Pill Testing: A Comprehensive Series on Pill Checking/Testing – Part 2: The Hidden Dangers of False Security

A Must-Read for All Australians, from Politician to Parent to Punter

This is Part 2 of our in-depth series examining the complex issue of pill testing in Australia. For a complete understanding of this critical topic, please refer to Part 1, which covers the initial aspects of this debate.

As we explore deeper into the pill testing controversy, it becomes increasingly clear that the issue is far more complex than initially presented. This second instalment aims to provide a thorough examination of additional scientific evidence, practical considerations, and potential unintended consequences of pill testing programs.

The Limitations of Pill Testing Equipment

Current Technology: Not as Effective as Claimed

Pill Testing Australia has primarily used Bruker Alpha devices for their trials. However, these machines have significant limitations when it comes to identifying complex drug mixtures. Dr. Andrew Leibie, a South Australian toxicologist, explains:

“This is a known issue for FTIR. Once you get more than 3/4/5 compounds present, the spectra (i.e., the IR light reflected off the sample) becomes too complex for the algorithms to identify. It’s not so much about the amount of individual drugs present, as to how ‘noisy’ the output is. This is a real problem for illicit pill testing as you can imagine there is typically a lot of contamination from other fillers, poor hygiene, solvent residues etc that would not be present in a commercial drug manufacturing process.”

This limitation is particularly concerning when considering the rare but dangerous “bad batch” incidents. For instance, the 2017 Melbourne deaths involved a complex mixture of MDMA, 4-FA, and 25C-NBOMe – a combination that the Bruker Alpha devices might struggle to accurately identify.

The Push for More Advanced Equipment: A Misguided Approach?

In response to these limitations, there has been a push for more advanced and expensive technology, such as DART-MS (Direct Analysis in Real Time Mass Spectrometry). However, this emphasis on equipment upgrades may be misguided, given the underlying issues with pill testing as a harm reduction strategy.

The Myth of MDMA Overdose

Rarity of True Overdoses

One of the key arguments for pill testing has been the need to prevent overdoses. However, evidence suggests that true MDMA overdoses are relatively rare. Reputable harm reduction organisations have acknowledged this fact:

The Drug Policy Alliance states: “Overdoses are extremely rare and are also usually linked to dehydration or mixing drugs, rather than as a direct result of using ecstasy.”
DanceSafe, another harm reduction group, urges people to “Stop calling them overdoses.”

Despite this, some pill testing organisations continue to emphasise the importance of testing MDMA dose and purity, perpetuating the misconception that overdose is a common risk.

The Unpredictability of MDMA Blood Levels

A critical flaw in the argument for dose-based advice is the unpredictable relationship between the amount of MDMA consumed and resulting blood serum levels. Scientific studies have shown that blood serum MDMA levels can vary widely among individuals who have consumed the same dose.

A graph from a South Australian study illustrates this point clearly. It shows that even small doses of MDMA (80-90 mg, which is on the lower end of what’s typically found in a single ecstasy pill) can result in blood concentrations well above the levels that caused 50% of Australian ecstasy deaths between 2000 and 2018.

This wide variance makes it virtually impossible to provide meaningful advice on “safe” dosing. As the study demonstrates, ingestion of just 100-115 mg of ecstasy (a standard dose for a single pill) can result in blood levels ranging tenfold, from 120 to 1040 ng/ml.

The Real Causes of Ecstasy-Related Deaths

Idiosyncratic Vulnerabilities

A significant proportion of ecstasy-related deaths are due to individual vulnerabilities to MDMA. The case of Anna Wood, Australia’s first ecstasy death in 1995, illustrates this point. Anna and four friends bought ecstasy tablets from the same batch, but only Anna died. There were no impurities or other drugs mixed with the MDMA – it was ecstasy alone that caused her death.

According to the Roxburgh study, ecstasy alone was directly responsible for 14% of all MDMA-related deaths in Australia between July 2000 and November 2018. Many of these deaths occurred from very small doses of ecstasy, highlighting the unpredictable nature of individual reactions to the drug.

