title: Ecstasy pill testing: harm minimization gone too far?
abstract: Harm reduction has become the focus of public health initiatives and therapeutic intervention in the management of dependent drug use over the last 20 years. The last decade has seen such approaches being extended to recreational drug use. Most harm reduction initiatives have aimed to inform users about risks and ways of minimizing risk. The concept of providing illicit drug users with quality assessment of their chosen drug is one possible harm reduction intervention that until recently has received little attention. In response to well-publicized 'ecstasy'-related deaths organizations in some European countries and the United States have chosen to provide a 'pill testing service' for users. There are two broad categories of pill testing offered. Simple colour reagent test kits (Marquis Reagent and colour charts) form the most widely used on-site pill testing method. Less frequently, but more accurately, laboratory personnel with access to sophisticated chromatographic equipment (high performance liquid chromatography (HPLC) or gas chromatography-mass spectrometry (GC-MS)) may provide analysis of a pill. Pill testing kits have been advocated as a 'tool to protect yourself against the polluted XTC market'. We refute this line of reasoning. Of the different tests only techniques such as GC-MS can identify satisfactorily the psychoactive constituents present in ecstasy pills. Colour tests based on an interpretation of a colour response in the presence of a drug are, at best, subjective. Pill testing of any description does not guarantee safety, or protect the consumer against individual responses to pills. At best it gives an artificial 'shine of safety' to a group of diverse drugs that remain both illicit and potentially harmful. Other simpler harm reduction mechanisms are likely to be more effective.
authors.affiliation: National Addiction Centre, Institute of Psychiatry, Kings College London, UK.
authors.forename: A R
authors.initials: AR
authors.lastname: Winstock
authors.forename: K
authors.initials: K
authors.lastname: Wolff
authors.forename: J
authors.initials: J
authors.lastname: Ramsey
mesh_terms: D002849:Chromatography, Gas; D002851:Chromatography, High Pressure Liquid; D002855:Chromatography, Thin Layer; D004340:Drug Contamination; D006801:Humans; D013287:Illicit Drugs / Q000494:pharmacology; D013058:Mass Spectrometry; D018817:N-Methyl-3,4-methylenedioxyamphetamine / Q000494:pharmacology / Q000592:standards*; D011237:Predictive Value of Tests; D011355:Prodrugs / Q000494:pharmacology / Q000600:supply & distribution; D011786:Quality Control; D011933:Reagent Kits, Diagnostic; D015203:Reproducibility of Results
chemical_list: D013287:Illicit Drugs; D011355:Prodrugs; D011933:Reagent Kits, Diagnostic; D018817:N-Methyl-3,4-methylenedioxyamphetamine