Delivery dilemmas: How drug cryptomarket users identify and seek to reduce their risk of detection by law enforcement

BackgroundCryptomarkets represent an important drug market innovation by bringing buyers and sellers of illegal drugs together in a ‘hidden’ yet public online marketplace. We ask: How do cryptomarket drug sellers and buyers perceive the risks of detection and arrest, and attempt to limit them?MethodsWe analyse selected texts produced by vendors operating on the first major drug cryptomarket, Silk Road (N = 600) alongside data extracted from the marketplace discussion forum that include buyer perspectives. We apply Fader’s (2016) framework for understanding how drug dealers operating ‘offline’ attempt to reduce the risk of detection and arrest: visibility reduction, charge reduction and risk distribution.ResultsWe characterize drug transactions on cryptomarkets as ‘stretched’ across time, virtual and physical space, and handlers, changing the location and nature of risks faced by cryptomarket users. The key locations of risk of detection and arrest by law enforcement were found in ‘offline’ activities of cryptomarket vendors (packaging and delivery drop-offs) and buyers (receiving deliveries). Strategies in response involved either creating or disrupting routine activities in line with a non-offending identity. Use of encrypted communication was seen as ‘good practice’ but often not employed. ‘Drop shipping’ allowed some Silk Road vendors to sell illegal drugs without the necessity of handling them.ConclusionSilk Road participants neither viewed themselves as immune to, nor passively accepting of, the risk of detection and arrest. Rational choice theorists have viewed offending decisions as constrained by limited access to relevant information. Cryptomarkets as ‘illicit capital’ sharing communities provide expanded and low-cost access to information enabling drug market participants to make more accurate assessments of the risk of apprehension. The abundance of drug market intelligence available to those on both sides of the law may function to speed up innovation in illegal drug markets, as well as necessitate and facilitate the development of law enforcement responses.     

#Drugsforsale: An exploration of the use of social media and encrypted messaging apps to supply and access drugs

BackgroundThe use of new technology is frequently harnessed by drug suppliers to both increase profits and reduce risk. While a growing body of research has investigated drug sales through online pharmacies and cryptomarkets, despite growing media interest, no published research exists on how smartphone-enabled social media and messaging applications (‘apps’) are utilised in the drug economy. This study analyses the ways such apps (e.g. Snapchat, Instagram and WhatsApp) are utilised to supply and access drugs.MethodsThree data collection methods were employed: an international online survey of 358 drug users that had either used or considered using apps to access drugs; ‘rapid’ interviews (n = 20) with a similar population; and in-depth interviews (n = 27). Key issues explored were the perceived benefits and risks associated with sourcing drugs through apps, with specific attention paid to novel supply and purchasing practices.ResultsApps appear to provide a quick, convenient method for connecting buyer and seller. They were often viewed as a valuable intermediary option between cryptomarkets and street dealing, providing ‘secure’ features and the opportunity to preview product without the requirement for technical expertise. Apps are used in a range of novel and diverse ways, including as social networking spaces in which drugs are advertised, and as encrypted messaging services for communicating with known sellers and arranging transactions. Key anxieties related to potential for exposure to law enforcement and legitimacy of substances.ConclusionThough ‘social supply’ through friends is still typically preferred and there is a degree of wariness toward app-mediated supply, our data indicate that apps are fast becoming a viable option for accessing drugs. Apps can provide an easily accessible platform that connects buyers with commercial drug suppliers and substances that may otherwise remain elusive. Potential harms can be reduced through the provision of information which demystify common-sense assumptions that apps are secure and that this ‘visual’ drug economy promotes safer purchasing practices.     

Polydrug use and polydrug markets amongst image and performance enhancing drug users: Implications for harm reduction interventions and drug policy

BackgroundOver the past two decades, the use of image and performance enhancing drugs (IPEDs) has increased significantly. Once largely confined to professional athletes, IPED use has transcended the elite sporting arena and is now predominantly found among non-elite, recreational gym users. This paper presents research findings from a qualitative study of IPED use and supply in a ‘hardcore’ bodybuilding gym in the north of England. This article makes an original contribution to the field by providing an in-depth account of the use and supply of IPEDs among this population, demonstrating the intersectionality that exists across IPEDs, diverted medication and both licit and illicit substance use and supply.MethodsThe findings are based on the research team’s privileged access to an independent, ‘hardcore’ body building gym in the north of England. Four fieldworkers undertook overt systematic observations, supplemented by 20 semi-structured interviews.ResultsAmongst this sample of bodybuilders, substance use transcended IPEDs to encompass a much broader cocktail of substances all who used IPEDs concomitantly used diverted medication as a means of negating anticipated side-effects, and over half used illegal psychoactive drugs. Furthermore, virtually all of these substances were available to buy via the gym, through fellow gym members and, at times, staff.ConclusionThis article draws three main conclusions. (1) We are witnessing a convergence of IPED use and supply with diverted medication and ‘traditional’ recreational substances. (2) The extensive poly-substance use reported by interviewees in this sample necessitates a review of existing harm reduction advice for IPED users that takes into consideration the full range of substances currently being used. (3) Punitive drug policy reform that aims to reduce IPED markets needs to consider the potential to displace social supply towards more commercially-driven dealing. Harsher drug laws may also risk criminalising and stigmatising IPED users.     

