Discuss about the Parliamentary Submission on Legalizing Pill Testing of Ecstasy.
In the last 20 years, the attention of the public health sector has been steering toward Social Determinants of Health (SDOH). These social determinants are the factors outside of medical care, which shape health and are influenced by societal policies in significant ways. There is a significantly large amount of evidence that has been accumulated and which gives compelling data on the role that social factors play in shaping population health across a broad range of settings, indicators, and populations (Marmot and Bell, 2012; Braveman, Egerter, and Williams, 2011; Adler and Stewart, 2010) . There have been several researches done which aimed at assessing the impact that social factors have on health. Some of these researches include those by McGinnis and colleagues where they estimated that preventable mortality (10%-15%) was caused by aspects of medical care (McGinnis Williams-Russo, and Knickman, 2002). Studies by Mackenbach (1996) showed that the results by McGinnis et al., were underestimated, which affirms the significance that social factors play. McGinnis and Foege (1993) in their research, showed that 50% of the deaths that occur in the US were as a result of behavioral causes.
Health commences in our communities, neighborhoods, workplaces, schools, and homes. It is common knowledge that staying healthy involves adopting habits that promote one’s health such as getting immunized, not smoking, visiting a medical center when sick, staying active, and eating well. In addition to adoption of positive habits, our health can be influenced by economic and social opportunities; available support and resources in our communities, neighborhoods, and homes; workplace safety; schooling quality; cleanliness of air, food, and water; as well as the nature of relationship and social interactions.
Healthy People 2020, emphasizes the significance of focusing on health social determinants by encompassing the creation of physical and social environments that encourage and bolster good health for every individual (Healthy People, 2010). The World Health Organization shares the same emphasis and to that end, it published the 2008 report: Closing the gap in a generation: Health equity through action on the social determinants of health. Some examples of social determinants include accessing healthcare; public safety; exposure to disorder, crime, and violence; social attitudes and norms, among many others.
By working toward establishment of policies that impact economic and social conditions in a positive manner as well as those that encourage changes in individual behavior, the larger population health will be improved in sustainable ways and over long durations of time. By improving the quality of individual relationships with each other as well as the conditions of our playing, working, learning, and living places, it will be possible to create a population workforce and society that is healthy.
Several scientific literatures have delved into the relative contributions made by behavioral, environments, and social factors in the promotion of health and in the reduction of premature mortality (Chiu et al., 2009; Lee & Paxman, 1997). These studies have given similar conclusions that when it comes to health, factors that are non-medical play a greater role than those that are medical. Researchers have estimated that accessing high quality medical care could result in 20% prevention of avoidable deaths. 60% of avoidable deaths are attributed to environmental, behavioral, and social health determinants while the remaining 20% are due to a person’s genetic makeup (McGinnis et al., 2002). Other researches allude similar patterns for diseases that are more specific such as diabetes, stroke, and heart disease (Hu et al., 2001; Platz et al., 2000; Stampfer et al., 2000).
The last six years has seen a sharp increase of NSW hospital visits by ecstasy users. A study done in emergency units of 59 NSW health facilities showed that patient presentations in these facilities by persons aged between 16 and 24 years increased to 814 in 2015 from 413 in 2010. These patients presented themselves with ecstasy related complications and complaints (Christodoulou, Hanna, Balendra, and Worthington 2016). The year 2015, recorded the worst statistics in the history of music festivals with four deaths occurring between the months of September and December. The total deaths reached an all time of 6 in 2015 and included the demise of Stefan Woodward and Sylvia Choi who passed on after attending Stereosonic festivals in Adelaide and Sydney respectively (Christodoulou et al., 2016). This rise in ecstasy related death toll points to the urgent need for the government to consider revising its hard-line stance of not legalizing pill testing.
Consumption of illicit drugs and especially ecstasy is quite common among young people. A survey by the EDRS(2014) shows that approximately 7% of persons between the ages of 18-19 years and 11% of persons between the age of 20-29years had consumed the drug over a 12 month period prior to conducting the survey. The survey also showed that 70% of ecstasy consumption occurs in dance parties, festivals, and clubs.
Availing pill-testing kits or setting up testing booths in places and venues where there is high consumption rates of ecstasy could be a way of informing users on the content of the said drugs. There is equipment that is capable of carrying out real time tests and this could help users check the drugs beforehand (Ritter, 2010). Research indicates that there is high support among youth for pill testing. A 2013 national survey carried out by the Australian National Council on Drugs and which included 2,300 participants, showed that 82% of the respondents aged 16-25 supported the introduction of pill testing. These findings are consistent with the overall views held by youth: better information for better decisions (Ritter, 2014). The idea of pill testing is not a radical one. There are countries across Europe including France, Spain, Germany, Belgium, Austria, Switzerland, and the Netherlands which provide the service as an intervention for harm reduction. (Ritter, 2014)
The first reason is that there is evidence that pill testing changes the black market. When a product is identified as a danger and is subsequently labelled as a hazard, it is likely to leave the market (Ritter, 2014). The second reason is that research has shown that over time, the contents of tested pills correspond to the component that is expected. What this implies is that there is high likelihood of resulting in positive changes in the black market. Thirdly, behavioural change is eminent.
