Jonathan Woods – Page 2 – Matters of Substance

Drug checking at music festivals

by Warren Michelow

The summer music festival season is full of fun and excitement, but there can be a dark side to the exuberance—people overdosing or suffering negative effects from drugs. Too often, what someone buys as ecstasy turns out to be something else, including chemicals with a history of causing injury or death. Enter drug checking, a quick and simple method for screening drug samples. The technique uses reagents to indicate the presence of target chemicals through changes in colour. While most of these tests don’t determine dose or purity, they do help people know if they are getting what they paid for and can identify contaminants or unwanted substances.

Drug checking using both reagent-based screening and mobile laboratories has been available at European venues since the 1990s. To date, tougher drug control in North America has made it harder to provide drug checking here; nevertheless, several community groups in Canada and USA have offered drug checking at events over the years. For example, ANKORS (AIDS Network Kootenay Outreach and Support Society) in Nelson, BC has provided drug checking at the Shambhala Music Festival for over a decade¹.

Chloe Sage from ANKORS and Warren Michelow, a graduate student associated with CARBC, have just released “Drug checking at music festivals: A how-to guide”, funded by the BC Ministry of Health, that distills knowledge and practices learned from providing drug checking and other harm reduction services at music festivals and events since the early 2000s. The guide is intended to help people in the community and public health groups interested in providing services at events or in other community settings. It describes in practical detail how to set up and run a drug checking service, how it can fit with other health-related services at a festival, and how to do the testing in a legal way.

Drug checking services are accessed by people interested enough in using drugs to already be in possession of a substance they intend to use. Seeking out drug checking demonstrates an interest in health-oriented information about substance use and potential hazards associated with the substance they think they have. Describing the strengths and limitations of results from reagent-based screening and getting confirmation of understanding is a key part of a drug checking encounter (see “Testing Disclaimer” in the Guide for an example). The natural flow of a testing encounter offers a scaffold to engage in conversation about drug-related knowledge and strategies for responsible use and managing risk. Field experience shows that after receiving an unexpected result—especially one that suggested the presence of something known to be harmful, e.g., suspected PMMA—people choose to dispose of that substance rather than take it².

Between 2008 and 2015, the United Nations early warning system received reports of 644 new psychoactive substances with 75 being reported in the first part of 2015 alone³. Sometimes these are sold as exotic new “legal highs”, but often they are misrepresented as more popular and better known drugs such as ecstasy or LSD. Being so new, we know little about the potential for adverse health effects from consuming these substances.

Having capacity to screen for misrepresented substances and known hazardous substances is an essential tool for preventing avoidable harm at festivals and other entertainment venues where substance use takes place. In the absence of any better alternative, rapid presence/absence screening serves a vital public health function.

Download the guide and find related resources at http://michelow.ca/drug-checking-guide/ and http://www.ankorsvolunteer.com/.

¹Warren Michelow, Cheryl Dowden. “Start Small, Take it Easy” Results from the ANKORS Harm Reduction Survey at the 2013 Shambhala Music Festival. Available at http://michelow.ca/r/smf2013rep.

²Chloe Sage. Harm Reduction and Drug Checking: A wrap-around service for festivals. Case Study: Shambhala Music Festival /ANKORS Drug Checking Harm Reduction Service data 2015. Available at http://michelow.ca/r/smf2015dcsum.

³United Nations Office On Drugs and Crime. World Drug Report 2016. (United Nations publication, Sales No. E.16.XI.7). Available at http://www.unodc.org/wdr2016/.

Warren Michelow is a graduate student affiliated with the Centre for Addictions Research of BC. He is currently a Ph.D. candidate in the School of Population and Public Health at UBC and his doctoral research is on simultaneous polysubstance among mainstream substance users. He has received the Frederick Banting and Charles Best Canada Graduate Scholarships Doctoral Award, the Integrated Mentor Program in Addictions Research Training Fellowship and a MITACS ACCELERATE Internship.