‘ E’ is for enterprise: Middle level drug markets in ecstasy and stimulants

This article is derived from a study of ‘middle-market’ drug distribution funded by the Home Office. It involved prison interviews with middle and upper level drug dealers, and interviews with a range of enforcement personnel. The focus of the article is middle level drug markets in Ecstasy and stimulant drugs such as amphetamine and cocaine. A number of case studies are used to illustrate the varying kinds of brokerage, go-between and ‘middle-man’ functions that link together the different levels of the stimulant drug market, to supply the needs of consumers within the burgeoning night-time economy. Some of these individuals sit just above the retail level supplying retail level dealers who are in turn selling direct to consumers; others involve serious crime networks that control regional and cross-regional distribution systems within the UK, and transport routes that facilitate importation from the Netherlands.     

Evaluation of a drug checking service at a large scale electronic music festival in Portugal

BackgroundDrug checking services are being implemented in recreational settings across the world, however these projects are frequently accused of a lack of evidence concerning their impact on people who use drugs. This paper describes the implementation of a drug checking service at the Boom Festival 2016 and explores the impact of this service on its users’ behavioural intentions.Methods753 drug samples were submitted to the drug checking service for chemical analysis. All drug checking users were invited to fill a pre-analysis and a post-analysis questionnaire. 310 pre- and post-analysis questionnaires answered by users of the service were successfully matched.ResultsWhen the test results were “unexpected” (N = 86), 94.3% of the service users reported that they would not to take the drug. When the test result indicated the sample contained “the expected substance plus adulterants” (N = 41) 32% of users stated they would not take it. When the test result was “only the expected substance” (N = 370), as anticipated, 98% of the participants reported they would take it. There was a statistically significant association between users’ behavioural intentions and drug‐checking result (χ²(2) = 350,042, p < .001).ConclusionsThese results support the hypothesis that providing drug checking services in large-scale festivals helps users to better manage their drug use and deal with drug adulteration. The data corroborates the supposition that when provided with objective information about the content of their drugs, some users consider health protecting behaviours. Additionally, these results can contribute to the design of tailored harm reduction interventions that take into consideration clients’ characteristics, profiles and motivations.     

Peer-delivered hepatitis C testing and counselling: a means of improving the health of injecting drug users

We hypothesized that providing injecting drug users (IDUs) with free hepatitis C testing and counselling at a needle and syringe programme (NSP) would be an effective model. Between August 1999 and January 2000, our peer outreach worker offered these services from a busy NSP in western Melbourne. Over 300 counselling episodes were provided, and 47 IDUs who were not tested in the previous 12 months were given tests and full pre- and post-test counselling, and were interviewed about reasons for not being tested, their knowledge of hepatitis C, and their risk behaviour. Twenty-eight IDUs (59.6%) tested antibody-positive, demonstrating the need to improve testing coverage and compliance with counselling requirements. Most were not tested because they did not think they were at risk, but their reported behaviour and antibody test results showed otherwise. Twenty people returned for a second interview, and improvements in their risk behaviour and knowledge of hepatitis C were detected. Our experience suggests that demand exists for hepatitis C testing and counselling of IDUs in Melbourne's western suburbs, that testing and counselling improve IDUs' ability to avoid harm, and that delivery of these services by a trained and experienced peer located at an NSP is an appropriate and effective model.     

