Illicit Tablet Information and

Transcription

1 A Feasibility Study for an Illicit Tablet Information and Monitoring Service Jim Hales Premier s Drug Prevention Council

2 A Feasibility Study for an Illicit Tablet Information and Monitoring Service Prepared for the Premier s Drug Prevention Council September 2009 Author J Hales. Health Outcomes International. Suite 1, 51 Stephen Terrace, St Peters SA 5069 (PO Box 1038, Kent Town SA 5071) Ph Fax ABN This document should be cited as: J Hales. A Feasibility Study for an Illicit Tablet Information and Monitoring Service. Report to the Premier s Drug Prevention Council Victoria; Health Outcomes International, Melbourne, September Design and art by Caridi Design Pty Ltd Research Note This report describes findings of research that was conducted in Further information about illicit tablet information systems may have been produced since that time. Identified costs would also be expected to have increased.

3 CONTENTS Feasibility Study for an Illicit Tablet Information & Monitoring Service Executive Summary Introduction Background Project Objective Scope Findings from the Literature Introduction Rationale for Illicit Tablet Information and Monitoring Web-based Drug Information Drug Monitoring Systems in New Zealand and Australia Early Warning Systems Tablet Information Services Tablet Testing Stakeholder Interviews Introduction Summary of Findings Implementation Issues and conclusions Introduction Accessing Illicit Tablets Testing Illicit Tablets Presenting Information in an ITIMS...49 Endnotes Glossary Appendices

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5 E Executive Summary Feasibility Study for an Illicit Tablet Information & Monitoring Service Background The Victorian Department of Human Services, on behalf of the (former 1 ) Premier s Drug Prevention Council (PDPC) commissioned a study to ascertain the feasibility of developing and implementing an Illicit Tablet Information and Monitoring Service (ITIMS) in Victoria. An ITIMS seeks to provide information about illicit tablets that enables individuals to be more informed of the content of the tablets that they may contemplate using; to identify the health and social risks associated with illicit drug use; to measure progress against strategies to offset drug use and to seek treatment, support and referral information. In addition, an ITIMS may assist in identifying emergent trends in drug use and in providing awareness of the presence of illicit drugs in specific regions, thus making it a useful resource for legislators, law enforcement personnel, health care providers, drug services and researchers. An ITIMS in Victoria would focus on tablets that are illicitly manufactured, distributed and sold/consumed, as well as tablets legally manufactured, but are illicitly obtained, distributed and sold/consumed. 2 Health Outcomes International was appointed to undertake the study. Project Objective and Scope The project objective is to: n Identify the major potential users of an ITIMS and determine their collective and respective information needs. n Develop and appraise a range of options (system models) for an ITIMS, which meets the collective and respective needs of the major potential information users. n Assess the feasibility, output costs, and risks of developing and implementing the range of options identified and propose recommendations as to the most preferable option/s. The methodology used in this study comprised a scan of the available literature on the use and experience of a range of information systems internationally, together with a series of face-to-face and telephone interviews with nominated stakeholders in Victoria. Further, implementation issues were explored and recommendations made, in particular regarding accessing illicit tablets, testing of illicit tablets and presenting information in an ITIMS. This report presents the project s consolidated findings. Findings from the Literature The literature was reviewed for existing web-based drug information, drug monitoring systems, early warning systems, tablet information services and tablet testing models in Australia and overseas. A number of reasons to support the provision of an illicit tablet information and monitoring service were presented in the literature, including: n The provision of information enables individuals to be properly informed of the content of the tablets that they may contemplate using. 3

6 n Identification of the health and social risks associated with illicit drug use. n Measurement of progress against strategies to offset drug use and to seek treatment, support and referral information. n Assistance in identifying emergent trends in drug use and in providing awareness of the presence of illicit drugs in specific regions, thus making them a useful resource for legislators, law enforcement personnel, health care providers, drug services and researchers. Data provided by an ITIMS must be widely disseminated and frequently updated if it is to be of practical value. However, the implementation of an ITIMS requires consideration of the type and amount of information that is to be provided, to whom, and via which medium or media. Consequently, the implementation of an ITIMS must identify the potential end users of the service and consider their specific needs. An ITIMS could thus be targeted at the needs of emergency services, law enforcement agencies and other key stakeholders in the drug and alcohol sector. Education and prevention information targeted at users and potential users may also be one of the objectives of a tablet information service. There are essentially three types of information that an ITIMS might collect and disseminate. These are: n Information relevant to the identification of substances. n Information relating to the use of specific illicit substances. n Information on the health and other consequences of using specific illicit substances. It is particularly important that such information be scientifically valid, objective and is based on appropriate testing procedures. Tablet testing methods identified in the literature include for example: n Tablet identification (i.e. visual comparison of tablets with details of formerly analysed tablets, such as size, shape, colour logos or other physical markers). n Colour reaction tests (e.g. the Marquis test). This can identify the presence of ecstasy substances such as MDMA, MDA, MDE, but cannot determine how much of the identified substance is present in the tablet. These tests are not capable of detecting a number of potentially dangerous chemicals that may be substituted for ecstasy. n Chromatography involves the separation of a drug compound into its separate chemical components, thus permitting the identification of individual substances in complex chemical mixtures. It is a relatively fast technique, taking as little as fifteen minutes, possesses high-level reliability and produces quantitative and qualitative results that can be used immediately in on-site testing locations. n Mass spectrometry involves the conversion of a drug or drug metabolite into charged particles and the mass-to-charge ratios of the particles generated create a pattern that provides a positive identification of the drug. 4

7 Feasibility Study for an Illicit Tablet Information & Monitoring Service n Immunological tests are based on the reaction of a specific antibody to a substance. Commercially available immunotest systems for urine drug tests are commonly employed in Europe for this form of testing. Immunology cannot be used directly for tablet testing, but is used to identify substances consumed after the fact. n Capillary electrophoresis describes a family of techniques that can be employed to separate a variety of compounds. These analyses, all driven by an electric field, are performed in narrow tubes and can result in the rapid separation of many hundreds of different chemicals. Chromatography is the most widely accepted and available testing method. The cost of tablet testing reported in the literature varied and there was no relevant information from Australia. Drug users have been identified as a potential source that would provide for the widest and most timely coverage of tablets on the market. In a number of countries, tablet testing at known sites and occasions (e.g. raves) is used as a point of data collection about illicit tablets, as well as providing immediate feedback to users on the tablets being tested at the time. Consequently, there is an inherent link between the timeliness and coverage of an illicit tablet information service and the use of tablet testing as the main source of the data. However, there are a number of factors relating to tablet testing that would need to be considered in the context of its role in informing an ITIMS: n The evidence about the influence of tablet testing on the behaviour of users is equivocal, and comes from overseas. Some research indicates that tablet testing raises the profile of the safety issues surrounding illicit tablets and provides a mechanism by which service providers can interact with drug users. This research did not show that tablet testing leads to an increase in tablet use, nor did it demonstrate dramatic behaviour changes towards safer tablet use that were associated with tablet testing. Other research has found that tablet testing would have little effect, or possibly an adverse effect, on the safer use of illicit tablets. n Current legislation in Victoria would see any person bringing a tablet to be tested as guilty of possession, and by handing a tablet to a tester as committing the offence of supply. The same offences apply to the tester by receiving the tablet for testing, and then handing it back. n A decision on the implementation of illicit tablet testing could also take into account the capacity to benefit. In this regard, data from the National Coronial Information System showed that from , there were 112 ecstasy-related deaths in Australia, of which 51 (46%) had ecstasy as the primary contributor; 16 (14%) had ecstasy as the secondary contributor, and 45 (40%) had ecstasy as the tertiary contributor. Importantly, in the large majority of cases where adverse outcomes have been experienced, ecstasy was rarely the only drug used, and other external factors such as the ambient temperature of the environment, the level of physical activity and the extent of fluid re-hydration after ecstasy use were also contributing factors. None of these would be affected by the provision of on-site tablet testing. 5

8 There are a number of legal and ethical issues associated with testing illicit tablets in public venues. A critical issue concerns what users should be told after testing. It is important that no information that could be construed as encouraging the consumption of illicit substances or that implies even the relative safety of any detected substances be made. It has also been suggested in the literature that tablet testing projects provide indirect benefits such as opportunities to access populations that are otherwise difficult to contact and to raise their interest in harm prevention and reduction. Harm reduction may be achieved if tablet testing provides opportunities to transmit safer-use messages relating to issues such as acute, short-term and longterm health hazards, addiction, legal risks and drug driving. Stakeholder Interviews The consultations undertaken for this study involved face-to-face and telephone interviews with a range of stakeholders in Victoria, and revealed widespread agreement that they, their clients and other stakeholders currently have unmet information needs regarding the illicit tablets available and their characteristics. In general, these concerns relate to an absence of timely and reliable information regarding chemical content and tablet appearance, for instance shape, colour, logos and any other distinguishing features. However, there was some variability in the needs expressed in regard to the nature and timeliness of the information required and its use, largely reflective of the various roles and interests of the parties interviewed. The most common required content of an ITIMS identified across stakeholder groups included: n Alert warnings about tablets that have been found to be dangerous due to contaminants or adulterants. n Information on tablet content, including both active and passive constituents. In this regard, legislative requirements call for constant definitions to be applied for three to four years. n Tablet description, including street names, appearance, colour size, shape, logos and any other differentiating characteristics. This may include photographs, but they would need to be of suitable quality. n Information on how different drugs may affect behaviour, as well as risks associated with potential negative effects. n Locations where the tablets were sourced in order to ensure that localised data are available, including rural locations. General information on harm minimisation and where to access additional services. Views were mixed as to whether the concentration of tablets contents should be included in an ITIMS. Consumer representatives generally considered that concentration of constituents should be included, but recognised that this information should be presented carefully in order not to infer increased effects. Other stakeholders were generally opposed to constituent concentration being presented. The preferred medium for an ITIMS was the internet. Telephone access and alerts were also suggested. 6

9 Feasibility Study for an Illicit Tablet Information & Monitoring Service Views regarding access to the information contained on an ITIMS varied considerably, and were divided fairly equally between the following perspectives: n Access to all the information contained on an ITIMS should be universal in order to maximise its influence and to inform the decisions of drug users. This view was held by advocacy bodies representing drug users and some other stakeholders. n The information on the ITIMS should be partitioned such that different groups would have access to different elements of the information. This approach would involve establishing a public component of the ITIMS and a private component that would require a password to access. n The general public (including drug users) should not have any access to the ITIMS; access should be restricted to organisations and their representatives in such areas as health, research, police and policy makers. This view was based on a concern about potential misuse by users and dealers, as well as the legal and health implications of suggesting that any particular substance or tablet might be less hazardous than another. The currency of the information contained on an ITIMS was regarded as particularly important by drug users and health professionals who might access the system for safety reasons. The illicit tablet market was seen as being highly dynamic and changeable, with new tablets appearing, and disappearing on a frequent basis. Consequently the need to keep abreast of these changes was seen as underpinning the value of the information contained in an ITIMS for these groups. For other stakeholder groups, the issue of timeliness was generally less pressing. The source of the information has clear implications for the timeliness of the data presented on an ITIMS. Police and Customs seizures were seen as being useful, but potentially limited in terms of their timeliness, coverage, and delays in presentation of results. However, views on this issue varied between stakeholder groups. Information gathered at hospitals, particularly emergency departments, was also seen as being useful, but also of limited coverage and uncertain timeliness. Additional potential data sources identified for an ITIMS include the analysis of tablets placed in amnesty bins or discarded at raves etc., and the use of covert tablet purchases by Police for the purpose of analysis. Both such approaches are likely to require legislative or regulatory changes. Perhaps the most controversial source identified was on-site tablet testing at sites where drugs are being used. It was recognised by most of those consulted that this source could potentially provide the widest and most timely coverage of tablets on the market. The issues associated with tablet testing embodied in using drug users as the source of information for the ITIMS were widely recognised, and reflect those reported in the literature review. Opinions were divided as to the merits of this approach. Views also diverged in regard to management of an ITIMS. The majority of stakeholders considered that an ITIMS system should not be under the management of Police or the judicial system. The general consensus was that both the philosophy underpinning an ITIMS (as a harm minimisation initiative) and the acceptability of the system to a wide range of its users indicated that its management should fall 7

