The coroner overseeing an says pill testing should be trialled because the evidence in favour of it is "compelling".
Deputy state coroner Harriet Grahame on Friday closed the inquest into six MDMA-related deaths at recent music festivals and called for the state to radically change its approach to drug policy.
"I am in no doubt whatsoever that there is sufficient evidence to support a drug checking trial in NSW," she told the NSW Coroners Court.
"In my view, the evidence is compelling."
She said she'd examined a wealth of peer-reviewed evidence, hours of testimony and opinions of police, parents and experts on medically supervised drug checking to form her opinion.
"Of course, drug checking is not a magic solution," she said.
"Of course, it does not guarantee there won't be more deaths."
But it could help and should go beyond music festivals, urging a Dutch-style community-based drug checking system.
At the inquest, Ms Grahame heard from the parents and friends of Joshua Tam, Nathan Tran, Alex Ross-King, Diana Nguyen, Joseph Pham, Joshua Tam and Callum Brosnan, as well as police and emergency services and an extensive list of drug experts.
Matthew King, the father of Alex King, 19, embraces Cornelius Brosnan, the father of Callum Brosnan, 21, outside the Coroner's Court. Source: AAP
Many at the inquest called for medically supervised drug checking, a police focus on harm reduction and high school illicit drug lessons that go beyond "just say no".
Before delivering dozens of recommendations, Ms Grahame called on Premier Gladys Berejiklian's government to look at drug problems at festivals with "fresh eyes" and examine evidence-based solutions.
The evidence before the inquest "clearly indicated" much can be done to prevent MDMA deaths, she said.
"There are practical solutions," Ms Grahame said.
"However the evidence draws into clear focus the need for the NSW government to look with fresh eyes at the potential dangers associated with drug use at music festivals."
She made the same call in March after overseeing an inquest into the accidental overdose deaths of five men and one woman as a result of heroin or multi-drug toxicity in 2016.
At the time Ms Grahame said lowering the rate of opioid overdose was clearly achievable but would "require a government willing to listen to health experts and to act decisively on their advice".
Joshua Tam, Hoang Nathan Tran, Diana Nguyen, Callum Brosnan, Alex Ross-King, who all died at a Sydney music festival. Source: AAP
Ms Berejiklian has been steadfast in refusing to facilitate pill testing in NSW.
Instead, her government has focused on ensuring high-risk festivals meet stringent safety standards, taking steps to increase emergency service numbers and provide free, chilled water.
The inquest, held this year, also exposed NSW police strip search procedures, with tearful young women detailing how she was ordered to squat and cough while naked and had been wrongly accused of hiding drugs.
As hearings closed in September Mr Tam's mother Julie Tam said her son and the five other young adults who died must be "the faces of change".
"I wish one reckless moment of abandonment hadn't brought about these tragic results, but that the six of you were meant to create a ripple so far and so wide that this changing landscape cannot and must not be ignored," she told the inquest.
"Those that stand in the way of change please step aside ... I don't believe that political parties should be involved in decisions like these at all. Re-election should not influence important reforms."
With AAP..
