Drug testing, accuracy and harm reduction: a response to Barratt & Ezard

This is the authors' abstract. We don't add key points for this paper.

We thank Drs Barratt and Ezard for the opportunity to clarify a number of issues they raise. It is clear to us now that some of our statements might be misinterpreted, and some of our findings might require further explanation. As Barratt & Ezard point out 1, we found substantial discrepancies between self-reported drug use and the results from the oral swabs 2. Nevertheless, we are more confident in these findings than studies which rely simply on self-report, including our own 3. While there are limitations associated with the drug tests used, we followed the same procedures outlined in the manuals and undertaken by police in roadside drug testing. We certainly had people who reported having consumed cocaine prior to interview, only to find that they tested positive for methamphetamine. In line with Australian seizure data 4, we also found people reporting ecstasy use who tested positive for methamphetamine. Although a very different design would be required to determine some of the vagaries of testing, we concluded that many people reporting cannabis use were not detected, most probably because they consumed a relatively small amount more than a few hours previously. Despite this, we remain confident that most of the people we spoke to had no objective information about the drugs they had taken, which is obviously a consequence of their illegal status and one of the major risks facing illicit drug users, as it has been for many decades. On the issue of whether pill testing or mobile laboratories offer a response to this, we should begin by saying that we believe this could be an important move to prevent harm from illicit drugs in nightlife contexts. We agree that in-situ drug-checking does have a place in drug monitoring, while also providing much-needed opportunities for harm reduction, but that the methods Barratt & Ezard describe will be difficult, if not impossible, to undertake on-the-spot with patrons in public nightlife settings. Our statements were regarding rapid testing, those which are similar to the process we undertook for the purpose of the study. The studies Barratt & Ezard cite for drug testing 5-8 all require further testing beyond what a consumer would be able to do quickly and easily in a busy nightlife environment 9. We are certainly aware of efforts in other countries, such as Spain, Portugal and the Netherlands, that involve testing and note that, while providing important harm reduction information for patrons, these tests also take a substantial amount of time. We would argue that many patrons may not be willing to wait or to remove themselves from the nightlife environment, and that the illicit nature of the market means that taking such drugs involves an inherent health risk with regard to the contents of the substances people consume. None of this undermines the reality that the systems currently available for in-situ drug testing are flawed, and we are enthusiastic about seeing improved illicit drug testing and further opportunities for the provision of harm reduction information. Testing should ideally be rapid enough for already intoxicated people to gain information on the substances they are taking in a timely fashion. Even more radically, a sensible policy approach to drugs and alcohol should be taken, resulting in safer use in regulated settings. None.