10 under the general umbrella of the health sector. However, the establishment and ongoing operation of an ITIMS was widely recognised as requiring a collaborative effort and communication processes across a range of government and non-government agencies. The application of an ITIMS in rural areas was regarded as being important in two respects. Firstly, access to a web-based ITIMS was seen as potentially providing rural drug users with improved access to information about the tablets on the market and their effects. The second aspect related to the need to collect tablets from rural areas to ensure that the information contained in the ITIMS was relevant to these locations. It was suggested that, if tablet testing from drug users is to be adopted, that it be extended to rural areas on a regular cycle, in addition to any other information gathered through other sources. Implementation Issues and Conclusions This section considers issues relating to the implementation of an ITIMS in Victoria, having regard to the findings from the literature and the views of stakeholders presented previously. Further, it presents recommendations for key implementation processes. The establishment of an ITIMS may be feasible within the current legislative and policy environments, and using existing infrastructure and processes to maximise efficiency and reduce costs. There are also a number of challenges that would impact on implementation, with the key processes involved in establishing and operating an ITIMS being identified as accessing illicit tablets for testing, testing tablets and presenting information in an ITIMS. The use of the tablets seized by Police and Customs is the recommended approach, as it will provide a more readily implementable, less costly and less controversial approach than other alternatives. Implementation of this approach would require further discussions with Police to ascertain the most appropriate processes to expedite the provision of tablets for testing, and any ramifications this may have on other Police operations (such as tablet storage, evidence handling, prosecution processes). The coverage and currency of the tablets collected under this approach would require monitoring to assess its appropriateness. Chromatography is the most widely accepted and available testing method that meets the technical quality and timing requirements of users of an ITIMS, and is the recommended approach. This technology is currently used in the Forensic Services Department of Victoria Police, which may have capacity to expand its services to meet the timeline needs of users of an ITIMS. Further, the Department meets the legislative and safety requirements for handling and testing illicit substances. Costs of the Forensic Services Department expanding its capacity to test an additional 100 tablets per week with a four-hour turnaround are approximately $140,000-$160,000 per annum, or $30 per tablet. A web-based application is regarded as the most accessible and effective mechanism for hosting an ITIMS. A specification for the design of the ITIMS was prepared as a guide to its structure, content and functionality. Hosting ITIMS on an existing website with a similar subject matter and synergy of content would be the recommended approach. This approach would provide for ITIMS to be located within a broader suite of relevant information, place it in an environment and location that users are more likely to 8

11 Feasibility Study for an Illicit Tablet Information & Monitoring Service find, and reinforce the harm minimisation message. An important factor to be considered is the cost of implementing an ITIMS, particularly in regard to expanding the capacity of the Forensic Services Department to meet the timing requirements of ITIMS and the design, development and maintenance of the ITIMS Website. An important factor to be considered is the cost of implementing the ITIMS, particularly in regard to expanding the capacity of the Forensic Services Department to meet the timing requirements of ITIMS and the design, development and maintenance of the ITIMS Website. Overall, initial establishment costs are estimated at $10,000 for website design and development, with annual operating costs of approximately $150,000 $200,000. If the decision is made to proceed with the implementation of an ITIMS, further discussions will need to be held with: n DHS, Victoria Police and the Forensic Services Department in Victoria Police about the content and accessibility of the ITIMS. n Police regarding processes for the forwarding of seized tablets to the laboratory, and the procedures required to maintain the chain of evidence and access to test results for evidentiary purposes. n Forensic Services Department in Victoria Police for their requirements to expand testing capacity to the level required. n A third party web-site provider to assess willingness to host the ITIMS (or alternatively implement an open tender process for this purpose). n A web-site developer to design and develop the ITIMS (or alternatively implement an open tender process for this purpose). Further consideration also needs to be given to managing a number of issues, risks and barriers to the establishment of an ITIMS, including: n balancing diverse community views associated with an ITIMS being regarded as promoting or supporting the use of illicit drugs. n ensuring that the methods used for collecting tablets for testing comply with the law. n Ensuring safety with regard to the the range of substances tested for and reported on. n achieving the right balance with pre- and post-test messaging in terms of drug users interpreting the information provided as implying that some tablets are safe. n preventing drug dealers using ITIMS to legitimate and promote their drugs. n balancing the costs associated with the collection and testing of tablets which may outweigh the benefits to be derived. n ensuring timely information contained in ITIMS given the changing pace of the illicit tablet environment means information could become outdated very quickly. These issues may not be insurmountable, but require consideration and planning, together with careful management and promotion of the ITIMS to ensure that each issue is catered for. 9

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13 1 Introduction Feasibility Study for an Illicit Tablet Information & Monitoring Service 1.1 Background The Victorian Department of Human Services, on behalf of the Premier s Drug Prevention Council (PDPC) commissioned a study to ascertain the feasibility of developing and implementing an Illicit Tablet Information and Monitoring Service (ITIMS) in Victoria. It intended that an ITIMS would focus on tablets that are illicitly manufactured, distributed and sold/consumed, as well as tablets legally manufactured, but are illicitly obtained, distributed and sold/consumed. Health Outcomes International was appointed to undertake the study. 1.2 Project Objective The project objective was to: n Identify the major potential users of an ITIMS and determine their collective and respective information needs. n Develop and appraise a range of options (system models) for an ITIMS, which meets the collective and respective needs of the major potential information users. n Assess the feasibility, output costs, and risks of developing and implementing the range of options identified and propose recommendations as to the most preferable option/s. 1.3 Scope The project focuses on the feasibility of the development and implementation of an ITIMS. The users of an ITIMS are likely to include, but are not limited to, health workers, law enforcement, researchers, policy makers and program planners, and users of illicit tablets. There were three key stages planned for the project, each with related tasks: Stage 1 Survey and analyse the needs of potential users of an ITIMS. This includes: n Review the local and international research literature relating to drug information and monitoring services, particularly that pertaining to illicit tablets. This should include a review of any existing models and the social and health risks surrounding these. n Identify and review existing activities, drug monitoring, research and surveillance underway by Government (including health and law enforcement) and non-government groups within Victoria and nationally that constitute part or whole of an illicit tablet information and monitoring service. n Identify the major potential users of an ITIMS. n Undertake initial, individual consultations with representatives of the identified information users to determine their respective needs, including: the purpose/s for which they would use ITIMS information; 11

14 the type (such as tablet content, drug effects, health warnings and referral information) and format of ITIMS information they would use/not use; and, the preferred timing and method of receiving/accessing ITIMS information and the risks involved in not achieving the preferred timing and method. n Analyse the findings of the consultations and literature review to form a needs assessment and a specification of the essential and non-essential requirements for an ITIMS and any risks surrounding these. n Compile a summary of the findings and analysis of the first stage into a brief report. Stage 2 Develop and analyse a range of ITIMS options: n Develop a range of options (system models) for an ITIMS which: provides accurate and timely information which addresses the collective and respective needs of the major potential information users identified; are within the existing legal and policy parameters of Government; takes into account the existing drug information, monitoring and research activities within Victoria and nationally that could constitute part or whole of an ITIMS; balances the health and safety interests of the general public and illicit tablet users with the output costs and risks associated with a tablet information and monitoring service. n Devise a clear criterion for assessing the feasibility, output costs and social and health risks of developing and implementing the range of options identified and for selecting one or more options as the most preferable option/s. n Assess the range of options identified and propose recommendations as to the most preferable option/s. n Develop and facilitate a consultation workshop with a representative sample of all identified users to present the options and draft recommendations and seek their feedback. n Compile a summary of the findings and analysis of the second stage into a brief report. Stage 3 Present Final Report and recommendations: n Compile the findings of the stages 1 and 2 and final recommendations into a Final Report for presentation to the PDPC and the government. n Present the main issues, findings and final recommendations in the Final Report to the government. This report presents the consolidated findings from the review. 12

15 2 Findings from the Literature Feasibility Study for an Illicit Tablet Information & Monitoring Service 2.1 Introduction The purpose of this section is to present the findings of a review of the literature on illicit drug information, monitoring programs currently available in Australia and internationally, and operational systems of testing the chemical content of tablets. The objective is to summarise the range and nature of extant illicit tablet monitoring and information services, to describe their operations, and to identify issues of relevance for the establishment and operation of an ITIMS in Victoria. There are numerous drug information and monitoring services located in Australia and overseas that are readily accessible via the internet. These services, individually or in combination, appear to address some of the objectives of the proposed ITIMS. In addition, the (former 4 ) Drugs Policy and Services Branch completed a scoping study of such services in Victoria which mapped the illicit tablet data collection, analysis and information dissemination systems in Victoria. These resources are referenced in the current review, with the objective of identifying the range of currently available services that at least partially address the requirements of Victorian stakeholders. It should be noted that, despite the numerous examples of drug information and monitoring services that exist internationally, no research was found about the effects of these services on drug use or drug taking behaviours, nor whether they were cost-effective. The following presents a rationale for illicit tablet information and monitoring, followed by findings on web-based drug information, drug monitoring systems in New Zealand and Australia, early warning systems, tablet information services, and tablet testing. 2.2 Rationale for Illicit Tablet Information and Monitoring The literature provides a number of reasons to support the provision of an illicit tablet information and monitoring service. Services that provide information in relation to illicit tablets enable individuals: n To be more informed of the content of the tablets that they may contemplate using. n To identify the health and social risks associated with illicit drug use. n To measure progress against strategies to offset drug use and to seek treatment, support and referral information. In addition, tablet information services may assist in identifying emergent trends in drug use and in providing awareness of the presence of illicit drugs in specific regions, thus making them a useful resource for legislators, law enforcement personnel, health care providers, drug services and researchers. The data provided by tablet monitoring systems must be widely disseminated if they are to be of practical value. However, the implementation of a tablet information service requires consideration of the type and amount of information that is to be provided, to whom, and via which medium 13

16 or media. Consideration must also be given to the rationale for the provision of specific types of information to specific target audiences. For instance, information provided to users may differ in format, content, focus and degree of scientific sophistication from that provided to drug support services, researchers and policy makers. A tablet information service should also collect data from a wide range of sources if it is to offer comprehensive and timely information. It should draw on disparate sources such as users, workers in the field, police, the judicial system, and clinical data from hospitals, clinics and laboratories. The implementation of an illicit tablet information service should identify all potential end users of the service and consider their specific needs. A tablet information service could thus be targeted at the needs of emergency services, law enforcement agencies and other key stakeholders in the drug and alcohol sector. Education and prevention information targeted at users and potential users may also be one of the objectives of a tablet information service. There are essentially three types of information that a tablet information service might collect and disseminate. These are: n Information relevant to the identification of substances. n Information relating to the use of specific illicit substances. n Information on the health and other consequences of using specific illicit substances. 5 Identification information should include details of the physical appearance of illicit substances, in this instance tablets, their street names and their chemical properties. Details such as shape, colour, weight, logos and other distinguishing characteristics should be provided. Information designed to assist with drug identification may also include details of substitute substances that are being marketed under common names, such as the range of chemical compounds that are passed off as ecstasy. Information relating to the use of illicit substances in tablet form should also profile the identified user group, the settings in which the drugs are likely to be used, and details of the range of observed effects on behaviour, mental processing and social functioning. A key issue for such an information system is the purity of the chemical substances found in illicit tablets, and the attendant issue of the substitution of one chemical compound for another, creating a situation in which users have no means of knowing precisely which drug they are ingesting. For instance, deaths associated with the substitution of paramethoxyamphetamine (PMA), a powerful stimulant, for MDMA or real ecstasy, have been reported in Australia, Europe, the UK and the US. 6 Drugs commonly substituted for ecstasy include PCP, DOB, ketamine, speed, cocaine, atropine, 4-MTA and a wide range of prescription and over-the-counter medications. The first three of these, in contrast to ecstasy s mild empathy and mood-elevating effects, can impair motor control and produce intense hallucinations. Many of the fake or adulterated substances presented as ecstasy can thus be far more dangerous and have severe and unanticipated psychological consequences for users. 7 For this reason, tablet monitoring has been proposed as a necessary harm reduction strategy. 14

17 Feasibility Study for an Illicit Tablet Information & Monitoring Service Where possible, the known health risks and other consequences associated with substance use should be detailed, although data on long-term effects will of necessity not be available for new illicit substances as they appear on the market. Tablet information services could also provide details to emergency service workers, police and users of potential risks such as seizures, drug induced psychosis or death associated with specific tablets or with substances which may be substituted for the expected content of those tablets. A more comprehensive model for describing new drugs as they emerge onto the drug market is provided by the formal risk assessment reports produced in Europe in response to newly identified synthetic drugs. These reports include the chemical analysis and description of the substance, including details of precursor chemicals and manufacturing processes; descriptions of the format and appearance of the substance; discussion of individual health risks including the acute, clinical and psychological effects and the potential for dependency; an analysis of the public health risks such as the availability and quality of the substance, user knowledge and perceptions of the substance, patterns and prevalence of use, the characteristics and behaviours of users, indicators of health consequences and context of use; discussion of the social risks including sociological aspects, social consequences, consequences for the social behaviour of users, other social consequences and criminological aspects; and a review of the legal consequences of prohibition, including a discussion of the substance s current legal status and the possible consequences of prohibition. The reports end with conclusions and recommendations. 8 Whilst this reporting model may be too comprehensive for a tablet information service to implement, elements of it could nevertheless be employed to inform the development of such a service. 2.3 Web-based Drug Information Numerous websites provide information about illicit and other dugs with a sample of sites reviewed below. These have been selected to provide a broadly representative cross-section of the different types of websites that present such information. It should be noted that the statements contained in the description of the various sites are largely those expressed on the sites themselves, rather than those of the research team, except where otherwise identified. For ease of presentation, the sites have been grouped into the following categories (note that some sites could be included in more than one category, but for ease of presentation, have been listed only once) n Drug monitoring systems, which contain information about drug use and associated trends in different countries. n Early warning systems that detect and identify new substances as soon as they come onto the drug market. n Tablet monitoring systems that provide specific information about different tablets and other drugs on drug markets. 15

