<div>Abstract</div><div><br></div><div>Background: The issue of drug checking at events such as music festivals has come to the fore in recent years both in New Zealand and other countries such as Australia and the UK. Drug checking, also referred to as pill testing, involves testing a small sample of a particular substance to determine what it contains. Alongside the actual testing drug checking services usually offer advice around how to take the substance more safely e.g. to keep hydrated, not to mix the substances together, and to avoid mixing alcohol and illegal substances. KnowYourStuff (KYSNZ) are a voluntary organisation that have been providing drug checking services at New Zealand festivals for approximately five years. KYSNZ operate in a grey legal area, making it difficult to provide a harm reduction focused service. For example, festival organisers could be prosecuted under s12 of the Misuse of Drugs Act (MODA) for openly having drug checking at their events.</div><div><br></div><div>Globally drug checking is not a new phenomenon and has been in existence in some countries such as the Netherlands since the 1990s. The international evidence so far about drug checking demonstrates that: it does not increase the use of illegal drugs; it does not encourage those who don’t use illegal drugs to start using them; behaviour change is evident when substances are not as sold; harm reduction advice is valued and acted upon by young people. Drug checking services often positively affect people’s behaviour and as such are an important harm reduction service, although drug checking is not just about the test itself - the information offered and advice given are important elements of drug checking services. Further, behaviour change should not be measured solely in terms of drug disposals as other behavioural changes are also important e.g. taking less, not mixing substances tested with other drugs or alcohol, as well as improvements in knowledge about harm reduction for service users. This research was undertaken to provide information and understanding about drug checking as a harm reduction intervention. Further, it aimed to explore both behavioural changes related to drug checking and attitudes towards drug checking services in New Zealand.</div><div>Methods: This mixed methods study gathered data via an online and in-situ survey as well as through structured and semi structured interviews. Four groups of people were interviewed: festival/event organisers; medical personnel who worked at festivals and events; volunteers working for KYSNZ; festival attendees/wider New Zealand public (recruited via the survey). Overall 66 people were interviewed, and 911 surveys were completed, with the final survey sample after cleaning totalling 861. The sample was a purposeful, focused, non-random sample.</div><div>Results - Survey: 68% of those who had used the services of KnowYourStuffNZ (KYSNZ) stated that they had changed their behaviour either through disposing of their substances after checking or through adhering to harm reduction advice. 87% of those who had used KYSNZ drug checking services stated that their knowledge of harm reduction had improved a great deal or a little. The survey results also found that the majority of participants (95%-97%) supported drug checking, thought that it reduced drug related harm, and supported the proposed change to s12 of the 1975 Misuse of Drugs Act (MODA) to give drug checking legal status legal.</div><div><br></div><div>Results – interviews: All of the groups that were interviewed thought that drug checking was an important harm reduction service and that it reduced drug-related harms. The interviewees noted that young people will take drugs regardless of their illegal status and that drug checking services were therefore a crucial harm reduction intervention. Festival organisers wanted to provide as safe an environment as possible for those attending their events and noted illegality as a barrier to providing drug checking services. Festival organisers who invited KYSNZ to their events noted fewer serious incidents related to illicit drug use and emphasised the importance of having drug checking at their events. Medical personnel who were interviewed noted the treatment problems that came with</div><div>festival attendees ingesting unknown substances, and supported drug checking as it enabled clear information about drugs that were circulating at particular events that might be dangerous. All 66 interviewees viewed drug checking as an important harm reduction initiative and believed that it reduced drug related harms.</div><div><br></div><div>Conclusions: The majority of people who had used the services of KnowYourStuffNZ changed their behaviour. This is in line with international evidence. Drug checking was recognised by research participants as an important harm reduction intervention that saved lives and kept young people as safe as possible when using illicit drugs. Drug use was also viewed by the majority of participants as a health issue and that it should be treated as such by supporting harm reduction initiatives such as drug checking. There is a high level of support to amend s.12 of the 1975 MODA to allow drug checking and make services like KYSNZ legal.</div>
The characteristics of behaviour change interventions used among Pacific people: a systematic search and narrative synthesis