We Asked an Emergency Room Doctor Whether There's a Safe Way to Take Drugs

Submit a question to our panel talk about the ethics of getting high in Sydney on August 3. In partnership with The Ethics Centre.

Next Wednesday, VICE is hosting a panel discussion with the Ethics Centre to ask the question, what are the ethics of getting high? Obviously, there are a lot of things to cover. Should you take drugs if you're an asshole when you're coming down? Can you really consent to sex, or anything sexual, when you're high?

There was one topic that stuck out for me though, and that's whether drug use can be safe. Sure, there are really dangerous ways of doing drugs, but are there ways of making consumption safer?

I decided I needed to ask an expert: Dr David Caldicott, who is an emergency room doctor from Canberra. After seeing too many young people admitted to his ER with overdoses, Caldicott has become one of Australia's leading advocates for safer drug use. I called David up after one of his shifts, and thankfully he pulled over his moped to have a chat with me.

VICE: Hey David, thanks for taking time off saving people's lives to talk to me. I really have just one question for you. That is, can drugs ever be safe?
Dr David Caldicott: I guess it depends on what you mean. To put it in context, hundreds of years ago there was a scientist, who we often call the "Father of Toxicology," called Paracelsus. He was the first person to ever say, "The dose makes the poison."

I think it is possible that everything can be deadly. So, if I was feeling malicious towards you, if I hadn't taken my sacred vow of the Hippocratic oath, it would be quite easy for me to kill you with air, to kill you with water, or to kill you with any number of things that are, in moderation, essential for life.

Please don't.
Well the converse is also true. In fact, in the United Kingdom they still have something called diamorphine. It's still prescribed for pain. Would you care to hazard a guess what that is?

Is it like Panadol, or something?
No, it's heroin. What we're seeing, for example in the United States, are some clinical trials that are emerging using 75 milligrams as a dose of MDMA or ecstasy for the treatment of post-traumatic stress disorder (PTSD). So, in fact, when you have controlled circumstances and when you have appropriate selection of the consumer, it is possible to prescribe many of the products that we regard, at the moment, as illegal, and do so safely.

So that's part of the answer to your question. But I guess the drive of your question, what you're talking about, are unknown pills of unknown purity, of unknown composition, in patients who we know nothing about—are they safe? And on top of that, we have no idea what other medications people are on. Or, indeed, their past psychiatric history. You're asking if doing that is safe.

Yeah when you put it like that, it's just kind of rolling the dice.
I guess the reason you're rolling the dice is that we have created a market that, I personally think, is even more dangerous than the drugs themselves. So the way in which illicit substances are sold is more dangerous now than it was a decade ago.

WATCH: VICE Asks: What Are the Ethics of Getting High?

What do you mean it's become more dangerous?
Well, you might be aware that a decade ago people like myself were actually conducting pill testing in South Australia. Maybe more like 15 years ago. We were really most worried about contamination. There were probably no more than 10 drugs that could do you any significant harm. In that time, what we've seen is the emergence of what we call NSPs, or "novel psychotropic substances."

So what changed, why did we see all of these new drugs—I'm assuming you're talking about synthetics—why did they come onto the market?
That market has emerged directly as a consequence of prohibition. It has resulted in now over 500 new and novel substances, the vast majority of which we have no idea about what they do to human beings. This makes it a far more dangerous environment for young consumers than it was in the early 2000s.

So you advocate for pill testing kits at music festivals?
No, let's be quite clear: I don't advocate for pill testing kits. I advocate for pill testing, or drug checking, depending on what you want to call it.

What's the difference between the two?
Back in the day, pill testing kits were probably suitable for purpose. They probably did what they were supposed to do because there were so few things to check for. But in this day and age, there are so many variations. Testing kits largely date from chemists from the late 19th century. Marquis, Mendellin tests are sort of from the laboratory of Dr Jekyll and Mr Hyde. They are very good for what they do, so they are still used for what they call "presumptive field tests" by hospitals around the world. But they give no indication of safety. If it turns out negative, it could just mean that the thing that is being tested for isn't in the pill, and something else is. So, when I say "I'm for pill testing," I'm not for pill testing kits.

What are you advocating for then?
I am for taking the entire laboratory, and moving it to the music festival. So that the machinery that is used at your airports, at customs, in the work of counterterrorism—this is the sort of kit that I believe we should be using at music festivals. Very much in the same way that our friends in Europe are.

I was a very big fan of the re-agent testing 10-15 years ago, unfortunately the market has evolved so much that we have to bring a lot more. Bringing a re-agent test to try and keep yourself safe is really today, in toxicological terms, the equivalent of bringing a knife to a gun fight.

Well that's depressing.
One of the things that we know for a fact is that the sales of these tests in Australia have gone up 1,000 percent. Young consumers are actually very keen to stay safe. They are just not prepared to say "no." So there is an opportunity for us to get in and talk to young people about safety, we just need to be able to provide them with the appropriate safety gear.

Yeah because I feel I know a lot of young people who've come to rely on these kits to test their drugs. I think young people actually go to a fair bit of effort to try and work out whether their drugs are safe.
I completely agree. If you look at the detail in the conversations on the various online forums, there is a lot of research that is done. As a doctor, of course, our first premise is: if you want to be 100 percent safe, the only way to do that is not to consume drugs. That's just a matter of fact. But the difference between us and our political friends is that we acknowledge that's not very palatable for many people. So we have something beyond just saying "no," we have Plan B. And Plan B is: If you insist on doing this, we can give you some hints about how you can be safer. Not safe but safer.

Are people surprised when you, a doctor, talk about drugs this way? I kind of thought you'd be all about strict abstinence.
I, personally, as a doctor see this in no way as condoning drug use. As a doctor, it's just important that young people don't die. The testing process, in my mind, is very much like condoms. You may have an issue with sex before marriage, which is kind of what prohibition is all about. And if you don't want to have sex before marriage, that's cool. But to expect that all young people aren't going to have sex before marriage—sorry, excuse me while I try on my corset because I'm about to bust my gut.

The same actually applies to drugs. From a medical perspective, if you think the correct message is to just say no, the implication is that you also think it's also okay for one or two people to die every year. Maybe to serve as a lesson to other young people. Now, as a doctor, that's completely unacceptable to me. That the cost of young people using drugs is death, that's rubbish. We accept that Australia will never be drug free, no country has ever been.

If you have a bad reaction to these drugs. Should you be worried about calling an ambulance or going to the hospital?
Never to the emergency room, absolutely not. There is a thing called "medical confidentiality" and if you breach it as a doctor, you can lose your license to practice. Period. It doesn't matter. There are certain things for which I'm allowed to grass you up. If you're a terrorist, I have to tell the police. But simple consumption, absolutely not. And if anybody does snitch on you—both doctors and nurses—they should be reported to APRA, and they should have their license suspended. The only thing any doctor or nurse should care about is whether you are safe, and whether you can stay alive.

And to be fair to the police, in most jurisdictions in Australia, there is an understanding that the police will not interfere, even before they get to hospital. So even when an ambulance is called, as far as the police are concerned, they are not interested any more. The place where this changes is when somebody dies. So when somebody dies, then the police are involved. When somebody dies because of a drug overdose, there's no way you can avoid getting the police involved.

The problem for me is that I don't think that's the best way to monitor the market. Apparently, what we need to do to identify dangerous drugs in Australia is to wait until people are already hospitalised or dead. Can you imagine if we managed dangerous diseases like that? It makes no sense whatsoever.

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