Staying in The Loop
Drug checking has been a hot topic of conversation recently, both in the media and among community. With the current state of NSW’s drug supply and nitazenes, and the recent NSW Drug Summit, drug and alcohol services, community orgs, the harm reduction sector and the community at large have been advocating for and demanding access to drug checking services in NSW. Drug checking offers multiple benefits for community, including knowing more about what is the drug supply, and giving people access to health information and interventions that they may not otherwise have had.
ACON has signed on to the “Just Check it Campaign”, along with dozens of other NGOS, earlier this year: Just Check It – Drug Checking Now!
Zeek (CHPO- Harm Reduction) recently sat down with Dr Rob Page, the clinical lead for The Loop Australia, to talk all things drug checking, what’s being found in the drug supply, and the impact that drug checking has on reducing risks of harm.
Zeek: What is The Loop Australia and what do you do?
Rob: The Loop Australia is a not for profit, health promotion charity, founded in 2018, with the goal of developing and delivering drug checking services in New South Wales, Queensland and Victoria. We have a team of chemists, pharmacists, GPs, sociologists, drug and alcohol specialists and other allied health staff. The Loop has been paving the way for accessible drug checking across Australia.
At the moment we are delivering several drug checking services: we’ve just finished up the drug checking pilot which was at the Medically Supervised Injecting Centre (MSIC), which was a time limited trial for people who inject drugs who are clients of the injecting centre. In Queensland we’ve delivered one festival-based drug checking service at Earth Frequency 2024 and we’ve got 2 fixed site services; one on the Gold Coast and one in Brisbane. We’ve also got a performance and image enhancing drug checking service and right now are up at schoolies delivering a service there!
Zeek: So, what is drug checking?
Rob: Drug checking is a proven harm reduction strategy that can allow for 1:1 harm reduction discussions and safer decision-making around drugs. The service allows people to submit samples of their drugs for chemical analysis, which can provide information around purity and adulterants found in each sample, which facilitates informed decision making around taking the substance.
We talk about it as drug checking rather than pill testing, as you may have heard it referred to – because pill testing has a certain implication that people are just testing pressed pills, whereas we know that people who use drugs use a big variety of substances, and almost all of these can be checked.
Zeek: What are some of the differences between drug checking services at fixed sites vs at a festival?
Rob: There are differences across drug checking locations, and the benefits can vary for different populations of people who use drugs. There’s people who inject drugs, there’s people who take drugs at festivals or in nightlife scenes, there’s people who use drugs for pain relief or psychological reasons and everything in between so it’s important for us to have a holistic approach to drug checking.
One of the biggest benefits of The Loop’s service is the conversations and referrals that are facilitated. The 2 fixed site drug checking services in Queensland are delivered in partnership with QuIVVA (Queensland’s drug user orgaisation) and QuIHN, a not-for-profit health service focused on people who inject drugs. This allows for internal referrals to be made on the day. For example, someone with substance dependence may be able to see a counsellor or doctor on the day, which can happen internally. Whereas at a festival, you might be making fewer of those direct referrals, but you might be the first drugs expert that a punter has ever spoken with, and you can provide really useful harm reduction advice and potentially help that person to make more informed and safer decisions. People often then share that advice with their friends, so they can keep one another safer.
Zeek: What substances are you commonly seeing at festivals versus your fixed site or pilot program?
Rob: At the injecting centre in Sydney, clients of the centre were typically bringing in samples they planned to inject, or a drug they’ve already used, that they thought may be a bit sus. We predominately had people bring in methamphetamine, heroin, cocaine and some other things as well. Whereas at fixed site community drug checking services you may get people who plan to consume their drugs orally, snort them, shelve/boof them and consume them in different ways so you’re going to get a wider variety of drug samples. We’ve seen a decent amount of MDMA, ketamine and its analogues, benzodiazepines, opioids and other psychoactive drugs. This is different again to a festival where most people are bringing in either MDMA, Ketamine or psychedelics and smaller amounts of other substances.
Zeek: Having drug checking services of different kinds must provide a good idea of the trends related to substance purity and adulterants. What are the trends you’re seeing?
Rob: Of the drugs people were submitting at the injecting centre, most were what people thought they were, but there were a few interesting contaminants like finding phenacetin (pain killer that can cause significant damage to kidneys) in cocaine.
Over the first four months in Queensland, we tested around 400 samples, most of them were MDMA. 70% of samples were what people thought they were getting and 30% were found to have other stuff in them. The unexpected adulterants included things like synthetic cathinones (often dimethylpentylone and a few others), ketamine analogues (such as canket), tusi (Ketamine, MDMA + cocktail) and a decent amount of fake benzos; people thinking they have Xanax but they have etizolam or bromazolam; and phenacetin in cocaine.
