What is pill testing and how does it work?

From detecting a deadly synthetic opioid circulating in the community to the Australian-first discovery of a mysterious new drug similar to ketamine, the opening of Australia’s first government-backed pill testing facility in Canberra, called CanTEST, represented a major turning point in the nation’s stance on drugs.

Not everyone is convinced the initiative is an appropriate response to address illicit drug use though, with some states and territories finding the concept hard to swallow. So what evidence is there to show pill testing reduces harms for drug users? What can you expect when you use these types of services? And should they be rolled out across Australia?  

What is pill testing? 

Pill testing, also known as drug checking, is a free and confidential service that allows people to drop by and test their drugs on-site to find out what’s actually in them.

The Australian Capital Territory (ACT) government has an agreement with the territory’s police meaning anyone can get their drugs tested without fear of being arrested upon entering or leaving the building.

After a participant enters the facility they are asked to sign a legal waiver before the tests begin. The client is not asked for ID and any information collected remains confidential. Participants store their mobile phone in a locker to ensure the privacy of others in the facility.

The Canberra clinic is capable of testing pills, capsules, powders, crystals and liquids, and only a small scraping or sample is needed for testing. It can take as little as 20 minutes to receive the results, depending on the type of substance and the testing method used.

Although CanTEST is a pill testing service, it is not exclusively for drug users. The clinic also offers consultations with a nurse to discuss alcohol, general health, sexual health and mental health concerns.   

How does it work? 

The analytical testing of the drugs – which is carried out by chemists from The Australian National University (ANU) employed by the service – doesn’t just test for drug purity, it also checks whether there are any unexpected and nasty drug components present. The on-site chemists use sophisticated machinery to cross-check the chemical ‘fingerprint’ of a substance against a database containing about 30,000 known drug compounds to try and find a match.

Once the tests are complete, a harm reduction worker explains to the client what substances have been detected in the drugs, which may contain potentially dangerous contents that the user wasn’t expecting. The client is then informed of any health risks from taking the drugs, and how the chemical compounds inside the drugs may react with one another.

The user then has a choice: they can decide to take their drugs as intended or they can choose to dispose of them in amnesty bins located inside the facility.  

What is being found in the drugs tested?  

CanTEST has analysed more than 1,800 samples since opening in July 2022. Many of the so-called ‘usual suspects’ have been detected, including cocaine, heroin, ketamine, MDMA and methamphetamine, also known as crystal meth or ‘ice’. But early results from the service provided some surprising findings.

Forty per cent of samples submitted for testing that were believed to be cocaine actually contained no cocaine at all. Another sample, which was thought to be methamphetamine, turned out to be sugar.

The clinic also tests for fentanyl, an extremely dangerous yet increasingly popular drug that is linked to fatal overdoses. As of December 2022, the clinic had tested 70 substances for traces of fentanyl, but none of them contained the deadly drug.

“The fact that fentanyl derivatives were not present in any of the samples tested is very good news for Australia, given these dangerous and potent synthetic opiates have ravaged North America,” David Caldicott, an Associate Professor at ANU and one of the architects of CanTEST, says.  

What happens if something nasty is detected in my pills? 

While the majority of drugs tested have been confirmed to be what the client thought they were, in some instances analysts have been caught by surprise. Earlier this year CanTEST issued its first public health alert after chemists detected metonitazene in a substance brought in for testing.

Metonitazene, which has also been found circulating in Victoria and New South Wales, is a deadly synthetic opioid that can be up to 200 times more potent than morphine. It was found in yellow pills that were falsely sold as oxycodone, also known as ‘oxy’ tablets.

The on-site chemists alerted the client that the tablet did not contain oxycodone but three unknown substances, prompting the participant to dispose of the drug. Later lab analysis identified the presence of metonitazene.

It was hailed as a life-saving discovery.

Caldicott, who is also an emergency doctor at the Calvary Hospital and Clinical Lead at Pill Testing Australia, says it’s further evidence of why pill testing is an effective and necessary resource to help reduce drug-related overdoses.

“The whole point of drug checking, or pill testing, is to prevent such tragedies and provide an evidence-based alternative to the potential consumer of the drug, as happened here,” he says. “We know there’s a place for pill testing in Australia; this provides another line of evidence to support the argument for it to be implemented in all states and territories.”  

Does a service like this encourage more people to take drugs? 

Although the ACT broke new ground in 2022 after becoming the first Australian jurisdiction to offer pill testing, the practice has been around for a long time overseas. Pill testing was first introduced in the 1990s in the Netherlands and has been rolled out with much success across many other European countries, as well as New Zealand and Canada.

Despite other countries embracing pill testing, it continues to face staunch opposition closer to home. But Caldicott says the idea that Australia will ever be drug-free is “magical thinking”. Instead of trying to stamp out illicit drug use altogether, he argues authorities should see pill testing as a pragmatic response to the reality that people will continue to take drugs.

“We would never support drug taking and that is made very clear from the moment a client enters the CanTEST facility. Doing drugs is not safe and there are serious risks. But the reality is we know people will continue to take drugs. We want to make sure they have the information they need to make an informed decision about their health,” Caldicott says.

“The benefit of a service such as CanTEST is that we are engaging with a new generation of young consumers, and for some that includes influencing their drug behaviour if they decide not to consume the drugs that they had volunteered to be tested.

“For others, they may choose to use their drugs in a way that makes them less likely to be harmed. Services such as pill testing reduce the risk of people overdosing on both unexpected and high potency substances, as well as reducing illness and death.”

Caldicott says in addition to reducing harms for users, pill testing provides valuable information about the types of illicit drugs circulating in the community, which can be useful for authorities to get a better idea of the local drug market. 

Is there evidence showing pill testing has a positive impact? 

A recent ANU-led evaluation into the first three months of CanTEST’s operations found almost one- in-five people disposed of their drugs on-site after they found out what was in them.

The report also found about two-thirds of people who used the service had never discussed or sought advice about their drug use with a health professional before visiting CanTEST. Another two-in-three had never tested drugs before in Australia. These findings show that pill testing can help change people’s minds when deciding to consume illegal drugs or not.

Public satisfaction with the service is also strong. The evaluation found 95 per cent of clients rated CanTEST 10 out of 10. Ninety-eight per cent of participants said they would recommend CanTEST to others, while 84 per cent reported they would use the service again. 

Why isn’t pill testing available everywhere in Australia? 

Although pill testing has been well-received by the Canberra community, Caldicott says it continues to face an uphill battle in Australia with some critics asserting the practice does more harm than good. However, the Canberra trial has clearly made an impression, with Queensland recently announcing plans to become the second Australian jurisdiction to offer pill testing.

“I suspect that some of the opposition is not against pill testing itself – it’s very hard to argue against it now – but instead what it does to the conversation around drugs in Australia,” Caldicott says.

“Previously, it’s been easier to opt out entirely from a difficult conversation that Australia needs to have, namely about how to ‘deal with drugs’. Pill testing has brought that conversation to the dinner table and injected science and medicine into the debate, where before politics and ideologies held sway. And for the loved ones of young people, that’s a move in the right direction.”

Whether or not pill testing will be provided in all states and territories remains to be seen. But it’s clear that pill testing is making positive waves in Australia and won’t come crashing to a halt anytime soon.

CanTEST is a collaboration between Directions Health Services, CAMHA, Pill Testing Australia and ACT Health, with chemical analysis and advice provided by scientists from ANU. The service is open every Thursday and Friday and is located inside the City Community Health Centre on 1 Moore Street in Canberra’s CBD.

You can learn more about CanTEST at the Directions Health website.