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‘Worth the test?’ Pragmatism, pill testing and drug policy in Australia RESEARCH Open Access ‘Worth the test?’ Pragmatism, pill testing and drug policy in Australia Andrew Groves Abstract Background: Recent deaths of young Australian music festival attendees from ‘party-drug’ overdoses have sparked debate about the effectiveness of drug policies. Australia is widely lauded for its harm minimisation approach to drugs, and yet, over the last 30 years, it can be argued its policies have been fragmented, sometimes inconsistent and contradictory. The present article examines the root of this inconsistency, using it as a foundation to advocate for drug policy reform. In keeping with the goals of the National Drug Strategy to promote policy innovation, there is an opportunity to learn from international studies which have shown promising findings in the reduction of party-drug use and its harms through application of pill testing. Method: This paper evaluates Australia’s National Drug Strategy and pill testing through a lens of pragmatism, to determine whether there is space for testing practices in contemporary policy. Specifically, the paper analyses current drug policy literature and research studies, examining a range of key drug use indicators, social and political debate and research evidence. Results: The need for policy reform, attitudinal and cultural shifts and development of stronger cross-sectoral partnerships is highlighted, to ensure a rational and logical approach that genuinely tackles drug policy-making and strategy from a broad public health perspective. Conclusions: Using a theoretical frame of pragmatism and drawing from national and international research evidence, this paper recommends the integration of pill testing into Australia’s harm minimisation strategy. Keywords: Pill testing, Harm minimisation, Pragmatism, Australian drug policy, Party-drug use Background Young people have long been associated with drug consumption, often displaying patterns of use distinct from the general population [1–3]. Like many other coun- tries, the emergence of dance-music culture and ‘raves’ in Australia in the 1970–1980s bolstered the relationship be- tween drugs and youth, creating dynamic settings in which consumption of so-called ‘party-drugs’ such as methamphetamines, ecstasy and other psychoactive sub- stances has become common [4, 5]. For many young people (i.e. 18–29 years old), attendance at dance-parties and music festivals is a rite of passage within a hedonistic lifestyle where identity and social capital are built, pleasure is ‘consumed’ and alcohol and other drugs (AODs) are ubiquitous. However, youth party-drug use is typically viewed by politicians, criminal justice professionals and the community as deviant, linked to risk-taking, transgres- sion and individual corruption [6], manifest in a range of physical, psychological and social harms [1]. Indeed, there have been several deaths of young music festival attendees in Australia [7–9], which have held youth party-drug use at the forefront of political, social and media agendas. However, notwithstanding the tragic loss of young lives, what is concerning is that these fatal overdoses, and sev- eral ‘near-misses’, may have been avoided through more pragmatic and amoral drug policy and practice. Pill testing offers an alternative, yet it remains at the fringe of policy debate, shrouded by punitive praxis and government reti- cence despite support in the community. Policy and practical ‘problems’ Similar to recent experiences in the UK [10, 11] and Europe [12], Australian AOD policy is at a significant Correspondence: andrew.groves@deakin.edu.au School of Humanities and Social Sciences, Deakin University, Burwood campus, Melbourne, Victoria 3125, Australia © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Groves Harm Reduction Journal (2018) 15:12 https://doi.org/10.1186/s12954-018-0216-z http://crossmark.crossref.org/dialog/?doi=10.1186/s12954-018-0216-z&domain=pdf http://orcid.org/0000-0002-1081-7909 mailto:andrew.groves@deakin.edu.au http://creativecommons.org/licenses/by/4.0/ http://creativecommons.org/publicdomain/zero/1.0/ juncture. At the policy level, the implementation of the seventh iteration of the National Drug Strategy (NDS) demonstrates commitment to consistent, ongoing na- tional drug policy [13] in response to the problem of drugs, both illicit and illicitly used (i.e. pharmaceuticals, alcohol and tobacco), under the philosophy of harm minimisation. The NDS outlines a series of principles addressing this philosophy, which prioritise delivery of evidence-informed responses, collaborative interdiscip- linary partnerships and a trifurcated approach targeting demand, supply and harm reduction [13]. With regard to party-drugs, however, the application of this policy is contested. While the NDS claims the ‘balanced adoption of effective demand, supply and harm reduction strat- egies’ ([13]:1), in practice, the distribution of resources, action and policy reform across its ‘three pillars’ falls short of this claim. As discussed below, there are consid- erable funding gaps in AOD treatment [14], zero- tolerance remains the bastion of public policy and resources are principally expended on law enforcement [15, 16]. While in practice, it is not an either/or approach to supply, demand and harm reduction, nor are these domains mutually exclusive, clearly a balanced approach has not yet been achieved. 