Adulteration of low-delta-9-tetrahydrocannabinol products with synthetic cannabinoids: Results from drug checking services

Since late 2019, low-delta-9-tetrahydrocannabinol (THC) preparations adulterated with synthetic cannabinoids (SCs) have been frequently observed in Switzerland. The unawareness of users concerning the presence of SCs and the typically higher potency and toxicity of SCs, when compared with THC, can result in increased health risks. In Switzerland, low-THC (<1%) cannabis products, except hashish, are legal. These products can act as carrier materials for SCs. In this study, cannabis samples and user self-reports received through three drug checking services were collected and analysed, to gain deeper insight into this new phenomenon. Samples were collected from January 2020 to July 2021. Liquid chromatography coupled with high-resolution mass spectrometry was used for the qualitative screening and semi-quantification of SCs, while gas chromatography with flame ionization detector was applied for the quantification of THC and cannabidiol levels. Reported adverse effects were compared between users who consumed adulterated (SC-group) and non-adulterated (THC-group) products. Of a total 94 samples, 50% contained up to three different SCs. MDMB-4en-PINACA was most often detected. All adulterated cannabis flowers contained ≤1% THC. Adulterated hashish also typically presented low THC-levels (median: 0.8%). The SC-group was associated with higher numbers of adverse events (p = 0.041). Furthermore, psychologic (p = 0.0007) and cardiologic (p = 0.020) adverse effects were more profound in the SC-group than in the THC-group. Drug checking services enabled the timely detection and monitoring of new and potentially dangerous trends. Furthermore, due to user-reports, additional valuable information was gained on adverse events associated with the consumption of novel SCs.     

Managing la malilla: Exploring drug treatment experiences among injection drug users in Tijuana, Mexico, and their implications for drug law reform

BackgroundIn August 2009, Mexico reformed its drug laws and decriminalized small quantities of drugs for personal use; offenders caught three times will be mandated to enter drug treatment. However, little is known about the quality or effectiveness of drug treatment programs in Mexico. We examined injection drug users’ (IDUs) experiences in drug treatment in Tijuana, Mexico, with the goal of informing program planning and policy.MethodsWe examined qualitative and quantitative data from Proyecto El Cuete, a multi-phased research study on HIV risk among IDUs in Tijuana. Phase I consisted of 20 in-depth interviews and Phase II employed respondent-driven sampling to recruit 222 IDUs for a quantitative survey. We also reviewed national drug policy documents, surveillance data, and media reports to situate drug users’ experiences within the broader sociopolitical context.ResultsParticipants in the qualitative study were 50% male with a mean age of 32; most injected heroin (85.0%) and methamphetamine (60.0%). The quantitative sample was 91.4% male with a mean age of 35; 98.2% injected heroin and 83.7% injected heroin and methamphetamine together. The majority of participants reported receiving treatment: residential treatment was most common, followed by methadone; other types of services were infrequently reported. Participants’ perceptions of program acceptability and effectiveness were mixed. Mistreatment emerged as a theme in the qualitative interviews and was reported by 21.6% of Phase II participants, primarily physical (72.0%) and verbal (52.0%) abuse.ConclusionsOur results point to the need for political, economic, and social investment in the drug treatment system before offenders are sentenced to treatment under the revised national drug law. Resources are needed to strengthen program quality and ensure accountability. The public health impact of the new legislation that attempts to bring drug treatment to the forefront of national drug policy should be systematically evaluated.     

Designing and testing of an effective oil-in-water microemulsion drug delivery system for in vivo application

The phase behavior of a new psedoternary system of clove oil/Tween 20 has been studied. Several compositions from the single-phase region were selected and their stability toward time, temperature, and electrolytes has been examined. A particular composition(clove oil/Tween 20/water as 5/30/65) was chosen as the drug delivery system from the clear oil-in-water zone of the pseudoternary system. The droplet dimension and the polydispersity state of the particular composition was determined by dynamic light scattering. A bioactive compound quarcetin was encapsulated in the vehicle. The efficacy of the drug in the vehicle was examined against leishmaniasis in hamster models. The hepatotoxicity of the vehicle (o/w microemulsion) with and without the drug quarcetin was examined by estimating serum alkaline phosphatase, glutamate pyruvate transaminase, urea, and creatinine.     

Food and drug administration guidelines for reproductive toxicity testing

The Food and Drug Administration generally requires reproductive toxicity testing of all new drugs to be used by pregnant women or women or men of reproductive potential. These requirements may vary among the centers within the FDA. Reproductive and developmental toxicity is usually tested in one or two animal species and is divided into three segments to represent treatment throughout the reproductive process. The FDA monitors adverse drug effects on human reproduction through postmarketing surveillance.     