Another things that’s been found in Queensland and in NSW is people coming in with their sample and saying “I’m sure this has been cut with something because its leaving me feeling, scat, nauseous, shaky etc” then us being able to test is and say, “Actually no, this is just ‘substance’, and the reason you’re feeling like that is because you’ve developed a tolerance- likely because you’re using a high purity substance.” This can lead people to rethink their substance use, and consider that it may be more of an issue than they previously thought, this allows people to make much more informed decisions about their drug use going forward.
At the time of this interview, no nitazenes or fentanyl had been found in the MSIC pilot or in the Queensland services. However, since then, Nitazene has been detected in fake oxcodone tablets in Brisbane. The alert can be found here.
Zeek: Accessing a drug checking service must be a bit intimidating, especially for first timers. Fear of being caught with an illicit substance or being found to have accessed the service might prevent people from seeking out these harm reduction services. How do you ensure privacy/confidentiality for people accessing your services, particularly at festivals?
Rob: When talking about privacy and confidentiality around drug checking at music festivals, much of this work is done with stakeholders (organisers, promoters, health and medical services, police, and security staff) before the festival begins. There’s quite clear arrangements when we’re going onsite that if you’re engaging with someone in a harm reduction or health way, that police are not to get involved if there are no threats of violence or aggression or anything like that. It’s always clearly delineated where police and security staff go in the festival and where they don’t go.
Once you’re in The Loop’s service, the people who are conveying results and having those discussions are trained health professions, so we all work in a confidential way every day… we know what that’s about and what that looks like. No identifying details are recorded, all data is stored in a secure way and no information shared in a consultation with someone gets discussed outside of that conversation.
Zeek: What are the common responses or reactions from people when unexpected adulterants are found in their drugs?
Rob: One of the big benefits of drug checking is that it opens up a lot of great conversations around drug use and harm reduction with people who have never had those conversations, regardless of what is actually found in their drugs and people’s responses to results can vary depending on the setting.
For example, at the injecting centre most drugs turned out to be what people thought they were, and so planned to take the drugs anyway, but you’ve often had really good conversations, or given someone take home naloxone to keep themselves and others safer. We’ve also facilitated quite a number of referrals into treatment. So even if they might have used the drugs anyway, they were then able to link in with treatment and work on managing their substance use. This is a huge win, that may not have been possible without the drug checking service.
At festivals or the fixed site services, that’s where we more commonly see those conversations having a more immediate impact on people’s planned drug use decisions. Of the people accessing the fixed site in Queensland, 16% of people said they would dispose of their drugs, 23% said they would reduce their dose, so that’s almost 40% of people who are going to make decisions around their substance use that is going to decrease their risk related to the use of that drug.
Zeek: What’s a myth about drug checking you want to bust?
Rob: A myth I want to bust is that we’re telling people that it is safe to take a drug or that we are encouraging or condoning drug use. Safety is a relative thing and the safest choice is always to not consume whatever substance it might be. However, almost half of the adult population has consumed an illicit substance at least once in their life. Rather than saying “it’s not safe don’t take drugs”; we treat people like adults, giving them more agency and giving them sensible and evidence-based advice that they can implement to keep themselves and the people around them safer. That’s what the goal is.
Zeek: What is the Loop hoping to see come out of the NSW Drug Summit?
Rob: We would love to see drug checking services available to varied populations who use drugs in NSW, including community based fixed site services – and those services should be delivered in conjunction with peer organisations who know the local environment. This means they can serve the communities who need it most, and involve those community members in design and delivery. Ideally services should be delivered at festival and nightlife environments as well and be adequately resourced.
Zeek: Is there anything else you think is important to know about the Loop?
Rob: People have been working to make drug checking a thing in Australia for decades. People have also analysed their own and their communities’ drugs in various ways underground in Australia for decades. The work of people in Cantest, Pill Testing Australia, and the Loop has shown that if you keep advocating and work with community, asking and listening to what they want, eventually we do get progress. So I’m hopeful that with ongoing hard work we can continue to move this stuff forward- it might take a bit more time than we want but eventually we will get there. We all want a future where all people have access to the harm reduction they need, including drug checking.
Zeek: Thank you so much Dr Rob Page, it’s been awesome chatting and hearing more about this exciting and important work. By knowing more about what is in the drug supply, we have a better chance of preventing drug related harm so hopefully we see increased access to drug checking in the near future.
If you’d like to find out more and follow this work, head to:
Website: The Loop Australia
Instagram: The Loop Australia (@wearetheloopau)
Cheqpoint: CheQpoint: Queensland’s free drug checking service (@cheqpoint.qld)