug [ecstasy] in the previous 12 months. According to annual research among 1,000 ecstasy users, 70% of these pills are taken at clubs, festivals and dance parties.
Australia is internationally applauded for our harm-minimisation approach to drugs but we have failed to introduce pill testing, even though it is an intuitively appealing strategy.
Research shows young people are highly supportive of pill testing; more than 82% of the 2300 young Australians aged between 16 and 25 years surveyed for the Australian National Council on Drugs in 2013 supported its introduction.
These are the people who are most at risk and whose voices we need to hear. Further -
The finding is consistent with young people's overall views about drugs: they want better information in order to make informed choices.
Informed choices may be not taking the drug at all and that would be the perfect outcome.
Professor Ritter also notes the limitation of pill testing and the need for a comprehensive approach -
A harm-reduction approach to drugs is always a balance between benefits and risks: the availability of pill testing reduces harm, but it may increase risk for some. Not everyone will use the service and some may ignore the results and risk being subject to potentially harmful drugs.
It may also lend the appearance of safety when, in reality, the pills remain illegal and potentially harmful. What's more, we will need to ensure that pill-testing results are accurate by researching the effectiveness of testing kits.
Of course, critics will argue the measure will 'send the wrong message'. But the messages we're currently sending are that we don't want informed consumers and we don't want to reduce harm from illicit drug use. Clearly, they're not quite right either.
Australia should run a trial of pill testing and assess its benefits and harms so we can then make an informed choice about this intervention.
The growth in new psychoactive substances and the ever-evolving chemical composition of drugs, coupled with the need to reduce the harms from pill user, means this is an idea whose time has come.
I am not suggesting pill testing should be a standalone tool; rather, it should form one part of our state drug policy with a health-related focus and harm minimisation approach. The way to determine the safety and efficacy of such a policy and to prevent gaps in service is by ensuring that a comprehensive health-focused approach is implemented. Furthermore, information gained during pill testing can provide both general data on consumption trends and market fluctuations and specific target information and education to users and potential users to reduce drug-related harm.
Whether we like it or not, the issue of both illicit and illicitly used drugs is a feature of contemporary social life and has been for decades, if not for centuries. Community attitudes are changing and alternative strategies are needed to reduce the harms for users, for their families and for the wider community. If members have taken time to talk to young people and festival organisers, publicans and others who hold events where young people gather and party, they will know this is the case. The reality is within these dynamic spaces party drugs such as ecstasy and methamphetamines are readily available and widely used, with recent evidence of increased consumption in more potent forms.
Whether we like it or not, this is the reality. Personally I would prefer not to need to have this conversation, but we know every generation seeks to engage in risky behaviour during this period of their lives. Turning a blind eye or ignoring it and hoping it is not one of our children, grandchildren or the children of our family and friends does not actually help anybody.
If we are to provide accurate information, advice and support to those most at risk of harm simply through not understanding the risks of such behaviour, isn't this a better outcome? No-one deserves to die for taking an ill-considered risk when opportunities to engage and educate them about that risks exist. That may be the last chance you get to do it.
Therefore pill testing is needed to monitor the quantity and content of the drugs used as well as to assess the rapid rise of novel and new psychoactive substances that pose significant risk to users and to those who share the social spaces of club and musical festivals. Although the Government displays strong philosophical support for harm minimisation in a range of risk areas, in practice, the Tasmanian Government's policy remains conservative in its approach by prioritising law enforcement strategies and zero-tolerance policies. We saw this reiterated in the media yesterday, despite evidence of the limited effectiveness of the law enforcement, zero-tolerance policies and growing support from experts, academics and the community highlighting the need for an alternative approach. Despite the illegal nature of activity and the fact that taking illicit drugs is not safe, there is wide support for harm reduction and the need for public health-focused strategies.
We need to move away from the politics of drug policy towards more evidence-based strategies to maximise the safety of young people who choose to use drugs, who, if given the opportunity to do so more safely, are more likely to grow out of their use without the stigma and the harms associated with criminalisation, and hopefully not die too young as a result of this risky behaviour. Sadly, some do not get a second chance. I hope the Government will alter its position and support this motion as a step towards the harm minimisation approach it supports in so many other areas.
As Dr Groves concludes -
While unambiguous, zero-tolerance messages are unrealistic and disregard contemporary patterns of youth drug use. In contrast, pill testing offers an alternative message; that drug use is dangerous, and informing users about what they are taking and the risks not only demonstrates social responsibility for this marginalised group but also that young people have the capacity for rational decision making and may desist from drug use because they see the risks for the first time.
... pill testing serves as a platform for more nuanced discussion of drug policy ideas and applications, particularly the need for innovative responses, to avoid the deaths of more young Australians.
Pill testing cannot eliminate the harms of drug use, but it is not intended to. It represents a model that best functions as one part of a much wider harm reduction strategy, to provide less punitive and more pragmatic responses to drug use for the protection of a generation of young club and music festival attendees, clearly establishing its worth in the Australian drug context.
Denial of the reality promotes ignorance. Ignorance is not bliss. Ignorance is harmful. I do not want to be one of those parents who gets a knock on the door from the police to be given the worst possible news - that one of my children is dead. While we cannot possibly prevent every young person's death from a range of causes, we can act to reduce the risk and minimise the harm. Just saying no and believing your kids, nieces, nephews, grandchildren and kids of your friends would not or do not take drugs is naive and denies the reality of youth culture. We may not like it and we do not condone it, but it is a reality. We should be focused on a serious law enforcement approach to drug manufacturers, traffickers and dealers. That should continue.
This is a pragmatic motion that does not call for the immediate implementation of pill testing. It is a call for the Government to explore how a pill testing trial could occur and what steps would be needed to facilitate a trial, particularly for this upcoming summer music festival season. I encourage members to support it from that perspective. Let us be on the front foot, acting proactively and being prepared to engage in a process that will educate our young people through a proven harm minimisation approach, save lives and build on the currently available data and research. That is what this motion is calling for.
The actual testing of the substances presented at pill testing stations is not the most important part of this process. The most important part is the interaction with qualified health professionals. The aim of those health professionals is prevention. The health professionals never suggest that a substance is safe to take and always explain the associated risk of consuming the substance. This is likely to be the first and possibly the only conversation the young person has, other than with a dealer or the friend they obtained the pills from, where they can get accurate information and advice about the risks associated with not just the drug they are holding in their hand but about illicit drug use generally. This can provide a way out for a young person feeling the effects of peer pressure, providing a legitimate and face-saving reason to dispose of their pills and thus not expose themselves to the risk. We know the pressure peer pressure can bring. This can give these young people an out.
Ongoing research in this area is being undertaken, following up with users of pill testing facilities to understand whether this also has lasting influence on the young person's future decision around pill taking. As I said at the beginning, taking illicit drugs is not safe and carries a real risk of serious adverse health outcomes and occasionally tragic deaths, whether we are talking about the so-called party drugs or any other illicit drugs.
This motion in no way condones, supports or approves of the use of party drugs or any other illicit substances. As a parent, and other parents of young people I have talked to, I would much prefer this potentially lifesaving option to getting a visit from the police with the worst possible news of all.
I call on the Government to revisit its opposition to a pill testing trial and investigate the framework with which it would need to be set up, for all the reasons I have raised. I ask it to recognise the broad community and stakeholder support for such a trial to commence once the necessary steps are explored about how to engage in that.
I encourage all members to support the motion.
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