A coroner has recommended pill testing be conducted in NSW, along with the decriminalisation of personal drug use and the scrapping of sniffer dogs at music festivals.
An inquest investigated the drug-related deaths of six young people, aged 18 to 23, at NSW music festivals over two summers.
Delivering her findings on Friday, deputy state coroner Harriet Grahame said there was "compelling" evidence to support pill testing, which could "prompt behavioural change".
"Drug checking is simply an evidence-based harm reduction strategy that should be trialled as soon as possible in NSW," she said.
Ms Grahame said high-visibility and punitive policing operations at festivals had "inherent dangers and few if any benefits" and drug detection dogs should be scrapped.
The coroner's draft recommendations were leaked last month and the NSW Government reiterated its opposition to pill testing trials.
On Friday, Ms Grahame said the evidence showed a heavy police presence and drug detection dogs could be intimidating and precipitate "panic ingestion" and "dangerous preloading", which could increase the risk of illness or fatality.
Ms Grahame gave recommendations to NSW Police including that drug detection dogs be scrapped.
She said the use of strip searches should be limited to circumstances where there is a "reasonable suspicion".
"The evidence arising from this inquest clearly indicates there is much that can be done to prevent MDMA deaths," Ms Grahame said.
"There are practical solutions to some of the issues identified."
Ms Grahame recommended a drug summit be held with relevant stakeholders to develop an evidence-based drug policy.
She said the Government should give "full and genuine consideration" to "decriminalising personal use of drugs, as a mechanism to reduce the harm caused by drug use".
Premier Gladys Berejiklian has consistently argued the harm reduction measure sends the "wrong message" to young people, instead arguing they should "just say no" to drugs.
Relatives of Nathan Tran, 18, Diana Nguyen, 21, Joseph Pham, 23, Callum Brosnan, 19, Josh Tam, 22 and Alex Ross-King, 19, attended the two blocks of hearings and some even travelled to music festivals to see first-hand the problems identified.
Outside the hearing Ms Ross-King's mother Jennie urged the Premier to "listen to the experts".
"It is not me, people, I'm just a grieving mum," she said.
"These are experts in their field who have been doing this for a long time, in excess of 20 years in Australia and longer than that overseas.
"So I think it is time that, instead of politicians believing that their opinions are what we should be doing, actually listen to what the experts are saying."
Ms Grahame said they had shown "extraordinary grace and courage" throughout the painful process.
"It is correct to say that my part in this process is complete, the faces of these young people will remain with me going forward, along with the hope that improvements will be made," she said.
NSW Opposition Leader Jodi McKay said it was "important" for the Government to consider the recommendations and that Labor would trial pill testing if it was in power.