18 2.4 Drug Monitoring Systems in New Zealand and Australia New Zealand Arrestee Drug Abuse Monitoring (NZ-ADAM) NZ-ADAM is a project which seeks to measure drug use among those people who have been detained in police cells. NZ-ADAM is the equivalent of Australia s DUMA study see below. Data from NZ-ADAM are used to examine issues such as the relationship between drugs and crime, to monitor patterns of drug use over time, and help assess the need for drug treatment amongst the offender population. NZ-ADAM s quarterly and annual reports provide details of the characteristics of detainees at each site, including self-reported drug use. In addition to tracking changes in local drug markets, NZ- ADAM collects information on key strategic issues. Illicit Drug Monitoring System (IDMS) A recent initiative of the New Zealand government is IDMS, a research program carried out annually to better understand trends in illicit drug use and associated harms. IDMS is modelled on similar types of drug surveillance and monitoring systems that operate overseas, which offer early warning of shifts in the markets for different drugs. IDMS results are built up from interviews with people who regularly use illicit drugs, as well as individuals with particular expertise or insight into drug related trends. The results of these interviews are compared with other indicators of drug use, such as seizure patterns, hospital data and information from drug treatment services. IDMS consists of three modules based on the type of frequent illicit drug user interviewed: (i) the Methamphetamine Module, which interviews frequent methamphetamine users; (ii) the Hallucinogen Module, which interviews frequent ecstasy (MDMA) and LSD users; and (iii) the Cannabis Module, which interviews frequent cannabis users. Each module of the IDMS draws on three types of data: interviews with frequent drug users; interviews with key experts who have regular contact with drug users through their work; and the collation and examination of secondary data sources on drug trends. The combined information from these three sources is used to identify emerging trends in drug use and drug related harm. 9 Australia Illicit tablet monitoring and/or information are currently provided in Australia by a range of research and government organisations. Government-funded information resources currently available on illicit drugs include the: n Ecstasy and Related Drugs Reporting System (EDRS). n Illicit Drug Data Report (IDDR). n National Illicit Drug Indicators Project (NIDIP). n Drug Use Monitoring in Australia (DUMA). 16

19 Feasibility Study for an Illicit Tablet Information & Monitoring Service Much of the information provided by these programs is sourced via annual data collection activities. Brief reviews of each of the programs are provided below. Ecstasy and Related Drugs Reporting System (EDRS) EDRS is a national study funded by the Australian Government Department of Health and Ageing and coordinated by the National Drug and Alcohol Research Centre to monitor the ecstasy and related drugs (ERDs) markets in Australia. ERDs cover a range of drugs including ecstasy, methamphetamine, cocaine, GHB and ketamine. EDRS employs a methodology similar to that used by the Illicit Drug Reporting System. Regular ecstasy users are interviewed on patterns of ERDs use, the current availability, price and purity of ERDs and perceived drug-related health issues associated with ERDs use. A semi-structured survey of experts in the field (e.g. party promoters, treatment providers, law enforcement personnel) is also conducted and indicator data, such as purity of drug seizures and overdose rates, are analysed. Data from these sources are examined together to identify convergent trends in the use of ERDs and in drug markets. 10 The Illicit Drug Data Report (IDDR) The IDDR, produced annually by the Australian Crime Commission, delivers information on law enforcement activity for the previous financial year. Specifically, the report provides statistics about drug arrests, seizures and detection by Australia s law enforcement agencies. 11 The data contained in the reports provide law enforcement, decision-makers, National Illicit Drug Strategy stakeholders and research bodies with a national overview of the illicit drug situation in Australia. 12 The reports are potentially of relevance to tablet information and monitoring by providing trend data with respect to the amounts of illicit substances detected by law enforcement agencies across the country and by providing profiles of the state and territory drug markets. However, currency may be a limitation of this information source as the reports are not released until some time after the data collection period. National Illicit Drug Indicators Project (NIDIP) The purpose of NIDIP is to improve the understanding of, and systematically track changes in, heroin and psychostimulant use and related harms using comprehensive, timely and reliable information. The project disseminates information on heroin and psychostimulant use and related harms and informs agencies and policymakers in assessing the need for, and outcomes of, policy and other interventions. Data indicators are collected across five broad themes: prevalence of drug use, drug-related morbidity, treatment, mortality and crime. Information from NIDIP is made available via several modalities including regular bulletins, journal articles and web-based bulletins and links, thus providing an accessible picture of trends in drug use and harms over time. A number of issues have been identified in the collection and presentation of data in the NIDIP, including lack of geographic specificity, lack of national datasets for some types of data, and time 17

20 lags in reporting some types of data. To circumvent these problems, jurisdictional data have been recommended for monitoring. 13 Drug Use Monitoring in Australia (DUMA) DUMA is a project which seeks to measure drug use among people who have been recently apprehended by police. Data from DUMA are used to examine issues such as the relationship between drugs, property and violent crime, to monitor patterns of drug use over time, and to help assess the need for drug treatment amongst the offender population. Data collected through DUMA sites provide a research and evaluation tool for local analysts, policymakers and practitioners. 14 DUMA s Annual Reports include an overview of the characteristics of detainees at each site, including self-reported drug use. 15 Whilst the DUMA reports focus on a specific population, they may provide a source of information for the proposed ITIMS. 2.5 Early Warning Systems Early warning systems are employed to detect and identify new substances as soon as they come onto the drug market, by collecting, exchanging, centralising and validating information obtained from a range of sources. 16 Their main objective is to prevent the spread of negative consequences, through rapid responses and preventative action with respect to new drug threats. Thus early warning systems are considered to be a critical component of drug monitoring strategies. This has been recognised by the European Union, which has undertaken considerable work in developing and implementing an Early Information Function (EIF) for Emerging Drug Phenomena (EDP). The central function of this multi-jurisdictional project is to develop systems that can quickly identify, assess and categorise EDPs in order to facilitate the production of relevant information and its rapid dissemination to target audiences, including consumers, policy makers and workers in the field. 17 Early Information Function (EIF) for Emerging Drug Phenomena (EDP) The European early warning system operates under a five-step operational model that was developed to structure the data collection, analysis and reporting processes. It comprises data collection, identification of EDPs, assessment of their likely impact, dissemination of information and follow-up/feedback obtained from those involved in the data collection. In addition, a three-tier information structure focusing on users, substances and settings underpins the data collection and describes the key areas of inquiry. 18 The EIF collects data from drug users, low-threshold facilities, health services, criminal justice settings, recreational night-life and other settings via a range of methods including observation, questionnaires, interviews, focus groups and population surveys. 19 This comprehensive approach to data collection facilitates the acquisition of information that can be cross-referenced against a number of sources to confirm its validity and reliability. The EIF incorporates a standardised assessment process, during which an identified EDP is assessed in terms of its diffusion potential, 18

21 Feasibility Study for an Illicit Tablet Information & Monitoring Service health, social and economic consequences. The assessment provides information regarding the prevalence of the EDP and the range and magnitude of potential consequences. Decisions can thus be made regarding the immediacy and seriousness of the EDP and policy responses formulated on the basis of evidence. The process of disseminating the results considers the purpose of the dissemination strategy, the appropriate audience(s) and the dissemination media, with the overall aim of early intervention to reduce the impact of the potentially harmful EDP. 20 The Drug Abuse Early Warning Network (DAWN) DAWN is a public health surveillance system that operates in a number of cities across the US. Collecting data via hundreds of hospitals, it monitors drug-related visits to emergency departments and drug-related deaths investigated by medical examiners and coroners. The range of drug-related data collected is comprehensive, including the use of illegal drugs, prescription and over-thecounter medications, dietary supplements, non-pharmaceutical inhalants, and alcohol alone and in combination with other drugs. DAWN s purpose is to measure drug-related morbidity and mortality and to monitor patterns of drug-related hospital cases, identify sentinel events, and increase drug awareness in hospitals. 21 The Illicit Drug Reporting System (IDRS) IDRS is Australia s main national illicit drug monitoring system and acts as an early warning system for emerging trends in illicit drug markets. It is funded by the Australian Government Department of Health and Ageing and the National Drug Law Enforcement Research Fund. IDRS data collection is conducted each year in every state and territory by participating research institutions, and is coordinated by the National Drug and Alcohol Research Centre. The IDRS monitors the price, purity, availability and patterns of use associated with the main illicit drugs. The IDRS triangulates data obtained from three sources: n A quantitative survey of injecting drug users, who act as a sentinel group for the detection of emerging trends in illicit drug use. n A qualitative survey of key experts who work in the field of illicit drugs. n A synthesis of extant indicator data sources, such as Customs data, seizure purity data, arrest data and so on Tablet Information Services A wide range of tablet information is available via the internet. Whilst many tablet information websites are government-funded, others are provided by users or other stakeholder groups relying on volunteers, donations or other non-government sources of income such as the proceeds from the sale of drug testing kits. Many of these websites allow community members to use forums to share ( post ) information detailing their experiences with illicit drugs. Information presented includes the content of the drug (this can be identified through drug testing kits), regions where 19

22 illicit drugs are being sold, and the positive and negative effects of drug consumption. Some sites also have access to literature on various illicit drugs, and links to health, treatment and support websites. Most of these sites aim to equip the community with knowledge on illicit drugs, thereby seeking to promote a harm minimisation approach to illicit drug use. Europe Bluelight Bluelight ( is an international internet message board that seeks to educate the public about responsible drug use (with a focus on MDMA) by promoting free discussion. It advocates harm reduction and is funded by private donations and maintained by a team of volunteers. It does not condone or condemn the use of illegal drugs. Bluelight seeks to educate the public about drugs by summarising whatever information is known about a subject, and to deliver accurate information in a readily understood manner that emphasises safety. There is also an aim to eliminate misinformation, whether it exaggerates or understates the danger, and the organisers suggest that if facts are unavailable, honest anecdotal stories can provide useful information. 23 Bluelight s goal is to find the middle ground between the fairly inaccessible published literature and the misinformation that often exists in street level drug culture. It claims that the consumption of new or exotic recreational drugs can start years before any scientific/medical studies can be attempted. Bluelight contains a mixture of facts and anecdotal information, and suggests a certain level of scepticism be adopted when viewing the answers and opinions of others. The website also links to which provides reports by individuals on their experience of different tablets, both positive and negative, including a physical description of the tablet. The United States Tablet information and monitoring services in the United States are numerous and even a limited web search identifies many relevant web portals. A number of relevant sites are reviewed below. The Partnership for a Drug Free America The Partnership for a Drug Free America ( is a non-profit coalition of communication, health, medical and educational professionals working to reduce illicit drug use and help people live healthy, drug-free lives. 24 The Partnership s website offers a broad range of resources targeted at parents and teenagers, that includes information on many common drugs, users stories, memorials to individuals who have died as a result of drug abuse and video clips of exusers describing their experiences with a range of licit and illicit substances. 25 The website includes a Drugs Guide page with information about a range of drugs. DanceSafe DanceSafe ( is a non-profit harm reduction organisation promoting health and safety within the North American rave and nightclub community, with local chapters in the USA and Canada. A coalition of independent, youth-based harm reduction organisations, it is supported 20

23 Feasibility Study for an Illicit Tablet Information & Monitoring Service entirely through donations from individuals. 26 Volunteers are trained to be health educators and drug abuse prevention counselors within their own communities, utilising the principles and methods of harm reduction and popular education. 27 DanceSafe has three tablet testing programs: a laboratory analysis program, an on-site tablet testing program at raves and dance clubs, and a testing kit distribution program. The Laboratory Pill Analysis Program monitors the US ecstasy market and provides general public information on the contents of ecstasy tablets. This seeks to help ecstasy users avoid ingesting tablets that contain more dangerous substances, and to educate researchers, health care professionals, treatment providers and policy makers on the variety of drugs people are being exposed to, who are taking what they think is MDMA. n The laboratory is licensed by the Drug Enforcement Administration (DEA) to handle anonymously-sent controlled substances. It provides this service for a fee of $US100 per analysis and performs qualitative testing only. The United States DEA currently forbids quantitative anonymous testing. The laboratory is only allowed to identify the ingredients in tablets, but not their concentrations. Tablets with more than one active ingredient have their ingredients listed in order of relative amount, with the dominant ingredient listed first. All tests are performed using gas chromatography (GCMS). The laboratory is able to identify the presence of MDMA, MDA, MDE, MBDB, MDOH, PCP, amphetamine, methamphetamine, ketamine, 2-CB, DOB, 4-MTA, caffeine, ephedrine, dextromethorphan (DXM) and many other known drugs. n On-site tablet testing is offered to ecstasy users at raves, nightclubs and other public events where ecstasy is used socially. Users who are unsure of the authenticity of a tablet they possess can bring it to a booth where trained harm reduction volunteers will test it for using a reliable, liquid reagent. All DanceSafe volunteers are trained to follow strict harm reduction protocols for responsible tablet testing. These protocols have become international standards and are used in a number of other countries. n The drug testing kit distribution service offers five different kits, ranging in price from $US25 to $50 for use in self-testing of tablets. In the reviewers opinion, this website provides one of the most comprehensive information sources found, and includes a section on how they have set up tablet-testing programs and how to replicate their approach. Erowid Erowid ( is a member-supported organisation providing access to reliable, nonjudgmental information about psychoactive chemicals and plants and related issues. It works with academic, medical and experiential experts to develop and publish new resources, as well as to improve and increase access to already existing resources. The organisation claims to strive to ensure that these resources are maintained and preserved as an historical record for the future. Erowid.org 21