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 [17] at a time when regular users have increased consumption of more potent forms, such as ice (crystal methamphetamine) and MDMA (3,4-methylenedioxymethamphetamine) [18, 19]. The current framework does not fully capture these nuances, constrained by hegemonic notions of abstinence. In- stead, 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 [20], current harm reduc- tion initiatives have been largely ineffective [21, 22], evident in monitoring data where certain groups of young people appear to resist social controls by continu- ing to use party-drugs. As noted in previous studies [23–25], 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 [25]. 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 [26].1 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 [28, 29]. Reports have increased of ecstasy pills containing large amounts of methamphetamine [30] and other toxic substances (e.g. rat poison), with others recorded as very high-purity [18], 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. Pill testing/drug checking Pill testing is a harm reduction strategy used inter- nationally, also known as drug checking or adulterant screening [31, 32], which emerged in the early 1990s in the Netherlands [33] where it is now part of official national policy. Similar initiatives have since been imple- mented in other European nations including Sweden, Switzerland, Austria, Germany, Spain and France, albeit primarily administered and funded privately [12, 34]. Organisations such as DanceSafe also operate in the USA focused on harm reduction through peer- education, where a language of pragmatism has been established [34, 35]. 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 [32]. In Europe, this is typically undertaken in mobile facilities located near or inside venues to allow timely feedback to users (approx. 30 min). Results are then ‘posted’ anonymously on information boards or event websites (often using red/yellow/green colour-coding), so users can review feedback clearly and discreetly. These practices are pos- sible through partnerships between event promoters, healthcare services and local police and a strong harm reduction philosophy [36, 37]. Most importantly, this approach has the capacity to influence consumption behaviour where, in contrast to relying on the strength of broad anti-drug campaigns, testing in situ can alter behaviour at the time of consumption, primarily shaped by peers and social networks [38], including health workers [39, 40]. Testing can also involve offsite analyses prior to events, encouraging planning among users, though it is less common as these services often require users to provide identification, increasing the perceived risks of being identified by police [41]. Pill testing is well supported at the local level in Europe, with self-report data from users, accounts from key stakeholders (including police) and wider commu- nity endorsement that it provides ‘safer’ drug settings by warning users about harmful and/or unexpected sub- stances [34, 41]. Although research on its effectiveness is mixed (discussed below), there is practical evidence that pill testing has helped to reduce overdose frequency, improve healthcare services, and increase knowledge of Groves Harm Reduction Journal (2018) 15:12 Page 2 of 13 harm reduction principles [34, 41, 42]. Increased publi- city for support services, advocacy for public health campaigns and opportunities for monitoring and re- search are further benefits observed internationally, which have fostered evidence-informed and more effect- ive prevention and treatment [34, 36]. These 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 by considering social contexts of drug use to understand the relationship that individuals and envi- ronments have on drug-related harms [43]. It is import- ant, however, to emphasise that drug use is dangerous and cannot be conceptualised as risk-free, nor is pill test- ing a ‘silver bullet’, with some well-documented concerns [44]. Instead, this article argues that pill testing needs to be viewed through a lens of pragmatism, where for cer- tain 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 asso- ciated harms, as well as making important practical changes to the settings in which drugs are used. As discussed herein, such thinking appears confront- ing within the Australian drug policy landscape, where current discourse is dominated by dogma, moral conflict and criminal justice debate. Yet, this has not always been the case, as Australian drug policy has a fragmented his- tory [45–47], shaped by the changing vagaries of various political, social and moral forces. The aim therefore is to determine whether pill testing ‘fits’ within this