This study investigated the prevalence of illicit drug use among young people attending a large Australian music festival, their attitudes towards on-site drug checking and the potential impact on-site drug checking would have on drug taking behaviour. Consistent with previous research in Australia and internationally [3, 5, 6, 27], the results demonstrate high levels of illicit drug use among this sample of festival attendees, with the rate of illicit drug use being almost three times higher (73.4 vs 28.2%) among festival attendees than in the young adult Australian population (20- to 29-year-olds) [1].Of particular note are the differences in the prevalence of cannabis (63.9 vs 22.1%), ecstasy (59.8 vs 7.0%) and cocaine (34.1 vs 6.9%) in the current study compared to the Australian general population [1]. A Danish study also reported high drug use among festival patrons. Illicit drug use was higher than that found in our study, with 92.8% having used cannabis in the past year, 66.7% having used MDMA and 51.2% having used cocaine in the past year [28].

The majority of study participants were in support of on-site drug checking being available (both free and at cost, 86.2 and 67.5%, respectively) and believed that it would help users seek help to reduce harm (84.9%). Free drug checking services were preferred to those at cost, especially among women. While these findings may suggest that charging drug users for drug checking services would be a barrier to access, a recent study into drug service utilisation demonstrated that two thirds of respondents were willing to pay up to $10 for a festival or nightlife drug checking service and almost all were willing to pay up to $5 [29].

Two thirds of participants believed that drug dealers may use the service as a ‘quality control mechanism’. Participants could have interpreted this in two ways. First, dealers could use the service to ensure that their product does not include unintended substances. Second, dealers could use it to promote their product as having a higher amount of a drug and thus being of better quality. Therefore, it is not clear from our survey if this is of concern to the population surveyed; however, it has been identified as an issue elsewhere. In the USA, this is a significant concern and is overcome by organisations providing drug checking services displaying the results of their tests as ratios, rather than quantitative amounts [22]. Due to the amount of unmeasured and undetectable substances in a drug, ratios cannot be linked to quantitative amounts [22]. This allows drug users to be informed about the possible unintended substances in their drugs but not about the quality. Similarly, across many countries in Europe, procedures have been implemented at drug checking services to ensure pills presented by obvious drug dealers are not being analysed, with the identification of drug dealers presumably being based on multiple presentations and high volumes of drugs to be tested [12].

Over a third of drug users in the sample had never attempted to find out about the content and purity of their drugs. A number of reasons were cited for responders not seeking further information, the most common being limited access and knowledge regarding availability of drug checking services. Among the two thirds of people who had attempted to find out about the content and purity of their drugs, only a limited number (5.7%) had used a personal drug testing kit. This highlights the need for further education among drug users regarding the benefits and limitations of reagent drug checking. When asked what methods participants had used to attempt to find out about the content and purity of illicit drugs, 78.6% had used friends, 36.2% had used dealers and 35.8% had used websites. On the contrary, Barratt and colleagues [29] found that 75% of Australian festival and nightlife attendees who had completed a web-based survey had used friends, 63% had used dealers and 53% had used websites.

The vast majority of respondents stated they were somewhat or highly likely to use a drug checking service at a festival (87.1%). This is consistent with recent research [29]. Barratt et al. [29] found that 94% of people would use drug checking service located at festivals or clubs. This supports the theory that drug checking services would potentially be utilised at festivals if offered. However, Barratt and colleagues also found that that 94% would not utilise the service if there was a chance of being arrested and two out of three also would not use the service if they would not be provided with individual results.

This study suggests a proportion of drug users would alter their drug taking behaviour if drug checking revealed certain unexpected or undesired substances in their products. This is consistent with previous work in the area, such as a review of the Austrian CheckIt! Program which indicated that, after testing revealed an unexpected substance, two thirds of people would not take their drug and would go on to warn their friends [17]. An Australian study also found that three quarters of regular ecstasy users reported that they would not take a pill found to contain ‘unknown substances’ [30]. The evidence thus suggests that the outcomes of drug checking has the potential to change drug use behaviour and therefore may reduce harm among this group. However, a number of participants in our study reported that they ‘did not know’ if they would still take a drug upon learning of unintended contents in their product (12.6–38.9% depending on the substance). This finding highlights the need for continued education in this area of public health and the opportunity created through the provision of drug checking services. This is evidenced by the CheckIt! Program demonstrating higher levels of engagement in education opportunities when concurrent chemical drug analysis was being performed [17]. Indeed, Hungerbuehler and colleagues [3] also concluded in their study among drug checking services users in Switzerland that drug checking in combination with a consultation were a vital harm reduction and prevention tool that reached a high-risk group of people who used high doses of drugs frequently and polydrug users. Importantly, the authors also acknowledged that different prevention measures need to be tailored to local situations and different target groups.

Research has identified that current drug checking kits are subjective and difficult to interpret [21], thus providing a precedent for testing being performed by a trained team member, who is well versed in explaining the results. However, the risk of reagent tests not detecting harmful substances remains.

Further research in this area include the feasibility and practicality of using laboratory-grade testing equipment on-site compared to reagent testing. Longitudinal research investigating the long-term effects of drug checking could also help to highlight the potential benefits and risks from the health intervention and education that a drug checking service offers.