24 is an online library of information about psychoactive plants, chemicals, and related topics. The site is a cross between a library and a journal, archiving older historical documents and information as well as publishing new articles. The Erowid website contains more than 30,000 documents related to psychoactive substances including images, research summaries and abstracts, media articles, experience reports, information on chemistry, dosage, effects, health and drug testing. 28 Australia A number of government and non-government websites in Australia provide drug information services. Some of these are reviewed below. National Illicit Tablet Database (NITD) In Australia, the National Illicit Tablet Database (NITD) contains standardised information about the size, colour, and shape of tablets seized by police. The database is maintained by the Victoria Forensic Science Centre and contains high quality photographs of these tablets. The database is a source of information for law enforcement agencies, forensic scientists, and other key agencies throughout Australia. The database is accessible only by authorised personnel via the National Institute of Forensic Science website. The database does not currently contain information about the content of the tablets seized by police. 29 The Australian Drug Foundation The Australian Drug Foundation (ADF) is a non-government, not for profit organisation, and was established in 1959 as the Alcoholism Foundation of Victoria. The core purposes of the ADF are to prevent drug problems and reduce drug-related harms, and to help people remain safe if, when and while they use drugs. ADF has a specific website called the DrugInfo Clearinghouse (www. druginfo.adf.org.au) which provides easy access to information about alcohol and other drugs, and drug prevention. Professionals and members of the general community can use the service as their first port of call for information from local, national and international sources. DrugInfo Clearinghouse offers a range of services, including free information products, a special library, a telephone and information service, a website, and alert services for people interested in drug prevention. Anyone with an interest in drug and alcohol issues can browse the library. Library membership is free to Victorians who work in the health, education, welfare, community, youth, justice and related sectors, and to postgraduate students. ADF s drug prevention resources are updated regularly and sent out to DrugInfo Clearinghouse members free of charge. Every three months a range of new resources is published, focusing on a particular drug prevention strategy or issue. In the reviewers opinion, this website appears to have the potential to act as a suitable site for an ITIMS, and is consistent with the general philosophy, format and content of an ITIMS. Further discussions would need to be held with the ADF to ascertain their interest in this concept. Further discussions would need to be held with the ADF to ascertain their interest in this concept. 22

25 Feasibility Study for an Illicit Tablet Information & Monitoring Service The National Drugs Campaign As part of the National Drugs Campaign, the Department of Health and Ageing operates a comprehensive website titled Information about drugs (see internet/drugs/publishing.nsf/ Content/Information-about-drugs) and Where s Your Head At, a youth-oriented website that provides information on a range of drugs. (see publishing.nsf/content/youth-home). Enlighten The Enlighten website ( is operated by Enlighten Harm Reduction, a non-profit volunteer organisation based in Melbourne. The stated aim of the organisation is to promote harm reduction, specifically techniques concerning the drug MDMA or ecstasy. 30 A central part of their strategy is the promotion of tablet testing, using both chemical reagents and portable laboratory systems. The site also provides a link to another site ( a global database of Ecstasy tablets based on both subjective user reports and scientific analysis. Ravesafe The Ravesafe website ( provides information and support to promote health, safety and enjoyment for punters at music events, raves, parties and nightclubs. 31 It offers information on a range of illicit drugs, including amphetamines, ecstasy (MDMA), GHB (gamma-hydroxybutyrate), ketamine, LSD (d-lysergic acid diethylamide), nitrites and PMA (para-methoxyamphetamine). The site offers detailed descriptions of each substance, including appearance and physical properties, street names, how they are used and their effects, known adulterations and substitutions employed by manufacturers, and the negative consequences of use. 32 Comment Some websites that provide photographs (though generally of poor quality) and information about ecstasy tablets include tablets that were tested up to two years previously and may therefore be out of date. Perhaps the major drawback of this approach is that it does not facilitate contact between ecstasy users and health and welfare professionals, which would encourage more broad-based harm reduction behaviours. Some of these sites are potentials for an ITIMS, however some of them have not been updated for some time and therefore would not fit with the expectations of a current content information source. With the exception of the NITD, the sites are easy to access and can be found easily, and with their existing profile could act as a suitable host for an ITIMS. On the other hand, databases such as the NITD are similar to the model adopted in the Netherlands. In that country, the results from laboratory testing are placed into a pictorial determination table. The table consists of tablets that have been tested in the past eight weeks. Tablets with identical characteristics need to be tested three times before they are described as coming from the same 23

26 batch. The determination table is available to workers who interact with ecstasy users, but not to the public. This methodology ensures that illicit drug producers cannot produce counterfeit tablets that have the same appearance as tablets determined by the tablet testing process to be low risk. 2.7 Tablet Testing Underpinning the currency of the information contained in any tablet information system is the source of that information and the capacity to collect, test and present the required data in a timely manner. In this context, the testing methods used and the sources of the tablets tested become particularly important. Tablet testing programs typically bring together multidisciplinary teams of experts that may include chemists, social workers, youth workers and psychologists. Testing can allow researchers to detect, track and monitor emerging drug trends and changing patterns of drug supply and consumption and can provide demographic information about drug consumers and others involved in the drug market. 33 Drug testing can take a number of forms, including laboratory analysis, on-site testing conducted at events where drug taking is prevalent, such as raves and dance clubs, and via testing kits supplied to users. Testing Methods Tablet identification, colour reaction tests (e.g. the Marquis test), liquid or gas chromatography, massspectroscopy, immunological tests and capillary electrophoresis are common methods employed in determining the chemical content of illicit substances. Different testing methods can require from 5% of the tablet to the whole tablet to be subjected to testing, making some testing methods more suitable than others, depending on the circumstances under which testing is conducted. A brief description of each testing method is provided below: 34 n Tablet identification involves a visual comparison of tablets presented for testing with details of formerly analysed tablets, such as size, shape, colour logos or other physical markers. Tablet identification is fast and cheap but offers poor reliability. n Colour reaction tests (e.g. the Marquis test) can identify the presence of ecstasy and ecstasylike substances (MDMA, MDA, MDE) but cannot determine how much of the identified substance is present in the tablet. These tests can also identify the presence of some nonecstasy substances and the absence of ecstasy but are not capable of detecting a number of potentially dangerous chemicals that may be substituted for ecstasy. n Chromatography involves the separation of a drug compound into its separate chemical components, thus permitting the identification of individual substances in complex chemical mixtures. It is a relatively fast technique, taking as little as fifteen minutes, possesses high-level reliability and produces quantitative and qualitative results that can be used immediately in on-site testing locations. 24

27 Feasibility Study for an Illicit Tablet Information & Monitoring Service n Mass spectrometry involves the conversion of a drug or drug metabolite into charged particles and the mass-to-charge ratios of the particles generated create a pattern that provides a positive identification of the drug. n Immunological tests are based on the reaction of a specific antibody to a substance. Commercially available immunotest systems for urine drug tests are commonly employed in Europe for this form of testing. Immunology cannot be used directly for tablet testing but is used to identify substances consumed after the fact. n Capillary electrophoresis describes a family of techniques that can be employed to separate a variety of compounds. These analyses, all driven by an electric field, are performed in narrow tubes and can result in the rapid separation of many hundreds of different chemicals. Of the various tests available, chromatography is widely regarded as being the most effective and appropriate method to this application. On-Site Tablet Testing On-site testing is typically conducted at venues where drugs are in circulation. These include festivals, dance clubs, car parks outside discotheques and rave parties, although testing is generally confined to legal rave parties where this distinction is made. Trained testers generally take small samples of the tablets presented for testing and apply a reagent capable of confirming the presence of the supposed drug, such as ecstasy. The reagent does not respond to other substances which may have been substituted. Testing is often conducted with the support of local law enforcement agencies who recognise the value of harm minimisation and who provide an amnesty for users who have their tablets tested. This type of response from police is comparable to the manner in which needle exchange programs, treatment facilities, hospital emergency departments and other drug use response facilities are dealt with. 35 A number of legal and ethical issues are associated with testing tablets in public venues. A critical issue concerns what users should be told after testing. It is important that no information that could be construed as encouraging the consumption of illicit substances or that implies even the relative safety of any detected substances be made. Responsible harm reduction strategies reinforce the message that the ingestion of any illicit substance constitutes a health risk and that death or serious injury may result. It is also important from a legal perspective that the anonymity of those who present drugs for testing be maintained. 36 The costs of tablet testing may be high. Recent (2004) cost data published in the US indicate that laboratory testing costs $US110 per tablet, not including any costs associated with the collection of samples at venues, project management, data entry or the dissemination of results to local communities. 37 Effective and reliable tablet testing also requires investment in high quality analytical tools that can easily be transported to testing and intervention sites. 38 In some cases, such as Austria s ChEck it! tablet testing service, no charge is made to potential consumers for testing 39, 25

28 whilst other tablet testing organisations charge consumers a co-payment, such as the $120 per test charged by the US EcstasyData.org. This fee was previously $30, but the website reports that the EcstasyData testing project has run out of money. The project has been temporarily discontinued while we seek additional funding. No new tablets are being accepted for testing (unless the entire lab fee of $120/tablet is covered by the submitter. 40 Dissemination of Test Results Policies regarding the dissemination of test results vary. Some testing services provide the results only to the individual consumers who have requested the test; some post all test results on notice boards at the testing venue and/or on an internet website; some release specific details of identified dangerous tablets only at the testing venue; and others record and report aggregate results only via scientific (prevalence) studies. A review of tablet testing and information services in Europe identified four types of information policies that are employed. These are useful to consider within the Australian context and are presented below: n Information is provided only to the individual who presents a tablet for testing (this is relevant only to tablet testing services). n Information is provided to potential consumers only in the case of especially dangerous tablets. n Some information is provided to potential consumers in cases where the expected substances are detected and all information is provided in the case of especially dangerous tablets. n All information is made available to all potential consumers. 41 Stationary Tablet testing Stationary tablet testing is conducted within a laboratory, often located within the offices of drug monitoring services. Consumers may make contact by presenting in person at the service or by submitting tablets for analysis by post. In Europe, services report tablet testing for up to 2,000 clients per month and identifying approximately 10 tablet types in that period. Results are made available to consumers on the same day or with a waiting period of up to eight days. 42 Tablet Testing in the European Union Tablet testing is conducted in a number of Western European countries, some since the early 1990s, and in a range of legal contexts. For legal reasons, most services in Europe have in place strict policies stating that testers may not touch or handle the drugs presented for testing at any time, and that all tablets must be returned to consumers after a sample has been taken but prior to any testing being carried out. Some tablet testing services, such as Hamburg s DROBS, require users to conduct the test themselves, thus completely avoiding the need for staff to touch tablets. Data reported from across Europe suggest that those requesting tablet testing are generally males, who represent 26

29 Feasibility Study for an Illicit Tablet Information & Monitoring Service around 80% of drug testing consumers, and aged in their late teens or early to mid-twenties. 43 The aim of tablet testing in the European context has been to warn consumers of harmful or unexpected substances either at the time of testing or via the internet and to make contact with potential consumers of illicit substances in order to provide information and counselling. It is also one of a number of strategies to obtain knowledge about the black market for tablets, for detecting, tracking and monitoring emerging trends, for identifying changing patterns of drug use and for developing demographic data on users and others who may be at risk. 44 Of the countries that make up the European Union, The Netherlands initiated national drug testing earliest at the beginning of the 1990s, as an official part of the drugs policy approved by Parliament. The Drug Information Monitoring System (DIMS) project consists of a nation-wide network of prevention organisations. DIMS was the first drug information and monitoring system and has provided a service since It is a unique system for gaining insight into what kind of drugs are on the market and whether there are new drugs and new substances promoted as party-drugs. The objective of the Dutch drug policy is to prevent and limit the associated risks of drug use, both to the user, to his or her immediate environment and to society. Brief summaries of tablet testing strategies in a number of other European Union countries appear below: n Regulations governing tablet testing in Switzerland resemble those of The Netherlands and testing has been conducted since 1995 with the support of public authorities, local police and rave party organisers. n Tablet testing has been undertaken in Austria since 1997 and is legal provided it is carried out by a scientific institution and conforms to strict guidelines regarding the handling of illicit substances. n On-site tablet testing commenced in Belgium in 2001, but its legal status remains unclear. Local police who do not approve of testing discourage use of tablet testing services by having a strong physical presence at testing venues. n On-site tablet testing has been available in France since 1997, and although it is illegal the government subsidises a number of tablet testing projects. With the exception of very dangerous substances, no information is provided to potential tablet users. n In Germany, testing of illicit substances may only be conducted by pharmacies or public authorities. However, a number of on-site tablet testing projects operate with the tacit support of public prosecutors and local police. n Whilst the legality of tablet testing is unclear in Spain, on-site and stationary tablet testing has been available since 1997 and is supported by the city municipality of Barcelona and the police

