We Can Lecture Kids About Bad Decisions, But Only If We Keep Them Alive
Why do young people take drugs, despite the risk to their health?
If you have been following the recent debate around pill testing, you could be forgiven for thinking that the main motivation for substance use was an elaborate quest for self-harm.
“No pill is safe” is the catch-cry of NSW Premier Gladys Berejiklian and many pill testing critics -- but that’s simply not the case. The vast majority of people who use drugs do so without developing any dependencies or serious problems.
Ignoring the true motivations for why young people take drugs at festivals, and the causes of health-related risks, have caused a lot of unnecessary confusion in this debate.
Why Take Pills At Festivals?
Most pills contain the active component MDMA -- a drug which brings about feelings of energy, pleasure and emotional warmth. It’s this pro-social ‘high’ which motivates young people to take drugs at festivals, in a vibrant music environment with their friends.
Pleasure is the primary motivation for substance users, despite the drugs’ illegality. It’s also why a prohibitionist approach of ‘just say no’ is incredibly naïve.
If you have had nothing but positive experiences with a drug and so have your peers, it’s very unlikely that an abstract ‘risk’ is going to motivate you to stop using. Indeed, the rate of MDMA use has remained steady for over a decade despite widespread fear campaigns over the inherent harmfulness of pills.
From a pleasure-seeking perspective, the decision by young people to consume drugs is not some risky thoughtless act but a calculated decision to pursue an enjoyable experience, even though it’s illegal.
Most adults make similar judgments when they consume above the recommended number of standard drinks in a wine-fuelled evening or sneak an occasional cigarette to relax, if you set aside illegality and compare the two behaviours in terms of willingness to take health risks.
There are two sources of risk from pills at festivals: those caused by MDMA itself and those caused by impurities (or ‘adulterants’) in the pill.
The main direct risk of MDMA is heatstroke, particularly during very hot summers or in a confined environment. Paradoxically, there have also been deaths resulting from consuming too much fluid to counteract overheating. There are also risks in taking MDMA for people who have heart problems or are taking medication that can adversely interact with the drug.
Nevertheless, the risks of MDMA pale in comparison to those associated with some impurities that have been detected in festival pills, many of which are synthetic substances designed to mimic MDMA but have much higher risk profiles.
In particular, PMA/PMAA adulterants have been linked to a string of pill related deaths in Canada, the UK and Australia. Moreover, concerns have been raised by new psychoactive substances whose effects are largely unknown.
Clearly taking any drug comes with health risks, but the dangers posed by impurities raise quite serious concerns that require a targeted health intervention.
Harms associated with pills at festivals can be effectively reduced with peer education on the risks and strategies to reduce harm.
Pill testing as a harm reduction intervention operates throughout Europe and the United States. It has been shown to result in better decision-making by substance users, reduced drug related harms and cleaner drug markets.
Australian surveys of festival attendees have found that a majority of substance users would use pill testing services and that the result of such testing would likely change their drug taking habits.
Humans are pleasure seeking animals and are willing to accept certain risks in their hedonistic pursuits, even if it means breaking the law. We need to think practically about the likely choices that are going to be made by young people and how we can effectively reduce risks of harm.
Recognising the reality of drug taking is the only way forward, even if we think better decisions should be made. As many a drug policy expert has said over the last week: we can lecture young people about their poor decisions, after we’ve kept them alive.