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Summer is around the corner in Australia and with the warmer weather young people will gravitate to music festivals around the country. These gatherings also draw enterprising drug dealers, eager for new customers and cash.

An Australian study found that at a recent major festival, almost 75 percent of patrons interviewed reported using illicit drugs. For this reason these events are coming to be called “drug fests”, which is a shame, considering the musical talent they pull.

Of the 75 percent, almost 60 percent named MDMA as their preferred party drug. Users have nicknamed methylene dioxy methamphetamine “Molly”. Molly, also called Ecstasy, induces feelings of empathy and turns everyone into a brilliant dancer, so she sounds like the perfect friend to take along to a music festival. In reality however, she is a nasty little pill and just a bit psycho. She promises to love you one minute, and tries to kill you the next.

MDMA, you see, damages the heart. Specifically, it affects the left ventricle, which can cause cardiac failure. I regularly nurse cardiac failure patients in Hobart, and most of them are in their 70s and 80s. Many years of living and hard work damage the heart’s contractility and ability to pump blood. Fluid starts to fill the lungs, making breathing difficult. In an acute phase, these patients feel like they’re drowning. They struggle to breathe and need aggressive medical treatment.

Cardiac failure in adolescents

So imagine how shocked I was when I nursed my first cardiac failure patient in their 20s. What caused this patient to have the heart of an 80-year old? Illicit drug-use. Seeing young people with drug-induced cardiomyopathy is a relatively new thing. With Molly being such a popular festival drug, though, it is an emerging health problem. I read a recent case study of a 18-year old woman presenting after MDMA use. She was in cardiac failure, suffering permanent, irreversible damage to her heart, which will not last nearly as long as it should. Her time to achieve her life dreams and adventures is now drastically limited.

Music festival dealers sell drugs made in clandestine labs. Analyses have revealed many strange additives. Some are mixed with concrete powder, industrial cleaners, and rat poison. Worse, some pills contain three to five times the regular dose of MDMA.  

Before the 2018 Falls Festival at Marion Bay, as parents helped load swags and duffle bags into car boots and waved off their kids, a text went out to festival-goers:

“SERIOUS DRUG ALERT: There is an extremely dangerous orange pill in circulation. Regardless of pill variation, one pill can kill. Seek medical help if you feel unwell.”

This raises serious questions. How did the medical team know about this particular drug? Is there a private “dangerous drugs” database? Shouldn’t the general public be made aware? What about the parents waving off their kids – shouldn’t they know?

‘A safe party drug doesn’t exist’

As every festival season rolls around the subject of pill testing comes up. We debate the pros and cons with very little real data. We now know more about the damage MDMA does to the heart, but it also has a potentially catastrophic effect on mental health.

Molly causes the excessive release of serotonin, “the happy hormone,” in the brain. This is what gives users the mood-elevating effects, but it leaves the brain significantly depleted of serotonin, resulting in negative psychological effects that lasts for days. Basically, it leaves you depressed. We need to look closely at youth suicide rates linked to MDMA use, particularly, in the period after big multi-day music festivals. There is much more research to be done about this.

In bioethics we weigh up beneficence and non-maleficence. We want to benefit people, or at least “do no harm”. Pill testing is a harm reduction strategy, premised on the belief that, “Kids will do drugs anyway, so let’s help them do drugs in a safer way.”

The Drugs and Information Monitoring System (DIMS) in the Netherlands is commonly regarded as the world’s best drug early warning system. It is operated by the Trimbos Institute, whose Dr Daan van der Guow told the ABC last summer that festival drug testing is “not really a bad thing”. But he also pointed out that “a safe drug doesn’t exist”. He went on to say that, like the DIMS-model of drug-checking, the model being proposed in Australia, will not entirely prevent deaths.

Over two years of trials in the UK some 2000 pills have been tested. About eight in ten festival-goers were getting the drug they expected. About one in ten chose to bin their pills.

Andrew Leibie, a scientist at Safework Laboratories, criticises the program, noting that on-site drug testing is technologically limited and cannot detect new designer drugs such as N-Bomb, linked to three deaths in Melbourne. It also does not test for concentration and high doses of Methamphetamine, which can be fatal on its own.

Harm reduction fosters a dangerous sense of safety

In terms of non-maleficence (do no harm), this seemingly good idea of warning young people about potentially lethal drugs in circulation can have the unintended consequence of facilitating a dangerous sense of safety with their drug usage.

One festival-goer may have a drug tested while their friends, having purchased the same drug, await the result. The punter is told that the drug is MDMA, which is what they wanted. They and their friends now trust the dealer from whom they purchased the pills, and feel safe with their product. The product is never safe, however, and the next batch from the same “trusted dealer” may be fatal.

In any case, who is counselling the punters, explaining the serious, permanent damage that MDMA will do to their heart?

In August 2016 the Senate passed a motion calling for the introduction of evidence-based harm reduction policies to counter-act the harmful drug use at festivals. We all want to reduce harm to young people; that is a no-brainer. But pill testing is not without harm, and illicit drug-taking is not abating. Given that drugs are now up to five times more potent – and potentially lethal – than in the 1990s, and up to three-quarters of festival-goers use illicit drugs, we are facing a catastrophic future public health problem.

Why not behaviour change?

When smoking was found to cause lung and other cancers, as well as heart disease and stroke, we did not invest heavily in harm-reduction strategies. Smoking was and is a huge burden on our health system and budget. It has taken serious targeted and consistent health promotion strategies to address this. Health departments produce educational material and use media and school-based Health education to inform people that smoking causes disease.

Many highly successful health education campaigns in this country have aimed at changing behaviour. Fewer people now die of smoking. Campaigns like ‘Slip, Slop, Slap’ have reduced the incidence of skin cancers in young adults. Education has reduced road injuries and deaths, gun deaths, and the prevalence of HIV and AIDS. This success over the last twenty years is due to strategic public health campaigns.

The growing problem of illicit drug use extends beyond music festivals. It may be the first contact many young people have with dealers, but often it is not the last. Given the right advice, our young people are capable of making good decisions. Targeting behaviour through health promotion campaigns, not pill-testing, is the solution to this growing problem.

We want to protect the lives of our young people and reduce harm. Let’s get to work on a strategic health promotion plan to keep our young people safe and healthy. While I can’t support pill-testing, sitting back is not an option.

Amanda-Sue Markham is a registered nurse, a two times Federal Liberal candidate and the mother of four grown children. She lives in Hobart, Tasmania, with her husband of 25 years, Rev Campbell Markham.

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Amanda-Sue Markham is a Registered Nurse, two times Federal Liberal candidate and proud mother of four grown children. She and Rev. Campbell Markham have been married for 25 years.