Polydrug Use

The most significant factor in MDMA-related deaths is polydrug use. The Roxburgh study found that 48% of the 392 MDMA-related deaths between 2000 and 2018 were caused by ecstasy consumed along with other substances such as alcohol, cocaine, or amphetamines.

Alcohol, in particular, is known to interfere with the metabolism of MDMA, leading to higher blood concentrations. Similarly, methamphetamine, like ecstasy, can cause hyperthermia, and when taken together, can increase the risk of fatal complications.

Accidents Resulting from Ecstasy Intoxication

A significant 29% of all MDMA-related deaths between 2000 and 2018 were from fatal accidents deemed by coroners to be caused by ecstasy intoxication. Most of these deaths involved vehicles, highlighting the dangers of operating machinery or driving while under the influence of MDMA.

Environmental Factors

Scientific studies with rodents have demonstrated the critical role that environmental factors play in MDMA-related deaths. Changes in social context and ambient temperature can dramatically increase the risk of fatal reactions to MDMA.

For example, rats given one-fifth of the lethal dose of MDMA exhibited brain temperature increases when placed in a social situation with other rats. When this was combined with an increase in ambient temperature from 22 to 29 degrees Celsius (which rats would normally tolerate well), all rats died from hyperthermic overheating.

This finding may explain why even experienced ecstasy users can die from taking pills similar to those they’ve consumed before, as the social and environmental context can significantly impact the drug’s effects.

The Ineffectiveness of Pill Testing in Addressing Real Risks

Given the complex factors contributing to ecstasy-related deaths, it becomes clear that pill testing is ill-equipped to address the most significant risks:

Pill testing cannot identify individual vulnerabilities to MDMA.
It cannot predict or prevent polydrug use.
It cannot foresee accidents resulting from intoxication.
Environmental factors such as ambient temperature and social context are not properties that can be tested in a pill.

Moreover, the Roxburgh study found that at least 95% of pill deaths in Australia between 2000 and 2018 were from ecstasy itself, either as a direct or contributing cause of death. Pill testing, at best, might have prevented up to 5% of these deaths, but would not have addressed the vast majority of fatalities caused by MDMA itself.

The Potential for Increased Harm

Perhaps most concerning is the potential for pill testing to inadvertently increase harm by giving users a false sense of security. The 2019 evaluation of a pill testing trial in Canberra by the Australian National University revealed some troubling findings:

Users who received test results confirming that their substance was what they expected were likely to take as much or more than originally intended.
About 90% of the pills tested were ecstasy pills.

These findings suggest that pill testing may actually increase the likelihood of MDMA consumption, potentially leading to more harm rather than less.

The Need for Evidence-Based Approaches

As we conclude this comprehensive examination of pill testing, it becomes clear that the current approach may be fundamentally flawed. While the intention to reduce harm is commendable, the evidence suggests that pill testing as currently implemented may not only be ineffective in addressing the primary risks associated with MDMA use but could potentially lead to increased consumption and harm.

Moving forward, it is crucial for all stakeholders – from politicians to parents to potential users – to critically examine the evidence and consider alternative approaches to harm reduction. These might include:

More targeted education campaigns that address the real risks of MDMA use, including individual vulnerabilities, polydrug use, and environmental factors.
Increased focus on preventing drug use altogether, rather than attempting to make it “safer.”
Enhanced support for addiction treatment and mental health services.
Research into the underlying factors that lead to drug use and addiction.

Ultimately, effective drug policy must be based on solid scientific evidence and a thorough understanding of the complex factors involved in drug-related harm. As this series has demonstrated, the pill testing debate is far more nuanced than often presented, and simplistic solutions are unlikely to address the real challenges at hand.

It is our hope that this comprehensive examination will contribute to a more informed and productive dialogue on how best to protect the health and well-being of all Australians, particularly our young people who are most at risk from the dangers of MDMA and other party drugs.