I have had the privilege to work with various peer-run organizations of people who use drugs for many years now. As a National Programs Manager at the Canadian AIDS Society (CAS), every harm reduction related project I work on first starts with creating a countrywide steering committee that includes people with lived experience of drug use to guide the project and ensure its relevance. Not having much guidance on how to properly include people with lived experience as part of decision-making, I navigated my way by trial and error. At times, I tripped over my own assumptions and clumsily had to adjust my process on the fly. The people I worked with also shared their experiences about participation in other committees, which had been at times positive, and other times negative or tokenistic. I became intrigued about finding out how to better include people with lived experience on such committees.

I decided to make this subject the focus of my PhD studies, under an amazing supervisory committee, Dr. Bernie Pauly, Dr. Cecilia Benoit and Dr. Budd Hall, and in partnership with the Drug Users Advocacy League (DUAL) in Ottawa, Ontario, and the Society of Living Illicit Drug Users (SOLID) in Victoria, British Columbia.

Now, we are so thrilled to be launching the fruits of our labour, From One Ally to Another: Practice Guidelines to Better Include People who Use Drugs at your Decision-making Tables, as part of the Centre for Addictions Research of BC’s (CARBC) Bulletin series.

Inclusion of individuals and groups marginalized by the stigma against drug use in decision-making structures has emerged as a way to challenge the dominant power structures. The goal is to render decision-making more equitable for groups that have historically been excluded from decisions that affect their lives. The premise is that by including people experiencing marginalization at decision-making tables, power will be shared and shifted from power over to power with people with lived experience. By sitting together around at decision-making tables, the possibility opens up for a shift in consciousness whereby people learn to relate to each other in non-stigmatizing, non-discriminatory ways. Research on the processes and outcomes of such inclusion, however, has been sparse.

Often over coffee with various people who use drugs, we discussed how interesting it would be to better understand the relational dynamics at play at decision-making tables and the factors that either contribute to or hinder the transformation of power inequities. These groups of people who use drugs longed for practice guidelines to hand over to organizations that wanted experiential people at decision-making tables.

Together, DUAL, SOLID and I established a partnership agreement with a shared understanding that the research was ultimately for my PhD pursuits, though we would work together along the way, using a community-based participatory research framework, to advance evidence-based practice guidelines. We developed the research questions and selected four harm reduction committees that DUAL and SOLID were involved in. We developed interview questions to speak to various committee members. I observed committee meetings and collected relevant documents to understand their decision-making processes and how they included people who use drugs at their table. As I compiled preliminary results, I had meetings with DUAL and SOLID to review them and get their feedback. I also presented preliminary results to each of the committees for their input.

Throughout my studies, I continued to work with peer-run organizations of people who use drugs across Canada and assisted the Canadian Association of People who Use Drugs to develop and mobilize. In 2013, they held a national meeting of 14 peer run organizations and produced a report entitled Collective Voices Effecting Change: National Meeting of Peer-run Organizations of People who Use Drugs. As a result of my research, I experienced my own transformation whereby I have learned to shift from a position of leadership to one of facilitation. I assist groups in whatever way I can, following their lead and working with their strengths and aptitudes. Together, we developed another useful resource, Peerology: A guide by and for people who use drugs on how to get involved.

In addition to the summary cited above, my full dissertation, At the Table with People who Use Drugs: Transforming Power Inequities, is now available, should you be interested.

As part of CARBC’s lecture series, I will also be speaking on this topic at the Royal Jubilee Hospital, in the Patient Care Centre, Room S169 (Lecture Theatre), on Friday, June 3^rd, 2016 at 10 am. If we want to be true allies to people who use drugs, let’s make our actions speak louder than our words.

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Lynne Belle-Isle, PhD, is a National Programs Manager with the Canadian AIDS Society and a Research Affiliate at the Centre for Addictions Research of BC, University of Victoria. She recently completed her PhD through the University of Victoria’s Social Dimensions of Health Program.

Author: Jonathan Woods

Avoiding Harm from Misrepresented Drugs

Actions speak louder than words: How to include people who use drugs in decisions that affect them