New drugs mean more risk of overdose. Experts say we need more pill testing now

At least once a fortnight, Zach, a Sydney man in his early 30s, consumes an illicit drug.

"I typically use cocaine and ketamine. I'll occasionally — probably like once a month if not less frequently — have MDMA as well."

Zach knows the drugs he buys could contain things he might not be aware of.

He says it's common knowledge that drugs in Australia are low quality, often cut with benign fillers by suppliers to maximise profits.

He says he trusts his dealer wouldn't deliberately harm him.

However, Zach knows there are cases where drugs containing unexpected substances can be harmful.

In late January, following three hospital admissions, NSW Health put out a warning about ecstasy, a pill typically containing MDMA, that may contain a nitazene, a new group of synthetic opioids. These are potentially very dangerous — for example one kind of nitazene is estimated to be 25 times stronger than fentanyl.

For Zach, the prospect of consuming a drug like a nitazene is terrifying. He says while no-one he knows has overdosed, friends of friends have done so through the use of drugs that contained unexpected substances.

To avoid this, Zach is maintaining a positive relationship with his dealer and only consuming small amounts of his chosen drugs. He says if he took something that didn't feel like it should, he likes to think he "would just stop using it".

But he says if there was a public drug checking service, he'd "be all over it".

Increasingly entirely synthetic substances are being detected across the world. Known as novel psychoactive substances (NPS), these drugs tend to be stronger and cheaper than traditional illicit drugs.

Increasingly NPS are being found in traditional drugs like MDMA or cocaine.

It's not uncommon for drugs to contain unexpected substances.

Chemistry lead of CanTEST, Australia's only fixed-site drug checking service, Malcolm McLeod told ABC RN's Life Matters that "around 10 per cent to 15 per cent of samples [are] maybe not as expected".

But NPS could mean users are at an increased risk of harm. It's a risk that has experts calling for more public drug-checking services in Australia.

What are NPS?

Novel psychoactive substances are synthetic drugs ranging from slightly tweaked variations of known substances (known as analogues) to entirely new drugs.

Over the last 15 years, the volume and variety of these new drugs has increased, with around 1,300 new drugs found in 140 countries so far.

Dimitri Gerostamoulos is the head of forensic science at the Victorian Institute of Forensic Medicine and he has researched the rise of NPS and their associated risks.

This could be because NPS can be cheaper and simpler to produce than more traditional drugs, and potentially not illegal, while also being more potent.

"The potency of some of these drugs has increased, which means that the dose required to elicit an effect is usually a lot less," Dr Gerostamoulos says.

But this potency also means risk, particularly with inconsistent dosages. "We also have found that there is quite a lot of substitution happening with the traditional drugs," Dr Gerostamoulos adds.

And he says another concern is how little researchers know about NPS and their interactions with other drugs, including prescription medication.

A drug-checking solution

One approach to minimising these risks could be increased public drug-checking services, like CanTEST and pill testing.

Drug-checking services range in format and effectiveness. In a service like CanTEST, members of the public can have substances tested for purity and ingredients. Once they have the results, harm reduction workers provide information about these substances, including their risk.

In January, CanTEST confirmed the discovery of three previously unidentified drugs in Australia, describing them as "unexpected, new psychoactive substances".

This information can be valuable to mitigate potential poisonings and overdoses.

"We're working with an unregulated drugs market," says Monica Barratt, an RMIT vice chancellor's senior research fellow. She has previously called for an increase in drug-checking services to address the risks of NPS.

"When these NPS are sold as something else or they're added to common illicit drugs, we don't know what the outcome is going to be. It's unpredictable," says Nicole Lee, an adjunct professor at the National Drug Research Institute.

Research shows that drug-checking services can reduce harm. In 2021, a systematic review of 90 studies concluded the information provided by drug-checking services influenced users to avoid taking the tested substances.

Dr Barratt says drug checking is based on a philosophy of providing people with information about a substance they intended to take.

"Anything that reduces harm from then on, we see as a win. Be that the discard of the drug … but it can also be taking it in less dangerous circumstances, or maybe not taking it in combination with another substance."

Barriers to introduction

While there is research supporting drug-checking services reducing harm, there appears to be political reluctance from some quarters.

Currently, the ACT is the only jurisdiction to introduce public drug-checking services, while Queensland announced in February 2023 that it planned to introduce these systems.

A Queensland Health spokesperson told the ABC "work is underway to introduce drug-checking services early to mid-2024".

No other state or territory has committed to similar plans.

In January, Victorian Premier Jacinta Allan said she was seeking further expert advice over introducing the service statewide.

Her announcement came after both the Victorian coroner and 77 community agencies called for drug checking to address the risks of NPS.

And other states seem reluctant to introduce public drug checking. In October, NSW Health Minister Ryan Park said pill testing was not a "silver bullet" to stop drug-related deaths.

Both the Tasmanian and Western Australian governments have historically shot down calls for drug-checking services for the public.

In 2021, then-NT chief minister Michael Gunner said he was open to a trial on pill testing, but the territory has not yet announced any plans for its introduction.

In a statement to the ABC, a NSW government spokesperson said that there "remain very real questions" on drug-checking services, including that "it doesn't take into account an individual's physiology".

According to Professor McLeod, CanTEST uses the same equipment as police and forensic laboratories around the country, run by qualified chemists. He says one technology used at CanTEST is accurate within a few per cent.

But while there are limitations to drug-checking services, those who support them say doing something is better than doing nothing.

Some research also suggests current approaches to discourage drug use may be having unintended consequences, such as increasing the risk of overdose.

Dr Barratt says reducing drug harms requires a multi-pronged attack.

"I think it's possible for us to do multiple things. We can have supply reduction, we can have demand reduction, and we can have harm reduction, because it's a practical response when we know that saying, 'Just say no', doesn't work for a lot of people," she says.

"It's just the reality."