New study on drug checking: Trend warnings and alerts

The new study from RMIT University analyses how other countries' drug checking services use and share data, as a way of helping Australia's policymakers decide what to do with ours.

Drug policy expert and author, Associate Professor Monica Barratt said beyond directly informing people about the contents of their drugs, there's a growing need to share trend data and warnings with the public.

"Drug checking services help people make more informed and careful decisions about drugs. We know that the data they produce has this effect not just for service users, but also for others in the community," Barratt said.

Barratt and RMIT Research Officer Isabelle Volpe spoke with people who use drugs, community organisations, policymakers and prospective drug checking service users to gauge how this information could be used.

The researchers say there was strong preference for making drug checking data public, and that the benefits of publishing this information outweigh the risks.

"By monitoring local drug trends -- like when cocaine was spiked with nitazenes in Melbourne last year -- and informing the public and support organisations as rapidly as possible, many more people can be warned to steer clear of highly dangerous substances," Barratt said.

"However, sharing this data could also increase the risk of the information being used to stigmatise drug use or increase locality-based surveillance by law enforcement.

"Despite this, community members and experts we spoke to mostly supported open access to drug checking data."

Choosing what data to share

Currently, Australian services and government departments most commonly share information about 'high-risk' findings in the form of alerts or notices. Services also share periodic reports about their findings.

However, study participants were strongly in favour of sharing more comprehensive and interactive results with the public.

Individual results are published in Canada, the United States, Switzerland, New Zealand, Italy and Germany. Results are often deidentified with a sample code which individuals can use to find their results and sometimes searchable by categories like location, drug type and unusual substances.

Many services seek to share this information in engaging and digestible ways. This includes through data dashboards, such as British Columbia's DrugSense dashboard and Massachusetts' StreetCheck platform. Drug checking services in Canada, the US, New Zealand and Spain also host interactive visualisations that share drug checking results.

While these global examples will be helpful in designing a Victorian system, the study noted variety in the kinds of data and information shared.

Most study participants preferred all individual findings be shared, as opposed to just those which identified unusual, unexpected or high-strength substances. This allows for informed research, treatment, advocacy and policy about how to respond to current trends. It also empowers individuals who may use drugs to better understand the risks.

However, one major concern was how law enforcement might use the data for purposes that may undermine health-based responses.

"Police can benefit from understanding drug market trends, but drug checking data should not be used in ways that undermine the harm reduction approach or that undermine community trust in the service itself," Barratt said.

"While drug checking services are anonymous in Australia, and therefore do not collect identifying information, some information -- like general location of purchase -- is useful for targeting warnings to community, but may also risk further stigmatisation or surveillance."

Moving beyond 'drug alerts'

Drug alerts are typically issued when a drug checking service detects unusual, unexpected or high-strength substances in samples submitted for testing. They are also issued in Australia following signals from other monitoring systems, like emergency department cases where blood tests detect unexpected substances.

The report found some health workers and community members expressed concerns about 'alert fatigue', nuance being lost and that people might become desensitised to drug checking information. It is also difficult for organisations to ascertain whether a substance or trend is alert-worthy or if it is, when it stops being alert-worthy.

However, the researchers concluded that single substance and trend alerts could be effectively combined with publishing individual results. This approach would be particularly useful for first-time detections in Australia, high strength, unexpected substances, or dangerous combinations.

A conservative approach would be similar to the UK and Spain, which tend to publish 15 or fewer alerts per year, or the Netherland's Red Alert, which only releases a couple of alerts each year. This contrasts with nations like Switzerland, which has a three-tier warning system and published 307 to 702 alerts per year in the same reporting period.

Isabelle Volpe, who researches drug alerts at RMIT, highlighted that sharing drug information rapidly is vital so people can heed warnings.

"Alerts should not be taken for granted as the best way to share what drug checking services find," Volpe said.

"The last thing we'd want is for people to tune out, or to inadvertently end up fear-mongering. If alerts are used, they should be used sparingly."

The researchers highlighted that information sharing could take any form of communication, depending on the audience and purpose.

"You need different strategies to get to different audiences. At festivals, for example, you might use posters in portaloos and even festival app notifications. But community networks and outreach workers are going to be crucial for reaching people sleeping rough, for example."

"Ultimately, we found working closely with local communities to ensure alerts are fit-for-purpose in local legal and cultural contexts is vital."

Drug checking in Victoria

Victoria has funded a drug checking trial over an 18-month period, putting it in a strong position to be a national and regional leader in drug checking services.

"We believe Victoria could lead Australia in how trends identified by drug checking services are shared, reaching far beyond the people who use these services to positively affect the millions of Victorians, and Australians, who use drugs, and those who serve them," Barratt said.

About the report

The project was funded by RMIT and conducted in partnership with Harm Reduction Victoria, Students for Sensible Drug Policy and the Victorian Alcohol and Drug Association. Both authors also work and/or volunteer with the drug checking service provider, The Loop Australia.

This report is an independent RMIT-led publication.