Those calling for pill-testing and other harm minimisation say young people are dying while the debate becomes more polarised

'We're dealing with a black market': is taking pills becoming more dangerous?

In 2001 the emergency doctor David Caldicott tried and failed to save the life of a man who had taken an ecstasy pill containing the so-called “Dr Death” adulterant, para-Methoxyamphetamine.

Known as PMA, the substance surfaces only intermittently in Australia. In 2007, for example, 20-year-old Annabel Catt died after taking two MDMA caps at the Good Vibrations festival in Sydney. Later tests showed they contained PMA.

• Sign up to receive the top stories from Guardian Australia every morning

The 2001 death affected Caldicott so much that, 18 years later, he is one of the chief advocates pushing for state governments to allow pill-testing at music festivals.

But a string of recent deaths have left Caldicott and other public health experts grappling with the question of whether the substances themselves are becoming more dangerous.

I was at a conference in Vienna two years ago where they were talking about the 750th new drug. The market has exploded David Caldicott

“There are definitely elements about the drug market that have changed in the last decade or two that have made it more hazardous,” Caldicott told Guardian Australia.

“In the early 2000s we were concerned about maybe a dozen to 20 products, PMA among them. I was at a conference in Vienna two years ago where they were talking about the 750th new drug. The market has exploded, and the turnaround of new products is such that even major drug geeks like me find it hard to keep track of.

“Ten years ago the cycle for new products was in years, now there is something new that irritates and scares me probably on a fortnightly basis, at least globally. And such is the nature of the market that if it’s in the Czech Republic in October it’ll be here by Christmas.”

Since the middle of September, five people have died from suspected drug overdoses at music festivals in New South Wales.

Defqon.1 deaths: sniffer dogs don't deter revellers from drug use, researchers find Read more

Alex Ross-King, 19, became the latest after she was transported from the Fomo festival at Parramatta Park to Westmead hospital on Saturday night.

It followed the deaths of Joseph Pham, 23, and Diana Nguyen, 21, who attended the Defqon.1 festival in Penrith on 15 September. Nineteen-year-old Callum Brosnan died at the Knockout Games of Destiny at Sydney Olympic Park on 8 December and Josh Tam, 22, at the Lost Paradise festival on the central coast on 29 December.

There’s no evidence PMA was linked to any of the deaths but experts say that’s part of the problem.

“No one would know what’s in these pills,” said Dr Alex Wodak, the president of the Australian Drug Law Reform Foundation. “It’s absolutely a potluck. Some might be dying from high doses of MDMA, some might be dying from contamination in the MDMA.

“Nobody monitors what’s available and there is no way of monitoring it. We’re dealing with a black market, and one of the consequences of that is we don’t really know what’s going on.”

A small step to rectifying that information gap was made on Tuesday, when the NSW coroner’s office announced it would conduct hearings into the five recent music festival deaths.

Slated for next week, the directions hearing could pave the way for an inquest to examine how similar deaths can be prevented.

But the factors that contribute to drug deaths at festivals are many and complicated.

Prof Alison Ritter, a public health academic from the University of New South Wales, said evidence showed “intensive policing” at music festivals could also contribute to the risk of drug-related deaths.

What tends to happen is that when people see the dogs, they consume the drugs before entering Alison Ritter

In 2006, for example, a NSW ombudsman report into the use of sniffer dogs found they could lead users to engage in “more risky and dangerous drug-taking practices in order to avoid detection”.

Ritter told Guardian Australia: “In NSW sniffer dogs actually have the potential to cause harm, because what tends to happen is that when people see the dogs, they consume the drugs before entering.”

That’s exactly what happened in 2013, when 23-year-old James Munro died at Defqon.1. While waiting in line to enter the festival Munro ingested three pills he believed to be ecstasy while waiting in line because of the police presence at the gate.

“He had some ecstasy tablets with him [and he] decided to take them before entering Defqon,” his father Stephen told the ABC in 2013. “There was a police presence at the gates and a concern he would be detected.”

Ritter also pointed to research from a 2016 pill-testing pilot in the UK, which showed that intensive policing led to festival-goers purchasing drugs on site, where they were nearly twice as likely to be found to be dangerous.

Overwhelming majority of voters support pill-testing – Guardian Essential poll Read more

The study, by Fiona Measham from the University of Durham, found intensive policing combined with on-site dealing “could significantly increase drug-related harm”.

Ritter agreed with Caldicott that there had been an “explosion” in new types of substances with the potential to increase the risk of drug use. Chemistry capabilities once reserved for large pharmaceutical companies are now widely accessible, and the internet has made access to a wider variety of products simpler.

“The whole dynamic of the drug market has changed,” Ritter said. “There are more substances, more dangerous substances, and easier access through the internet. It’s certainly a more risky environment.”

The most obvious solution, according to experts who spoke to Guardian Australia, is pill-testing.

Both the NSW and Victorian governments remain resistant to introducing pill testing.

This week the NSW premier, Gladys Berejiklian, said pill testing could give people at festivals “a false sense of security”, and advised young people not to do drugs.

“We are concerned by the unintended consequences of pill-testing,” she told Nine’s Today Show on Monday.

The premier said young people needed to be better educated and told it was OK to seek medical attention if something was wrong.

“The message to young people is do not take these tablets.”

Caldicott led Australia’s first ever pill-testing trial at the Groovin’ the Moo festival in Canberra last year.

A total of 85 substances were tested. One pill returned traces of the highly toxic chemical N-Ethylpentylone, responsible for a number of overdoses around the world.

When young people hear politicians talk about drugs in a way they don’t think is reasonable, they’re less likely to listen David Caldicott

Caldicott sayd Australia has entered “an evidence-free zone” on drug policy.

“This issue of pill-testing is climate change for drugs,” he said.

“Young people understand climate change and they understand the consequences. So when politicians wave coal in parliament, young people think they’re knobs.

“Similarly when young people hear politicians talk about drugs in a way they don’t think is reasonable, they’re less likely to listen. In the last 20 years in Australia all nuance associated with drug policy has left the field, so the only message that’s palatable and acceptable is don’t use drugs.

“That’s just not an acceptable message to someone at a hardcore festival who has drugs in their possession and has every intention of taking them. We need a more nuanced message than that.”