A study done in Austria showed that 50% of persons who submitted their drugs for testing said that the result affected their choice to consume or not. Of the surveyed population, two thirds indicated that that they would opt not to consume the drug and would go a step further and warn their friends against consuming the same in cases where the results were negative (Ritter, 2014). Fourthly, a visit to a pill testing booth is an opportunity to access information and support that goes beyond the testing. These booths allow drug service providers to access a population that is normally difficult to access as the users do not experience any acute drug problems. The fifth reason is that pill testing allows for the opportunity for the various stakeholders to capture data on the actual substances in drugs used on site. This also means that an early warning system can be created. This will be especially useful as there are new psychoactive ingredients that are being added as adulterants and in a more frequent manner
Regulation or prohibition of recreational drugs has been an issue that society has grappled with over a long period of time. Although it is at times necessary to prohibit the use of recreational drugs, it also poses the risk of increasing danger. Besides the harmful effects that these drugs pose, the untested and unregulated nature of the market exposes them to contamination or adulteration. More specifically, there are three risks that are related to illicit drug production (Hunt et al, 2003): contamination during the process of production; adulteration using cutting, bulking, imitation, or cheap agents; dosages that are excessively pure or strong.
The aforementioned problems are common in parties in held in places including night clubs, festivals, and music events. Most often, party drugs are pills that can be easily adulterated and impossible to sight quickly (Schroers, 2002). Ecstasy pills sold and distributed in Australia rank among the highest with regard to causing danger. This was revealed after conducting a review of more than 27,000 pills in five countries and over a period of one decade (Project Know, 2014) The said ecstasy pills have the highest toxicity as well as the highest amount of potentially fatal ingredients (PMA)(Project Know, 2014). In the period between 2000 and 2004, there were a total of 112 fatalities, all linked to ecstasy use. This lead to the identification of ecstasy toxicity as a high clinical risk (Kaye et al., 2009)
The drug policy in Australia is founded on three pillars namely: harm reduction, demand reduction, and supply reduction. States such as Victoria have policies in place that focus on demand reduction via deterrence. This is done using sniffer dogs. However, the success rate of the sniffer dog programs is unsatisfactory in terms of drug detection and prosecution outcomes. The program is also a health risk as people may be tempted to consume their drugs at one go to avoid arrest and this could potentially result in death of the consumer.
An alternative approach, based on harm reduction, provides the best way forward. This will include drug market monitoring for the creation of an early warning system, on-site pill testing, data publication from drug seizures carried out by police in parties. For starters, on-site pill testing reduces the potential for persons to consume illicit drugs as most opt not to use them once they are alerted on contents and strength risks. Secondly, early warning systems are effective in preventing consumption of fatal drugs. Thirdly monitoring of the drug market and campaigning against harmful drugs results in withdrawal of such drugs from the market (Kaye, 2009).
A monitoring system would allow for easier diagnoses in healthcare facilities as well as treatment of patients in emergency rooms as well as in the field. Forensic police departments in States such as Victoria compile data on drug seizures that though comprehensive, is not shared or publicized. No legislative change would be required to publicize the information and neither would it require large amounts of additional resources (Kaye, 2009).
Harm reduction calls for the evaluation of policies with regard to overall impact of drug harm and not on the overall impact of drug use. It is therefore the recommendation of this Submission that the primary concern should be proposed measures’ effectiveness in harm reduction of drugs of unknown toxicity and purity, even when they will not contribute necessarily to drug use reduction.
Several surveys show that pill testing reduces consumption of high risk recreational drugs (Tregoning Submission). In a hypothetical study done in Australia, 76% of the participants reported that they would refrain from consuming a drug that had unknown ingredients in it. A majority (63%) were interested in the availability of pill testing. With regard to GHB, on-site testing can also detect the presence of this substance in alcohol which could prevent date rape and spiking (Johnston et al., 2006)
References
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Chiu, G. R., Araujo, A. B., Travison, T. G., Hall, S. A., & McKinlay, J. B. (2009). Relative contributions of multiple determinants to bone mineral density in men. Osteoporos Int, 20(12), 2035-2047. doi: 10.1007/s00198-009-0895-0
Christodoulou, Hanna, Balendra, and Worthington (2016) Government urged to consider pill testing as number of ecstasy users appearing at NSW hospitals doubles. https://www.abc.net.au/news/2016-02-15/ecstasy-government-pressured-to-consider-party-drug-testing/7166220
EDRS (2014) 2014 Drug Trends Conference Handout https://ndarc.med.unsw.edu.au/sites/default/files/ndarc/resources/2014%20Drug%20Trends%20Conference%20Handout%20EDRS.pdf
Healthy People(2010)Secretary’s Advisory Committee on Health Promotion and Disease Prevention Objectives for 2020. Healthy People 2020: An Opportunity to Address the Societal Determinants of Health in the United States. July 26, 2010. Available from: https://www.healthypeople.gov/2010/hp2020/advisory/SocietalDeterminantsHealth.htm
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Johnston, J et al (2006). ‘A survey of regular ecstasy users’ knowledge and practices around determining pill content and purity: Implications for policy and practice’, International Journal of Drug Policy 17: 464-472.
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Project Know (2014) ‘Jagged Little Pill: Examining the contents of 27,000 ecstasy pills’, Project Know: Understanding Addiction, 2014, accessed at <https://www.projectknow.com/discover/jagged-little-pill/> on 14 April 2016.
Ritter, A (2014) ‘Six reasons why Australia should pilot ‘pill testing’ party drugs’, National Drugs and Alcohol Research Centre (NDARC), UNSW Faculty of Medicine, NSW, accessed at <https://ndarc.med.unsw.edu.au/blog/six-reasons-australia-should-pilot-‘pill-testing’-party-drugs> on 23rd March 2017.
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