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Beyond ‘pill testing’: Calling for appropriate event health care services at music festivals
The ‘pill testing’ debate in Australia has been shown to be a political minefield with governments on both sides of the political divide seeming to box themselves into positions which are at odds with the evidence (1, 2) and advocates (3) alike. The drug checking issue is challenging for politicians who are wary of being portrayed as ‘out of touch’ on one hand (4), or ‘soft on drugs’ on the other (1). This is a significant problem as it can undermine the political endorsement needed for health and law enforcement stakeholders to work together to trial and evaluate this very promising intervention. This is despite us now having had two high profile examples which show that drug checking can be done effectively at Australian music festivals (5-7).
One response to this stalemate is to reframe the issue away from a focus on ‘pill testing’. Rather, to see the music festival as another entertainment setting where it is incumbent upon governments and promoters to ensure that the venue is safe for the public to enter and enjoy themselves. This means providing adequate harm reduction services and access to appropriate, coordinated, event health care services. In some international examples, event medical services have grown over many years to even include permanent onsite medical facilities (eg 8). However, these are the exception. Event health care services should include: outreach teams that roam the festival site providing water, sunscreen etc, and identifying people at risk who can be referred to the onsite health service; qualified health practitioners providing assessment and triage; onsite management of acute conditions and referral and ambulance transport for those requiring hospital management; and trained staff providing information and counselling services (8). Drug checking services are likely to be an important additional component of event health care services, and their additional benefit should be carefully evaluated in a number of Australian settings.
This is important because recent surveys of Australian festival-goers have found that some 60-65% of respondents said that they took illicit drugs at the last festival they attended (9, 10). That suggests this is a venue with good reach into a population of people who use drugs. Furthermore, UK research indicates a 95% reduction in drug-related hospital A&E department presentations (from 19 to 1) associated with a festival in years when comprehensive drug checking services were offered compared to when such services were not offered (11). Importantly too, the same research found that some 20% of substances people had tested were not what they thought they had purchased, and 67% of these people disposed of their remaining drugs onsite, 9% said they would dispose of them, and 2% said they would return them to their dealer. Only 9% said they would take their usual amount. Those who purchased their drugs at the festival were almost twice as likely to have purchased drugs which, when tested, were not as expected (11).
On the other hand, evidence regarding the use of drug detection dogs at music festivals calls into question that strategy. For example, a 2016 online survey of festival-goers in Victoria and Western Australia, conducted by NDRI PhD candidate Jodie Grigg, found that only 4% of respondents who intended to take drugs and expected drug sniffer dogs to be present said that led them to decide not to take drugs at the festival. Rather, 48% decided to better conceal their drugs, 15% to get someone else to carry them, 11% to buy their drugs inside the venue, 10% to take less easily detected drugs, and 7% to take their drugs before entering (12). Some 10% of those who carried drugs into the festival concealed them in a body cavity and 1% swallowed them to retrieve once inside the venue. And one in 10 of those who had drugs on their person when they saw a drug detection dog reported consuming drugs in response. None of the 418 respondents who carried drugs in reported being detected by the sniffer dogs (12).
The focus on ‘pill testing’ also gives the impression, for those who don’t look beyond the headline, that people simply bring their drugs in for checking and get told what’s in them and leave. Of course this is far from the truth. Best practice drug checking services at festivals typically take 15-30 minutes and involve medical professionals and trained analysts using laboratory grade equipment to scrutinise the sample and give a best estimate of what it contains, including ideally an estimate of the drug’s purity or dose. This is important because not all the risks are about the action of unknown contaminants in a drug. High dose pure drugs can also be dangerous. The limitations of the analytical procedure are also made clear. Drug checking services never deem a drug as ‘safe’. Rather, they reinforce the message that all drug use is risky. The results of the drug analysis inform the counselling interaction between a trained expert and the potential drug taker about their drug use and reducing risk, including that not using drugs is the safest option. It appears that having the results of the drug sample analysis makes the risks more concrete for the mostly young people that are engaging with the service. It provides an opportunity for them to talk with a qualified counsellor about their drug use, often for the very first time. Amnesty bins are provided where drugs can be discarded, and when particularly dangerous drugs are detected, warnings can go out to inform festival-goers about particularly risky drugs that are going around. Beyond the festival environment, the results of drug analysis can be used to inform health services and law enforcement authorities about the make-up of drugs in circulation (6, 11).
Drug checking services at music festivals will never be a silver bullet for all drug related harm and deaths associated with music festivals. But the existing evidence suggests that they can make a significant contribution to reducing drug-related harm associated with these events. We should expand and evaluate this intervention. To do this political support is needed. This may best be achieved by changing the debate to see this intervention as one component of broader, coordinated, event health care services.