What is drug checking or pill testing?
Drug-checking services enable individual drug users to have their drugs chemically analysed, providing information on the content of the samples as well as advice, and, in some cases, counselling or brief interventions. Service aims vary, ranging from information collection to harm reduction by informing and warning users about the drugs on the market. The analytical techniques used also vary: from sophisticated technology that is able to provide information on strength and content of substances to self-testing kits that simply show the presence or absence of a particular drug. The sites at which testing occurs include fxed laboratories, to which individuals and organisations can submit drugs for testing (with results days later), and mobile laboratories at festivals or in clubs, which provide almost immediate results.
An important aspect of drug-checking services is how the results are communicated to individuals and whether this is accompanied by harm reduction advice or brief interventions.
What is known about the effectiveness of drug checking?
Drug-checking services are controversial. They have certainly provided a valuable contribution to early warning systems in the European Union. However, evidence of their impact on drug use or risk behaviours remains limited. Advocates argue that there are case examples in which information from drug-checking services has had a positive public health impact and that drug checking can potentially reduce harm by engaging with young recreational drug users not seen by existing services; identifying drugs that contain unwanted or unknown chemicals allowing an early public health response; and helping avoid overdose by providing information on potency. On the other hand, critics suggest that drug checking may give a false feeling of safety because the reliability of some of the testing approaches used is questionable; may give the impression that drug taking is normal and acceptable behaviour, potentially undermining prevention efforts; and that drug users will go ahead and use their drugs regardless of results. Any assessment of these arguments is hampered by the lack of robust studies and the difficulties in generalising given the very diferent approaches and models used. Nevertheless, given the growing importance of synthetic drugs
in the European market, including high potency synthetic opioids, any response that may reduce risks merits careful consideration and evaluation.
Drug checking in Europe: challenges for the future
The impact of different models of drug-checking services should be evaluated in order to identify the best models for different purposes (e.g. early warning versus harm reduction). The behavioural impact of drug checking is particularly in need of research. This research needs to pay particular attention to risk communication, and a behavioural insights approach may be useful.
Legal questions around the handling of controlled substances must be addressed, as many countries do not accept drug checking as a reason for a legal exemption to drug control laws, whatever the purpose. This issue also extends to users of drug-checking services, staff and proprietors of recreational settings where there is on-site testing. Close collaboration with the police is always recommended.
Changes in drug use and markets pose challenges for drug checking and associated responses:
- Accurate drug checking requires advanced and sophisticated laboratory equipment, although simpler and cheaper techniques are being developed. In addition, testing new psychoactive substances requires knowledge of their chemistry and spectral databases. Co-ordination between drug checking, academic and forensic services could maximise the value obtained from investment in these services.
- Even when substances can be identified, the risks of using them may still be unknown. Polydrug use further complicates the provision of advice linked to drug checking because interactions between drugs are much less predictable than the risks of using one drug alone.