30 The Impact of Tablet Testing There is currently limited research and evaluation data to support the protective or harm reduction impact of on-site tablet testing, nor to support claims that such interventions promote drug use or are being used by drug dealers for marketing purposes. 46 Research undertaken in Amsterdam, Hanover and Vienna [Benschop, Rabes & Korf, 2003], all cities with long-running programs, suggests: n Tablet testing services result in better-informed drug users and increasingly health-conscious behaviour. n Tablet-testing services enable drug workers to contact and communicate with drug users who were previously out of reach. n Health warnings about dangerous substances are received with more credibility and acceptance when delivered in the context of tablet-testing services. n Provided that certain conditions are fulfilled, tablet-testing services can potentially enable the monitoring and analysis of synthetic drug markets. n Tablet-testing services do not stimulate the use of ecstasy and most likely will not extend the circle of ecstasy users. n Tablet-testing services lead potential ecstasy users to postpone or abstain from an initial use of the drug. n As a secondary prevention measure, tablet testing yields valuable information for primary prevention efforts. n Tablet-testing services serve to demystify synthetic drugs. 47 In other research, the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) concluded in a 2001 analysis of the impact of tablet testing in Europe that although the effectiveness of tablet testing on recreational drug use could not be accurately assessed, such projects had other benefits relating to the acquisition of knowledge as to which drugs are being used and by whom. The authors therefore supported the implementation of tablet testing programs. 48 In 2005, the PDI survey asked a number of questions around tablet testing. The data indicated that: n The vast majority of people attempted to find out about the content and purity of tablets at least some of the time. n Most of the sample asked friends and dealers about the content and purity of tablets, while about a quarter used personal testing kits. n Over half of those participants who reported using testing kits indicated that they were aware the kits had limitations. 28

31 Feasibility Study for an Illicit Tablet Information & Monitoring Service n Most people would take a tablet if it contained an MDMA-type or amphetamine-type substance, just under half would take it if it contained ketamine, and about a quarter would take it if the test indicated it was benign or unknown. n Approximately two-thirds of the sample reported that testing kits would be a useful resource. 49 Restrictions on tablet testing relate mainly to a ban on testing substances on behalf of obvious drug dealers or producers and special arrangements for dealing with ecstasy, which is considered a hard drug. The testing is primarily undertaken to monitor illegal drug markets, rather than to inform users of the content of the tablets they are consuming, but users are provided with test results and extensive information regarding the health risks associated with drug use. 50 Considerations for Potential Tablet-Testing Operations Drug testing may result in a range of direct and indirect outcomes. For instance, testing can assist users in avoiding more dangerous drugs that have been substituted for the substances they believe they have acquired, and can inform researchers, treatment providers, health care professionals, law enforcement agencies and policy makers on the actual, as opposed to supposed, substances that are circulating in the community. 51 It has also been suggested that tablet testing projects provide indirect benefits such as opportunities to access populations that are otherwise difficult to contact and to raise their interest in harm prevention and reduction. 52 Harm reduction may be achieved if tablet testing provides opportunities to transmit safer-use messages relating to issues such as acute, short-term and long-term health hazards, addiction, legal risks and drug driving. 53 In addition to monitoring drug trends via quantitative means such as tablet testing, the collection and analysis of qualitative information should not be overlooked. Such information obtained from users in settings where recreational drugs are used can provide powerful insights into the context of drug use and emerging trends in the market. 54 Comprehensive drug monitoring programs incorporating both quantitative and qualitative methodologies can also assist in identifying possible points of intervention for anti-drug programs and in developing responses to potential harms as they emerge, for instance informing the content of web-based health promotions and drug counselling programs. 55 Tablet Testing in Australia In Australia, tablet testing has encountered substantial governmental resistance and no official or regulated trial has yet been permitted. 56 Data from the National Coronial Information System 57 showed that from , there were 112 ecstasy-related deaths in Australia, of which 51 (46%) had ecstasy identified as the primary contributor; 16 (14%) had ecstasy as the secondary contributor, and 45 (40%) had ecstasy as the tertiary contributor. Importantly, in the large majority of cases where adverse outcomes have been experienced, ecstasy was rarely the only drug used, and other external factors such as the 29

32 ambient temperature of the environment, the level of physical activity and the extent of fluid re-hydration after ecstasy use were also contributing factors. None of these would be affected by the provision of on-site tablet testing. A recent paper by Nicholas (2006) 58 is of particular relevance to this issue, in that it relates specifically to the Australian context, and is current in its content. In this paper, Nicholas considers that, from a Police perspective and despite the lack of strong evidence to support the efficacy of tablet testing programs, if a decision is made to support the implementation of such programs in Australasia, such an approach should incorporate the following characteristics: The health sector should bear the financial burden of any costs associated with such programs, although Police would have a role. n A high degree of quality control should be applied to the whole process of tablet testing, dissemination of results and the provision of relevant harm reduction messages. Appropriately qualified, officially approved health personnel, whether on-site or off-site, should carry out tablet testing programs. n Tablet testing should take place in the context of a legislative structure and/or clear guidelines about the appropriate use of policing discretion, which are designed to facilitate this. n The involvement of well-intentioned, voluntary groups operating in a legislatively grey area (or clearly in breach of the law) is not encouraged. n The testing of tablets should be carried out using quality certified chromatography techniques (or similar scientifically sound techniques) by health sector staff that are qualified and legally approved to do so. Appropriate measures would also need to be in place to ensure the security of any drug samples and the witnessed destruction of those samples at the end of the testing process. n The dissemination of information about the results of tablet testing warrants careful consideration. For example, there would be merit in information about dangerous tablets being widely disseminated. On the other hand, information should not be openly disseminated that indicates that certain tablets would be associated with a low risk to most users. Nicholas further states that the methods that could be used to obtain tablets for testing would require careful consideration. Some possibilities include: n The routine analysis of all tablets (or samples of batches of tablets) seized by police in the course of general or drug-focused operations. n The analysis of tablets placed in amnesty bins, or discarded at dance venues. n The use of authorised covert tablet purchasing operations for the purpose of analysis. In this context, Nicholas asserts that the results obtained from on-site reagent-based tablet testing are simply too unreliable to make a useful contribution to reducing the harm associated with the 30

33 Feasibility Study for an Illicit Tablet Information & Monitoring Service use of drugs. The lack of precision associated with this process and the legal difficulties inherent in it, strongly suggest that this is not an approach that Police should be supporting according to Nicholas. He goes on to suggest that the potential value of such an approach lies in two areas. Firstly, it could facilitate the ability to detect the presence on the market of ecstasy tablets that are so dangerous that they are likely to lead to serious adverse outcomes for a significant number of users. Secondly, the ability to provide information about tablets which are potentially very harmful, could provide a focus on the safety issues associated with ecstasy use. Likewise, having this information available to disseminate could provide an opportunity for health authorities to access a group of illicit drug users, which is difficult to access using other means. This group of users could then be appropriately targeted with information about the safety issues associated with ecstasy use

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35 3 Stakeholder Interviews Feasibility Study for an Illicit Tablet Information & Monitoring Service 3.1 Introduction A series of face-to-face and telephone interviews was conducted with a range of stakeholders nominated by the Department. Representatives from the following organisations were consulted: n Department of Human Services, Drug Policy Group, Drugs Policy and Services Branch n Department of Justice, Justice Policy, Legislation and Policy n Enlighten Harm Reduction n Metropolitan Ambulance Service, Clinical Standards and Audit n Royal Melbourne Institute of Technology (RMIT) Student Health Centre n Rural Ambulance Victoria, Operations, Clinical and Education Services n St Vincent s Hospital, Emergency Care Centre n Turning Point Drug and Alcohol Service n Victoria Police, Drug and Alcohol Strategy Unit n Victoria Police, Forensic Services Department n Victoria Police, Major Drug Investigation Division n VIVAIDS n VIVAIDS, Ravesafe Project n Western Hospital, DASWest The interviews were of a semi-structured nature, with questions posed that reflected the terms of reference for the review. The questions asked of participants are presented in Appendix A. The following is a summary of the responses received. 3.2 Summary of Findings Unmet Information Needs There was general agreement among those interviewed that they, their clients and other stakeholders currently have unmet information needs regarding the illicit tablets currently available and their characteristics. In general, these concerns related to an absence of timely and reliable information regarding chemical content and tablet appearance, for instance shape, colour, logos and any other distinguishing features. Information currently available tends to be either out-of-date, anecdotal or subjective, or lacking in scientific/objective value. However, there was some variability in the needs expressed by different stakeholder groups in regard to the nature and timeliness of the information required and its use, largely reflective of the various roles and interests of the parties interviewed. For example: n Hospital Emergency Departments and Ambulance Services need a general knowledge of the 33

36 types of drugs available (and their potential effects and side-effects) when presented with a patient suffering adversely from tablet use. However, their clinical response is not generally contingent on this information, and their use of an ITIMS would be of a more general rather than immediate nature. n The perspective of Police differs, depending on the purpose of the data. At a strategic level, Police require intelligence on what drugs are on the market in order to develop strategic policing responses (for example whether they are from overseas or locally made). At an operational level, specific data are needed for the purposes of prosecution, which requires a different level of information and its application to specific cases. The latter is not a need that an ITIMS would seek to address. n The Department of Justice needs timely information on new drugs entering the market to ensure legislation keeps abreast of them to support prosecutions as required. n The Department of Human Services needs timely information in order to issue alerts when a new and/or dangerous drug is discovered, as well as information supporting the development of appropriate strategies for the treatment of emerging drugs. Again the required timeliness and specificity of this information is likely to vary. n Agencies representing drug users identified two main areas of need: The capacity by drug users to test and identify the tablet they have at the time in order to ensure that it is what they think it is and does not contain contaminants or adulterants that are dangerous; and Reliable, objective information on the tablets generally available in the market to inform their decisions about whether or not to use them, together with relevant harm minimisation information. An ITIMS may address the latter of these needs directly, and the former to some degree if the user is able to match the tablet they have to the information provided in an ITIMS. However, this does not eliminate the risks associated with tablet use, as there is always the risk of wrong identification, dangerous counterfeits or new look-alikes. Nevertheless, these representatives were clear in their view that there is a need to more readily accessible, timely and reliable information on the types of tablets available, their positive and negative effects and associated harm reduction information to inform their decision making regarding tablet use. Overall, stakeholders were able to identify a range of unmet needs regarding illicit tablets, but these vary in regard to the timeliness of the information, the nature of the information required, and access to the information. 34

37 Feasibility Study for an Illicit Tablet Information & Monitoring Service Type of Services Required The type of services required by the various stakeholder groups reflected the unmet needs identified previously. Again, these varied somewhat between stakeholder groups according to their interest and role, although the most common required services identified across stakeholder groups were: n Alert warnings about tablets that have been found to be dangerous due to contaminants or adulterants. n Information on tablet content, including both active and passive constituents. In this regard, legislative requirements call for constant definitions to be applied for three to four years. n Tablet description, including street names, appearance, colour size, shape, logos and any other differentiating characteristics. This may include photographs, but they would need to be of suitable quality. n Information on how different drugs may affect behaviour, as well as risks associated with potential negative effects. n Locations where the tablets were sourced in order to ensure that localised data are available, including rural locations. n General information on harm minimisation and where to access additional services. Views were mixed as to whether the concentration of tablets contents should be included in an ITIMS. Consumer representatives generally considered that concentration of constituents should be included, but recognised that this information should be presented carefully in order not to infer increased effects. Other stakeholders were generally opposed to constituent concentration being presented. The timeliness and reliability of this information was heavily emphasised in order to maximise its utility. Preferred Medium/Media The internet was universally identified as the most appropriate and accessible medium for an ITIMS. The information contained on this site should be comprehensive in its content. It was also suggested by consumer representatives that the site have WAP access so that it could be accessed by mobile phone. Telephone access was also suggested by a number of stakeholders. alerts were also suggested to emergency departments and ambulance services for new drugs that are found to be dangerous. The potential for regular newsletters was suggested as a further mechanism of dissemination of information, although it was not clear as to how and to whom the newsletter would be distributed. 35

38 Access to ITIMS Views regarding access to the information contained on an ITIMS varied considerably, and were divided fairly equally between the following perspectives. Advocacy bodies representing drug users, as well as some other stakeholders, were clear that access to all the information contained on an ITIMS should be universal in order to maximise its influence and to inform the decisions of drug users. They considered that any restriction in access would defeat the purpose of an ITIMS and fail to meet the needs of one of the main audiences for the system. This group was also concerned that the timeliness of the information was important to the needs of drug users in particular. Other stakeholders considered that the information on the ITIMS should be partitioned such that different groups would have access to different elements of the information. This division of information would reflect their different roles and interests. Conceptually, this approach would involve establishing a public component of the ITIMS which anyone could access, and a private component that would require an appropriate password to access. Among the information they felt should be withheld from drug users were details of the concentration of the active component and its effects, as this could act as an incentive to try different tablets. Further, it was considered that drug dealers could use this information to promote their drugs as being better than others. A further, though slightly smaller, group of stakeholders considered that the general public (including drug users) should not have any access to the ITIMS, and that access should be restricted to organisations and their representatives in such areas as health, research, police and policy makers. These views were based primarily on a concern about the misuse to which such information could be put by users and dealers, as well as the legal and health implications of suggesting that any particular substance or tablet might be less hazardous than another. Currency of ITIMS Information The currency of the information contained on an ITIMS system was widely regarded by stakeholders as being of critical importance to the utility of the system. This was particularly true for drug users and health professionals who might access the system for safety reasons. The illicit tablet market was seen as being highly dynamic and changeable, with new tablets appearing, and disappearing, on a frequent basis. Consequently the need to keep abreast of these changes was seen as underpinning the value of the information contained in an ITIMS. Views varied somewhat as to what current means in practical terms. Some suggested that, ideally, information on tablet content would be posted to the ITIMS within 24 hours of being tested, and certainly no longer than seven days after being tested. The currency of the information was recognised as clearly depending on the level of resourcing provided for the collection and testing of tablets, the technical nature of the testing process and the use to which the information is being put. 36

