A difficult pill to swallow
BY JESSICA YANG, PRESIDENT, AUSTRALIAN MEDICAL STUDENTS’ ASSOCIATION
Festival season comes and goes each summer and, along with it, the debate on mitigating harm from recreational drug use rears its head. Following a spate of tragic overdoses at music festivals across the country, it is clear that Australia needs a new approach. Harsh legal penalties and media storms are clearly not changing the behaviour of Australia’s young people, so perhaps reframing recreational drug use as a health issue could make addressing this crisis easier.
The main debate of ‘harm minimisation’ versus ‘zero tolerance’ seems confusing when considering that Australia’s National Drug Strategy is actually built upon three pillars of harm minimisation: demand reduction, supply reduction and harm reduction. Demand reduction involves a cultural shift among young people that may be beyond the grasp of one lifetime. Supply reduction is in full-force with Australia’s world-class border security, with So, the most achievable pillar modification is harm reduction. However, current resource allocation amongst these three pillars is greatly skewed against this course. Of the $1.7 billion spent on illicit drug interventions in 2009-10, 66 per cent was spent on law enforcement, 21.3 per cent on medical treatment, 9.2 per cent on prevention and a mere 2.1 per cent on harm reduction. Despite this funding, lifetime use of illicit drugs has been gradually increasing since 2001; suggesting the current distribution of resources, and subsequently, our focus, is on the wrong pillar.
Harm from illicit drug use poses unique public health and social issues. In 2016, there were 1808 drug-induced deaths in Australia, the highest in 20 years. The burden of drug-associated harm is distributed disproportionately across Australian society, tending to affect Indigenous communities, rural and remote Australians, LGBTQIA+ individuals and especially young people.
Pill testing trials have been supported by many major medical organisations, including AMA and AMSA, as an alternative which seeks to change the behaviour of Australia’s youth, while recognising that the presence of recreational drugs in youth culture is not going to disappear overnight. This is where the zero-tolerance policy is failing. Illicit drug use has its roots as a youth health issue, with people in their 20s most likely to use recreational drugs. Pill testing services at music festivals and the like may be the first time young Australians come into contact with relevant health services that can help them make informed decisions about their drug use. Australia’s first pill testing trial at Canberra’s Groovin’ the Moo Festival 2018 had 130 patrons using the service, with 42 per cent changing their behaviour as a result of undesired substances detected with or instead of the desired intoxicant, and two novel substances detected among festival-goers’ party favours
Of course, pill testing is not the antidote to the burden of drug-associated harm. There needs to be ongoing, meaningful support for national drug prevention programs and relevant education, which could, for instance, start at the grassroots level with pill testing facilities. Young people who are using drugs recreationally are not choosing to overdose, but with less than 10 per cent of drug intervention funding focused on prevention, and the nature of recreational substances, it is impossible to make informed decisions. Making pill testing available empowersour young people to make more responsible decisions, which ultimately bring about less harm, if we give them the tools to do so.
“None of these deaths at music festivals have been intentional. Young people would support pill testing, but no one is talking about alternatives in a meaningful way. There is no information available about how it would work. In this age of information technology, young people will always support quick and easy access to information, for instance, finding out what is in their pills when they plan to take them,” remarked a medical student I spoke to recently.
Use of illicit substances and the associated consequences is an issue every health professional encounters. As part of Australia’s youth demographic we are privy to the culture and motivations of substance use, while as future doctors, we also see the potential consequences of such choices. This puts us in a unique position to advocate for meaningful, appropriate change to Australia’s approach to substance use. We can only hope that with greater research and reframing of recreational drug use as a health issue, rather than a criminal one, that we can see happier, healthier, more well-informed patients when the responsibility of their care falls on our shoulders.
Published: 18 Feb 2019