39 Feasibility Study for an Illicit Tablet Information & Monitoring Service Sources of ITIMS Information The potential sources of the information to be presented in an ITIMS have clear implications for the timeliness (and some stakeholders suggest utility) of the ITIMS system. Police and Customs seizures were seen by some (particularly representatives of drug users) as being useful, but limited in terms of their timeliness (i.e. may occur after the drug has been on the market for some time), coverage (i.e. may include some tablets that never make it to the market and miss others that do), and delayed in presentation of results (i.e. are collected primarily for evidentiary purposes and do not have the same time requirements as an ITIMS). However, it was suggested that Police could, under the appropriate circumstances, randomly purchase tablets to monitor supply, and that the information could then be provided to ITIMS. Such an approach would clearly require careful consideration of the legal and ethical implications. Information gathered at hospitals, particularly emergency departments, was also seen as being useful, but also of limited coverage and uncertain timeliness. A number of clinicians commented that they rarely see the tablets themselves only their effects. The final, and perhaps most controversial source identified was on-site tablet testing at sites where drugs are being used more widely. It was recognised by most of those consulted that this source was potentially that which would provide for the widest and most timely coverage of tablets on the market. There were a number of suggestions as to how tablets from this source could be accessed, ranging from on-site tablet testing at raves and other major gatherings, to nominated drop-off points for collection and analysis (not dissimilar to the needle and syringe program concept). Such an approach would require an amnesty for those providing drugs for testing. The issues associated with tablet testing embodied in using drug users as the source of information for the ITIMS were widely recognised, and reflect those reported in the literature review in Section 2. Opinions were divided as to the merits of this approach, notwithstanding the fact that it has the potential to provide the broadest and most timely coverage of tablets on the market. However, many stakeholders expressed concerns about the legal, moral and social issues associated with this approach, and questioned whether these issues outweighed the potential benefits. Others (particularly user representatives) had a different perspective and suggested that the additional information to be gathered through such an approach would outweigh the risks. Costs associated with testing tablets on an ongoing basis were also recognised as an issue requiring careful consideration. It should be noted that current legislation in Victoria would see any person bringing a tablet to be tested as guilty of possession, and by handing a tablet to a tester as committing the offence of supply. The same offences apply to the tester by receiving the tablet for testing, and then handing it back. Notwithstanding the differences in stakeholder perspectives, there was widespread agreement that an ITIMS should source its information from multiple sources (Police, Customs, hospitals and 37

40 perhaps drug users), in order to maximise its coverage, timeliness and relevance to as wide an audience as possible. It was also recognised that a staged approach might be required to include these various sources in the process. Management of ITIMS The majority of stakeholders considered that an ITIMS system should not be under the management of Police or the judicial system, although recognition was also given to the fact that the cooperation of these sectors was essential to the system. The general consensus was that both the philosophy underpinning an ITIMS (as a harm minimisation initiative) and the acceptability of the system to a wide range of its users indicated that its management should fall under the general umbrella of the health sector. However, views diverged as to whether an ITIMS should be a government or non-government managed program. Clearly, funding for an ITIMS would need to come from government sources (to do otherwise would undermine its perceived independence). Some stakeholders suggested that the ITIMS should be a government website managed by the Department of Human Services (DHS), as this approach is consistent with the role and function of DHS as the lead agency involved with drug use prevention and treatment and the harm minimisation approach. Others suggested that the site should be separate from government and should be managed by a non-government organisation (e.g. Turning Point or the Australian Drug Foundation) to avoid any concerns about political influence or bias. Most considered that the site should not be managed by a drug user representative organisation, as it could undermine its credibility and objectivity. Links to Other Services Views expressed by stakeholders recognised that an ITIMS has the potential to act as an information conduit between drug users and services that seek to reduce the harms of illicit tablet use. However, opinions were somewhat divided about the extent to which drug users might access this information and subsequently act on it. There was agreement that any ITIMS site should incorporate links to other drug and alcohol services, as well as other sites that provide additional information about illicit tablets and their effects, in order to provide the opportunity for drug users to both expand their knowledge of illicit substances and their effects, as well as where and how to access treatment and other related services. Support and Operating Resources The establishment and ongoing operation of an ITIMS was widely recognised as requiring a collaborative effort and communication processes across a range of government and nongovernment agencies. The extent of such efforts would vary to some degree depending on the particular model adopted for the collection of tablets for testing. Regardless of the model adopted however, the following issues were identified: 38

41 Feasibility Study for an Illicit Tablet Information & Monitoring Service n Support from Police was seen as being essential for an ITIMS, whether it be by providing tablet samples directly for analysis, or through their cooperation in enabling other sources (including drug users) to be utilised. n An ITIMS should be seen as a health initiative, and as such would fall under the umbrella of DHS. n The timeliness and coverage of the information collected and presented in an ITIMS is of particular importance to the majority of stakeholders. n Chromatography is regarded as the most appropriate tablet testing method. Costs and the time required for these tests depend on the range of substances to be tested for. n The Victorian Police Forensic Services Department has the technical infrastructure to undertake the required testing, but not the human resources to undertake this additional workload with results presented in the required timeframe. n Costs of tablet collection would vary significantly between different approaches, and these need to be considered in the light of the anticipated benefits. ITIMS in Rural Areas The application of an ITIMS in rural areas was regarded as being important in two respects. Firstly, access to a web-based ITIMS was seen as potentially providing rural drug users with improved access to information about the tablets on the market and their effects. This was seen as being important as such access was regarded as being less available and timely than in metropolitan areas. The second aspect related to the need to collect tablets from rural areas to ensure that the information contained in the ITIMS was relevant to these locations. It was suggested that, if tablet testing from drug users is to be adopted, that it be extended to rural areas on a regular cycle, in addition to any other information gathered through other sources. Existing Information Sources Stakeholders reported currently using a range of information sources in regard to illicit tablets, and that these varied according to their role and available sources. Examples include Police and Customs seizure data, forensic testing for evidentiary purposes, health alerts, the Pill Report website operated by Enlighten, and the various drug monitoring reports identified in Section 2. However, all were regarded as being insufficient or flawed in some way, and lacking in terms of their coverage, timeliness, objectivity and reliability. Indeed it was these limitations that most stakeholders saw the potential for an ITIMS to address, albeit with varying levels of support. Benefits of an ITIMS The main benefit of an ITIMS was universally regarded as greater access to timely, comprehensive and reliable information about the range and nature of tablets available in Victoria, both in total and 39

42 on a regional basis. Such access would be of potentially greatest benefit to drug users in informing their decisions about drug use and improving safety. Clinicians were also seen to benefit from an ITIMS, although the extent to which they might use such a system was reported as variable. Police and health authorities were also seen to benefit to some degree through raised awareness of the trends in tablet appearance and use it as part of their intelligence activities and community monitoring. Risks and Barriers A number of issues and risks associated with an ITIMS were identified by stakeholders. These included: n Balancing diverse community views associated with an ITIMS being regarded as promoting or supporting the use of illicit drugs. Addressing these risks would require, as a minimum, the incorporation of appropriate caveats and warnings on the website regarding the context in which information is presented, together with appropriate referrals to other information and treatment agencies/services/sites. n Ensuring that the methods used for collecting tablets for testing comply with the law. In this regard, current legal barriers to the application of on-site testing of tablets in Victoria need to be considered. n Ensuring safety with regard to the range of substances tested for and reported on; and n Ensuring the right balance with pre- and post-test messaging in terms of drug users interpreting the information provided as implying that some tablets are safe.. Again these issues need to be addressed by ensuring that appropriate content information, caveats and referral information is presented on the website. n Preventing drug dealers (and others) using an ITIMS to legitimate and promote drugs. A number of existing international sites use moderators or editors to ensure the objectivity/suitability of the information presented on the sites, although this varies widely in its application. This implies that protocols would need to be established on the range, nature and format of information to be presented on the website. n Balancing the costs associated with the collection and testing of tablets which may outweigh the benefits to be derived. n Ensuring timely information is contained on an ITIMS given the changing pace of the illicit tablet environment means that the information presented could become outdated very quickly. It would be important that processes are established to review and update the information on the website on a regular basis. These issues and risks were not seen as being insurmountable, but would require careful consideration and planning in the establishment of an ITIMS, together with careful management and promotion to ensure that each risk was catered for. 40

43 Feasibility Study for an Illicit Tablet Information & Monitoring Service The Ideal ITIMS Model As previously noted, the expectations and requirements of an ITIMS varied between the various stakeholder groups, and there was only limited agreement on the features that stakeholders considered to be a requirement of the ideal ITIMS model. Areas where there was a common perspective included: n The use of a web-based system as the primary host, together with free telephone access. n Timeliness of the information presented. n The objectivity and reliability of the information presented. n The need for appropriate caveats and safety information. n The need for the information to be location specific. n Linkages to other health information and resources. n Areas where there was less agreement included: n Who should have access to an ITIMS (especially the public). n Who should host an ITIMS. n What information should be presented in the system, particularly in terms of drug purity. n Whether the costs associated with establishing and operating an ITIMS were warranted relative to the benefits to be derived. 41

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45 4 Implementation Issues & conclusions Feasibility Study for an Illicit Tablet Information & Monitoring Service 4.1 Introduction This section considers issues relating to the implementation of an ITIMS in Victoria, having regard to the findings from the literature and the views of stakeholders presented previously. Additional consultations with Victoria Police, including the Drug and Alcohol Strategy Unit and the Forensic Services Department, and the Department of Human Services, explored further the issues that would need to be addressed in implementing an ITIMS. These issues are considered under three domains: n Accessing illicit tablets for testing; n Testing tablets; and n Presenting information in an ITIMS. In each of these areas, options are presented and discussed in regard to their advantages and disadvantages, including timeliness, costs, facilitators, barriers and recommended approach. 4.2 Accessing Illicit Tablets From the review of the literature and discussions with key stakeholders in Victoria, it is clear that essentially there are two potential sources of illicit tablets with the required breadth of coverage and timeliness that could provide input to an ITIMS: Tablets obtained through Police and Customs seizures; and Tablets obtained from drug users through on-site tablet testing. Police and Customs Seizures In Victoria, all illicit tablets seized by Police and Customs as part of their operations are tested at the Forensic Services Department of Victoria Police. A significant proportion of Police seizures occur at street level which provides the opportunity to access illicit tablets as they appear among users, and to monitor changes in the market. Advantages n Established processes exist for the collection and analysis of illicit tablets seized by Police and Customs. The use of this approach would therefore incur no additional collection costs. n Drugs tested include those seized at a wide range of locations across Victoria, including those from street level users, drug dealers, manufacturers and importers. n The collection and analysis of drugs via this method is covered by existing legislation, and would require no legislative or regulatory changes. n Whilst some changes to Police procedures would be required (relating to the timing of forwarding the tablets to the testing service) this study assumes that this option could be implemented.. n This approach is likely to alleviate some community concern about illicit tablet testing as it 43

46 maintains the status quo rather than introducing what would be seen by some as a controversial alternative. n The political risks of this approach are likely to be much less than the alternative of on-site tablet testing, as it maintains the status quo rather than introducing what would be seen by some as a controversial alternative. Disadvantages n Currently there is a six to nine month delay in reporting test results for tablets obtained by this method. However, this delay is largely due to resourcing of the testing laboratory (see below), not the currency of the tablets themselves. n Some stakeholders (notably those representing consumers) expressed concerns about the currency and coverage of the tablets derived from this source, believing that neither of these aspects are sufficiently covered under this approach. This view was not supported by Police, who considered that the breadth of locations (including street level seizures), and the frequency of seizures are such that this source is both timely and broad in its coverage. n As noted previously, this option may require some changes to Police procedures regarding the timing of forwarding the tablets to the laboratory for testing. In so doing, recognition must be given to the need to have the tablets available for evidence when required in any prosecution, and to ensure that the chain of evidence is not affected. On-Site Tablet Testing On-site tablet testing is conducted in a number of European countries and in parts of North America, as a mechanism for providing immediate feedback to users at high-use locations as to whether the tablets they have contain any known adulterants. Whilst not the primary focus of this study, on-site tablet testing has the potential to act as a source of data for inclusion in an ITIMS in Victoria. Advantages n This approach was advocated by user representatives as providing a more timely and comprehensive coverage of tablets in what was described as a volatile and rapidly changing market. n The presence of on-site drug and alcohol service personnel collecting tablets for testing provides an opportunity for engagement and interaction with drug users, and hence enables additional safety and harm reduction messages to be provided. n It has been argued that on-site tablet testing leads to more informed and safer practices by users (although the evidence on this issue is equivocal). Disadvantages n Current legislation in Victoria would see any person bringing a tablet to be tested as guilty of possession, and by handing a tablet to a tester as committing the offence of supply. The 44

47 Feasibility Study for an Illicit Tablet Information & Monitoring Service same possession offence applies to the tester by receiving the tablet for testing. Consequently, legislative changes would be required for this approach to be implemented. n The nature of the testing process (and its reliability) impacts on the suitability of this approach. It is widely expected that the information presented in an ITIMS be of high scientific reliability, the most suitable testing method for which is chromatography. This in turn requires a suitably sized sample to be tested. It is unknown whether users would be prepared to provide such samples for testing, raising questions as to the level of coverage this approach will provide. Alternatively, whilst a scraping of the tablet might be sufficient for testing purposes, this still only covers the surface of the tablet, not a cross-section. n Clear protocols and processes would need to be established for the handling and transfer to the laboratory of the tablets collected that comply with both legislative and safety standards. n The costs associated with this approach depend largely on the frequency and locations (metropolitan, rural etc.) at which tablet collection is undertaken. Based on an assumption of two FTE (at a salary of $60,000 per annum), and allowing for after-hours loading (25%) and staff on-costs (27%), staff costs would be approximately $200,000 per annum. Motor vehicle costs together with transportation costs of the tablets to the laboratory are estimated at a further $30,000-$50,000 per annum. In total, this approach is estimated to cost approximately $230,000-$250,000 per annum. Any expansion of capacity to provide greater coverage would increase these costs proportionally. It should be noted that these collection costs are independent of the costs of testing the tablets, regardless of which testing method is used (see below for discussion of testing alternatives). n The evidence supporting the effectiveness of on-site tablet testing in regard to its impact on drug use is equivocal. On the other hand, tablet testing may be seen by some sections of the community as promoting drug use. Balancing diverse community views is always a challenge and would need to be considered in planning for implementation. Potentially negative responses can flow into perceptions of an ITIMS itself and its role. Recommended Approach It is apparent from a comparison of the relative advantages and disadvantages of the alternatives considered for the collection of tablets for testing and presentation in an ITIMS, that the use of the tablets seized by Police and Customs provides a more readily implementable, less costly and less controversial approach than on-site tablet testing. There is no evidence to support the argument that this source would be significantly less comprehensive in its coverage or timing than on-site tablet testing. Feasibility of this approach depends on, further discussions with Police to ascertain the most appropriate processes to expedite the provision of tablets for testing, and any ramifications this 45

48 may have on other Police operations (such as tablet storage, evidence handling, prosecution processes etc.). The coverage and currency of the tablets collected under this approach would need to be monitored to assess its ongoing appropriateness. 4.3 Testing Illicit Tablets The literature and consultations identified a number of alternative methods for testing tablets (see Section 2.7.1). The choice invariably entails a trade-off between cost, reliability and timeliness. Currently, tablets seized by Police and Customs are tested by the Forensic Services Department of Victoria Police. Three alternatives are discussed below: n Reagent testing kits. n Portable Ion Mobility Scanners (PIMS). n Chromatography. Reagent Testing Kits Colour reaction tests (e.g. the Marquis test) can identify the presence of ecstasy and ecstasy-like substances (MDMA, MDA, MDE) but cannot determine how much of the identified substance is present in the tablet. These tests can also identify the presence of some non-ecstasy substances and the absence of ecstasy but are not capable of detecting a number of potentially dangerous chemicals that may be substituted for ecstasy. Advantages n Reagent testing kits are portable, readily available and are comparatively inexpensive. Disadvantages n The reliability of these tests has been heavily criticised, and they are widely regarded as lacking sufficient scientific validity to be appropriate to an ITIMS application. n Processes by which the results are transferred in a consistent manner to an ITIMS would need to be established, and are likely to be problematic. Portable Ion Mobility Scanners (PIMS) In a submission to the Parliamentary Joint Committee on the Australian Crime Commission, Inquiry into Amphetamines and Other Synthetic Dugs, Brennan and Davidson 60 suggested that new technologies, such as portable Ion Mobility Scanners could serve to collect and report on samples of tablets used at high-use sites as part of on-site tablet testing. A scan of the literature found a number of references to the use of this technology in settings such as airports and prisons, but none in relation to tablet testing in public areas 61. This technology appears to be used primarily for trace detection on objects to reduce the entry of illicit drugs into prisons and similar locations. 46

49 Feasibility Study for an Illicit Tablet Information & Monitoring Service Discussions were also held with the Forensic Services Department of Victoria Police regarding the suitability of this approach. The comments below largely reflect the findings in the literature together with commentary made by the various stakeholders consulted on this issue. Advantages n PIMS provides a portable mechanism for detecting the presence of a wide array of substances, and can be pre-programmed to detect any specified drugs (e.g. MDMA) as well as other commonly used additives. n The use of PIMS does not require extensive training, and could be readily implemented. n The process of testing would not require the user to actually hand over the tablet to the tester, but would involve touching the surface of the tablet with the PIMS. This would avoid the legal issues relating to handling illicit substances. n The PIMS provides immediate feedback to the user of the tablet s identified contents (assuming they are included in the pre-programmed list), reducing the risk of ingesting dangerous additives. n It is potentially possible for the PIMS to link directly to an ITIMS database using the web, providing for immediate posting of results (this capacity would need to be verified and tested). Disadvantages n To our knowledge, PIMS have not been used in this setting, so their acceptability and functioning in this context is yet to be demonstrated. (This could be addressed through a controlled trial to evaluate their effectiveness). n The technology has a number of limitations, including the fact that it is an indicative test only and does not have the scientific validity of some other tests (e.g. chromatography); it cannot compare results to any reference standards; it cannot test for purity; and it tests only the surface of the tablet and not a cross-section. n This approach does not provide for photographing the tested materials, which would need to be undertaken on-site. This then brings back into question the legal issues associated with handling of the illicit tablets, as well as the quality and consistency of the photographs in a non-controlled environment. Chromatography Chromatography is used internationally for testing a wide range of licit and illicit substances, is regarded as being the gold standard for such tests, and is used extensively for the presentation of evidence in courts. Advantages n Chromatography is widely accepted as the most reliable scientific and appropriate testing 47

50 method for tablet content, and meets the expectations of stakeholders with an interest in an ITIMS. n Chromatography can produce a report on the identity and purity of a sample within four hours, making it both reliable and timely. n The Forensic Services Department of Victoria Police uses chromatography for tablet testing for both evidentiary and intelligence purposes, and has the technology and experience in its application. It further has the necessary protocols and processes in place to meet current legislative and safety requirements for handling of illicit drugs. n The Forensic Services Department is one of a number of laboratories nationally that contributes to the National Illicit Tablet Logo Database, which is akin in content to an ITIMS, but access is restricted to law enforcement authorities. (However, resource limitations mean that there is currently a six-month lag between seizures and their inclusion on this database.) n Discussions with representatives from the Forensic Services Department indicate that with an increase in resources, it has the technical capacity and equipment to expand its services to meet the timing requirements of an ITIMS. n Estimates of the costs of testing an additional 100 tablets per week with a four-hour turnaround are approximately $140,000-$160,000 per annum (covering additional staff, professional supervision, capital equipment, maintenance, consumables, and incidentals). This equates to approximately $30 per tablet. By comparison, the Department charges $160 per hour for commercial services. n The Department also has available the required cameras and processes to enable tablets to be photographed to a consistent standard for inclusion in an ITIMS. Increasing capacity of this service to ensure timely transfer of photographs to an ITIMS however, would be likely to incur additional costs. Disadvantages n The use of chromatography inherently requires a lag between the time of collection and the results of testing tablets, given the need to transport the tablets to the laboratory. However, this study assumes that processes could be established whereby this lag could be reduced to a level that would meet the time requirements of users of an ITIMS. Additional costs would be incurred in order to meet these timelines. Recommended Approach Of the alternatives considered, chromatography is the most widely accepted and available testing method that would meet the technical quality and timing requirements of users of an ITIMS, and is the recommended approach. This technology is currently used in the Forensic Services Department of Victoria Police, which may have the capacity to expand its services to meet the timeline needs of users of an ITIMS. Further, the Department meets the legislative and safety requirements for handling and testing illicit substances. 48

51 Feasibility Study for an Illicit Tablet Information & Monitoring Service Costs of the Forensic Services Department expanding its capacity to test an additional 100 tablets per week with a four-hour turnaround are approximately $140,000-$160,000 per annum, or $30 per tablet. It must be remembered however that additional costs would be involved with increasing photography services and meeting acceptable tablet transfer timelilnes. Chromatography testing for an ITIMS, undertaken by the Forensic Services Department, is nevertheless recommended, as the most realistic option. As previously noted, this will require additional funding, as well as some changes to Police procedures in order for tablets seized to be forwarded to the Department as soon as practical for inclusion of the tests results in ITIMS in a timely manner. 4.4 Presenting Information in an ITIMS A web-based system is universally regarded as being the most appropriate medium for hosting an ITIMS. HOI approached a commercial website development organisation for a proposal to design, develop and, if required, to host an ITIMS 62. The response was provided to DHS for comment and feedback. The advice received from the Department indicated that the proposal represented an appropriate approach to the design and development of a suitable website. The key features of the proposal are summarised below. Design and Development Design The design involves gathering information provided by the client and storyboarding a site map. From this, up to 2 designs will be created. One design could be for a splash/home landing page and the other could be the layout for all other main pages of the site. This also includes up to 3 reiterations of the designs. Development The site would be built to conform to the World Wide Web Consortium (W3C) web and accessibility standards utilising XHTML & Cascading Style Sheet (CSS) technologies. It would use an online Content Management System (CMS) and provide a fully customisable interface where content can be easily managed, updated and edited by nominated site administrators. This includes the following items: CMS Installation The CMS could be installed on the web and database servers. Template Creation Website designs could be provided as Photoshop PSD files from the designer and sliced into images and HTML. These files, combined with CSS could be integrated in the CMS s templates to create W3C and accessibility standard XHTML. This allows for up to 2 templates. 49

52 Copy Implementation This includes entering all content provided by the client and converting it into XHTML. This could be a combination of text and graphics controlled by CSS and entered into the CMS. Content Pages The website could contain a number of pages outlined in the sitemap as follows: Home/Main Page This page would be designed to be simple, functional and effective in delivering the key information to the user. There would be a Photo Scroller on the page that would scroll with photos of the various new drugs that have been added to the database. The user would be able to click on these and be taken directly to the information relating to that particular drug. There would also be a search area that may be filtered by keywords, category, shape, size, colour and symbol of tablet. There would also be an A-Z link listing to take the user to the specific item or to allow for general browsing. Specific Drug Information Page This page would list all the information related to the drug. It will also offer links to similar drugs based on the previous search criteria entered. About/Prevention/Tips/General Information pages A number of pages would be included to provide information pertaining to the appropriate awareness of each drug, their effects and preventative tips. Further gathering of information would need to be implemented for this to take place. Resources/Links An area of the site would be dedicated to the provision of resources that relate to drugs featured on the site. Also, links to other websites with further information would be presented. Forum/News Feed/Blog Current affairs may be included in the site. The general population may benefit from a news feed related to drugs. A forum for discussion may also be a good way to deal with questions and ideas that have been posted. Online Enquiry Form This would be a standard contact form (fields include Name, Company, Country, , Subject & Message) with up to 5 additional text fields. Tablet Management Area This area of the site would enable a site administrator to add, update and remove information regarding specific items in the web page. The data structure would be standardised so that each page would display in a similar format. This would be split up into the following areas: n Category Management. n Drug Management. n Voice Over (Optional). 50

53 Feasibility Study for an Illicit Tablet Information & Monitoring Service Category Management The drugs would be split up into categories this enables the user seeking information to be able to search by category and also simplifies management, especially if the number of records is high. The administrator would be able to add, edit and remove categories. Drug Management Each individual drug would have a record made up of a number of fields. Rich text would be included in some of these fields to incorporate flexibility in design and layout. This would typically be presented in a WYSIWYG (What You See Is What You Get) editor which would be like editing a Word Document with features such as bold, underline, fonts, colours, images etc. The administrator would be able to add, edit and remove tablets. Voice Over (Optional) Some of the target audience may be illiterate or may have reading difficulties. An optional component could be added where voice over may be included on the tablet information to cover some of the key information. This could be done as an automatic process or each recording could be done individually. Search Engine Optimisation (SEO) Maintenance This includes an assessment of current and additional keywords to see what is most effective to drive customer traffic to the site. A monthly report containing an analysis of the site would be provided. This report would include important information regarding the source of the website hits in an easyto-understand manner. Regular maintenance is highly recommended as it keeps the site alive. Web Hosting This is for the hosting of the website on web and database servers to ensure that they are visible to the outside world. Online Course An online self enrolling course that would raise awareness for audiences such as parents, children, bars, clubs and restaurant owners could be developed and implemented. This can be done and delivered via the CCM Learner Management System called capable. This would be costed separately when advised. Costs The quotation provided by a web development company (and confirmed by the Department of Human Services as being realistic) comprised the following: n Website Design & Development $7,150, (GST inclusive). n Voice-Over Recording $50/hour. n Voice-Over Production $50/hour. n SEO Maintenance $100/month. n Web Hosting $50/month. 51

54 Website Location There are three suggested options for hosting an ITIMS, utilising the design outlined above: n The DHS website. n An existing external website. n ITIMS own website. There are no technical differences between these alternatives, and the functionality of the site (assuming common adoption of the features described above) would essentially be the same. The choice is more about optimising access to the site, and seeking synergies with the subject matter contained in the alternatives. DHS Website Advantages n This option is likely to be the least expensive of the three options, as the ITIMS could be hosted within the existing framework of the DHS website. n The Department would have direct control over the content and formatting of the website. Disadvantages n Hosting the ITIMS on the DHS website has the potential to draw adverse criticism from some sections of the community in the context of being seen as supporting drug use. n The DHS website may not be seen by users of ITIMS as the most obvious or logical location, limiting utilisation of the site. Existing External Website There are a number of existing external websites that could potentially host an ITIMS in Victoria, as described in Section Among these, the website of the Australian Drug Foundation (ADF) appears to be particularly suited to an ITIMS application. ADF has a specific website called the DrugInfo Clearinghouse ( which provides information about alcohol and other drugs, and drug prevention. This information is compatible with the suggestions made about an ITIMS application in the previous section. It should be noted that we have not held discussions with ADF to determine their interest in such a proposal. Advantages n This option is likely to be the second least expensive of the three options, as the ITIMS could be hosted within the existing framework of the ADF website, with a weekly/monthly charge to be negotiated for its maintenance. n The subject matter presented on the DrugInfo Clearinghouse is compatible with the content of an ITIMS, and provides synergies of content and the capacity to cross-reference the information. 52

55 Feasibility Study for an Illicit Tablet Information & Monitoring Service n Given the existing profile of the ADF website, it is more likely to be accessed by users of an ITIMS, enhancing its profile and accessibility. n The underlying philosophy and activities of the ADF are consistent with the provision of an ITIMS, and consequently this approach is less likely to be seen as representing support for illicit drug use. Disadvantages n This option is likely to cost slightly more than housing the ITIMS on the DHS website. n The willingness of ADF to host an ITIMS on its website is uncertain at this time and would require consultation to ascertain its acceptability. ITIMS Own Website The establishment of a unique website for ITIIMS represents the third option considered. The site could be managed by a third party under contract to DHS, and could include ADF or any third party with the appropriate capacity and skills. Advantages n The establishment of a unique website for ITIMS would provide it with an identity of its own, and differentiate it from the other alternatives in terms of its independence. n Once established, the site could be readily identified by users. n The independence of an ITIMS site could distance it from the government, thereby limiting any adverse responses to the site being seen as supporting illicit drug use. Disadvantages n This option is potentially the most expensive of the three alternatives, although this would be subject to tender and contract processes. n The capacity for an independent site to attract the attention of users is uncertain at this stage, and may require some promotion for users to become aware of its availability. This could reasonably be expected to diminish over time. Recommended Approach Of the alternatives considered, hosting ITIMS on an existing website with a similar subject matter and synergy of content (such as the ADF) is the recommended approach. This approach would provide for ITIMS to be located within a broader suite of relevant information, place it in an environment and location that users are more likely to find, and reinforce the harm minimisation message. This approach could be expected to cost approximately $10,000 for the initial design of the website, with annual operating costs of approximately $2,000-$5,000. Assessing feasibility of developing and implementing an ITIMS is complex and involves a range of determinants, some known and some unknown. Feasibility of the recommended approach depends on a range of factors outlined below, including further discussion with: 53

56 n DHS, Police and the Forensic Services Department about the content and accessibility of the ITIMS. n Police regarding processes for the forwarding of seized tablets to the laboratory, and the procedures required to maintain the chain of evidence and access to test results for evidentiary purposes. n Forensic Services Department for their requirements to expand testing capacity to the level required. n A third party web-site provider to assess their willingness to host the ITIMS (or alternatively implement an open tender process for this purpose). n A web-site developer to design and develop the ITIMS (or alternatively implement an open tender process for this purpose). Further consideration would also need to be given to responding to a number of risks and barriers to the establishment of an ITIMS, including: n Balancing diverse community views associated with an ITIMS being regarded as promoting or supporting the use of illicit drugs. n Ensuring that the methods used for collecting tablets for testing comply with the law. n Ensuring safety with regard to the range of substances tested for and reported on. n Ensuring the right balance with pre- and post- test messaging in terms of drug users interpreting the information provided as implying that some tablets are safe. n Preventing drug dealers using ITIMS to legitimate and promote their drugs. n Balancing the costs associated with the collection and testing of tablets which may outweigh the benefits to be derived. n Ensuring Timely information provision given the pace of change in the illicit tablet environment that means information could become outdated very quickly. These issues may not be insurmountable, but require careful consideration and planning, together with careful management and promotion of the ITIMS to ensure that each risk is catered for. 54

57 E ENDNOTES Feasibility Study for an Illicit Tablet Information & Monitoring Service 1 The Victorian Drug & Alcohol Prevention Council succeeded the PDPC in Department of Human Services (2006). Tender Brief for the Preparation of a Feasibility Study for the Development and Implementation of an Illicit Tablet Information and Monitoring System. 3 Nicholas, R., (2006) On-site ecstasy pill testing a consideration of the issues from a policing perspective, Australian Centre for Policing Research, Australia. 4 The Mental Health and Drugs Division of DHS has now responsibility for drugs policy and services. 5 European Monitoring Centre for Drugs and Drug Addiction. (2002). Early-warning system on new synthetic drugs: Guidance on implementation. 6 php 7 Ibid. 8 Horizontal Working Party on Drugs of the Council of the European Union. (2003). Report on the Risk Assessment of 2C-T-2 in the framework of the joint action on new synthetic drugs. Lisbon: HWPD EDRS 11 publications.html 12 iddr2004_05.html 13 NIDIP European Monitoring Centre for Drugs and Drug Addiction. (2002). Early-warning system on new synthetic drugs: Guidance on implementation 17 Alvarez, J., Bello, P-Y., Faasen, I., Feijão, F., Karachaliou, K., Kontogeorgiou, K., Lagerqvist, J., Mickelsson, K., Siamou, I., Simon, R. & Vaissade, L. (2003). Emerging Drug Phenomena: A European Manual on the Early Information Function for Emerging Drug Phenomena. Commission of the European Communities.10 notes.med.unsw.edu.au/ndarcweb.nsf/page/edrs 18, 19, 20 Ibid 21 http;//dawninfo.samhsa.gov 22 IDRSa 23 http;// what_is_bluelight ibid Nicholas, R., (2006) On-site ecstasy pill testing a consideration of the issues from a policing perspective, Australian Centre for Policing Research, Australia html 34 See for example European Monitoring Centre for Drugs and Addiction (2001). An Inventory of On-Site Pill-Testing Interventions in the EU , 37 Ibid 38 Burkhart, G. (2001). On-site pill-testing interventions in the European Union: Executive summary. European Monitoring Centre for Drugs and Drug Addiction. 39 European Monitoring Centre for Drugs and Addiction (2001). An Inventory of On-Site Pill-Testing Interventions in the EU Burkhart, G. (2001). On-site pill-testing interventions in the European Union: Executive summary. European Monitoring Centre for Drugs and Drug Addiction. 42 European Monitoring Centre for Drugs and Addiction (2001). An Inventory of On-Site Pill-Testing Interventions in the EU. 43 Ibid. 44 Burkhart, G. (2001). On-site pill-testing interventions in the European Union: Executive summary. European Monitoring Centre for Drugs and Drug Addiction. 45 Ibid. 46 Kriener, H., Billeth, R., Gollner, C., Lachout, S., Neubauer, P. & Schmidt, R. (2001). An inventory of on-site pilltesting interventions in the European Union. European Monitoring Centre for Drugs and Drug Addiction. 47 Brennan, M., & Davidson, J., (2006) Inquiry into Amphetamines and other synthetic drugs, Enlighten Harm Reduction, Canberra emcdda.europa.eu/html.cfm/index426en. html 49 Johnston, J., Barratt, M., Fry, C., Kinner, S., Stoove, M., Degenhardt, L., George, J., Jenkinson, R., Dunn, M., & Bruno, R., (2006) A survey of regular ecstasy users knowledge and practices around determining pill content and purity: implications for policy and practice, International Journal of Drug Policy, 17, Ibid emcdda.europa.eu/html.cfm/index426en. html 53 Burkhart, G. (2001). On-site pill-testing interventions in the European Union: Executive summary. European Monitoring Centre for Drugs and Drug Addiction 54 European Monitoring Centre for Drugs and Drug Addiction. (2002). Early-warning system on new synthetic drugs: Guidance on implementation. 55 Johnston, J, Laslett, A-M., Miller, P., Jenkinson, R. Fry, C. & Dietze, P. (2004, October). Trialling enhanced drug trend monitoring of Melbourne Psychostimulant Markets. Turning Point Alcohol and Drug Centre, Fitzroy. 56 Brennan, M., & Davidson, J., (2006) Inquiry into Amphetamines and other synthetic drugs, Enlighten Harm Reduction, Canberra. 57 Cited in Nicholas, R., (2006) On-site ecstasy pill testing a consideration of the issues from a policing perspective, Australian Centre for Policing Research, Australia. 58, 59 Ibid. 60 JBrennan, M., & Davidson, J., (2006) Inquiry into Amphetamines and other synthetic drugs, Enlighten Harm Reduction, Canberra. 61 See for example Stewart, S., Evaluability Assessment of Trace Detection Technology at nij/trace-detection-technology.pdf. 62 Correspondence between Wise Orange and Health Outcomes International, February See for example Stewart, S., Evaluability Assessment of Trace Detection Technology at nij/trace-detection-technology.pdf. 55

58 G Glossary 2-CB 4-MTA ADF DAWN DHS DOB DUMA EDP EDRS EIF ERDs GCMS IDDR IDMS ITIMS MBDB MDA MDE MDMA MDOH NIDIP PCP PDPC PIMS PMA A hallucinogenic drug An amphetamine derivative Australian Drug Foundation The Drug Abuse Early Warning Network Victorian Department of Human Services A hallucinogenic drug Drug Use Monitoring in Australia Emerging Drug Phenomena Ecstasy and Related Drugs Reporting System Early Information Function Ecstasy and related drugs Gas chromatography (i.e. a method for analysing and testing drugs) Illicit Drug Data Report Illicit Drug Monitoring System Illicit Tablet Information and Monitoring Service Amphetamine-based hallucinogens (ecstasy) National Illicit Drug Indicators Project A hallucinogenic drug Premier s Drug Prevention Council Portable Ion Mobility Scanners A powerful stimulant 56

59 A Information A Feasibility Study for an Illicit Tablet and Monitoring Service (ITIMS) This interview focuses on key stakeholders needs for and expectations of a Victorian Illicit Tablet Information and Monitoring Service (ITIMS). It will cover areas such as the need for and potential uses of an ITIMS, the range and type of information that should be made available and to whom, potential information sources, concerns regarding cost and resourcing and any suggestions or recommendations that you may have for the proposed service. 1. Do you or your clients/stakeholders currently have unmet information needs regarding illicit tablets that are available in your area of operation? If yes, can you describe those needs? 2. What role or type of services should an ITIMS provide in order to meet your/their needs? 3. How should an ITIMS be made available (i.e. what medium/media)? 4. Who should have access to an ITIMS? 5. Should illicit drug users have access to the ITIMS? 6. What do you perceive to be the different information needs of potential ITIMS user populations? (e.g. tablet content and effects, health warnings, referral information) 7. What should an ITIMS monitor (e.g. tablet content, effects, supply, appearance, availability) 8. How current should the ITIMS information be and how might currency be maintained? 9. Where should the information for an ITIMS be sourced? 10. Should users and/or user groups be consulted as a source of information for the ITIMS? 11. What does your ideal ITIMS model look like? 12. Who should manage the ITIMS? 13. What links should an ITIMS have with other similar drug and alcohol/medical and/or community support services and/or information services? 14. What support/operating resources from the various levels of government or other organisations would be required to set up an ITIMS? 15. What ongoing support would be required to sustain the operations of an ITIMS in the longer term? 16. What are the benefits associated with access to an ITIMS? 17. Can you identify any risks associated with an ITIMS? What barriers to establishing an ITIMS can you envisage? 18. Can you identify any risks associated with the ITIMS not achieving the preferred timing and delivery methods specific to user needs? 19. How could an ITIMS be implemented in a rural setting? 20. Do you currently access any ITIMS information systems that provide information, warnings or alerts on illicit drugs or other dangerous substances etc? If so, what are they and what form do they take (e.g. telephone, internet etc.) 21. Can you describe the aspects of these ITIMS or other information services that work well and that meet your needs as a consumer? 22. How could these services be improved? 23. Are there any types of ITIMS that you would not access? If yes, why would you not access those types of service? 24. Are there any other comments or suggestions that you would like to make with regard to the design, Implementation and operation of an ITIMS? 57

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