门诊药房药物咨询服务分析

目的探讨门诊药房提高药物咨询服务的措施,帮助患者合理用药。方法收集我院门诊药房2009年7-9月的药物咨询记录,对咨询内容进行总结、分析。结果患者咨询内容广泛,咨询药物的用法用量最多(26.5%),其次是药物的适应证(20.3%)、药品价格(13.4%)、不良反应(12.4%)。结论通过药物咨询可以使患者了解正确的用药方法,避免不良的相互作用,提高患者的用药依从性,保证患者用药安全、有效。     

Attitudes of intravenous drug users in London towards the provision of drug consumption rooms

Aim: The study investigated the attitudes of intravenous drug users (IDUs) towards the provision of drug consumption rooms (DCRs) in the UK and their willingness to use DCRs. Methods: Participants were 90 methadone-maintained outpatients recruited from a London clinic. A questionnaire asked about their willingness to use a DCR, their views on various rules commonly-implemented by DCRs, and how they believed DCRs might impact on the drug-taking behaviours of drug users and their peers. Findings: A large majority (89%) expressed willingness to use a DCR and accepted the need for rules such as no drug sharing (84.3%), no assistance with injecting (81.8%), compulsory supervision (76.7%) and compulsory hand washing (92.1%). However, the IDUs were split over whether injection in the neck or groin should be disallowed and whether certain categories of IDUs (e.g. juveniles, pregnant women) should be excluded from DCRs. Majorities thought it unlikely that DCRs would encourage users to try risker drug preparations (76.6%), or encourage non-injectors to inject for the first time (74.5%). Conclusions: In a country where DCRs are not available, the study highlights the willingness of IDUs to use a DCR and accept its rules, even for a sample most of whom were not homeless.     

Incidence and risk factors for non-fatal overdose among a cohort of recently incarcerated illicit drug users

Background

Release from prison is associated with a markedly increased risk of both fatal and non-fatal drug overdose, yet the risk factors for overdose in recently released prisoners are poorly understood. The aim of this study was to identify risk and protective factors for non-fatal overdose (NFOD) among a cohort of illicit drug users in Vancouver, Canada, according to recent incarceration.

Methods

Prospective cohort of 2515 community-recruited illicit drug users in Vancouver, Canada, followed from 1996 to 2010. We examined factors associated with NFOD in the past six months separately among those who did and did not also report incarceration in the last six months.

Results

One third of participants (n = 829, 33.0%) reported at least one recent NFOD. Among those recently incarcerated, risk factors independently and positively associated with NFOD included daily use of heroin, benzodiazepines, cocaine or methamphetamine, binge drug use, public injecting and previous NFOD. Older age, methadone maintenance treatment and HIV seropositivity were protective against NFOD. A similar set of risk factors was identified among those who had not been incarcerated recently.

Conclusions

Among this cohort, and irrespective of recent incarceration, NFOD was associated with a range of modifiable risk factors including more frequent and riskier patterns of drug use. Not all ex-prisoners are at equal risk of overdose and there remains an urgent need to develop and implement evidence-based preventive interventions, targeting those with modifiable risk factors in this high risk group.     

Mortality of registered drug users in Central Asia

BackgroundWithin the fifth phase of the Central Asia Drug Action Programme (CADAP) covering five post-Soviet Central Asian countries, an analysis of the mortality of drug users was performed. The results for Kazakhstan and Uzbekistan are presented in detail in this paper since results from Kyrgyzstan and Tajikistan are not considered valid and Turkmenistan did not provide data at all.MethodsA system of registration of all users of illegal drugs known to the health and/or law enforcement authorities (“narcological registers”) exists in Central Asian countries inherited from the system of Soviet “narcology”. According to the legal norms, the death of a registered person should be recorded. We conducted indirect standardisation of crude mortality rates and computed the standardised mortality ratio (SMR) comparing observed number of deaths with expected number of deaths according to age and gender specific mortality rates in the general population of the same country.ResultsThe results show excess mortality in registered drug users, particularly in registered females, in Uzbekistan (the latest available SMR for all those registered is 7.4; the SMR in females is 16.3) and Kazakhstan (4.0 and 12.9). The excess mortality is highest among young adults (18–34) in all the studies.ConclusionTaking into account the limited quality and reliability of the data – first of all, the likely under-reporting of deaths in the narcological registers – the crude mortality rate among registered drug users is quite high when compared to EU countries. The SMR in total is comparably lower as a result of the high background mortality in the general population. This excess mortality is preventable and should be targeted by the national drug policies. Specifically, the programmes should target registered and unregistered female drug users.     

The prevalence and characteristics of injecting drug users in Australia

The prevalence of injecting drug use has increased significantly in Australia in recent years. Using the nationally representative 1998 National Drug Strategy Household Survey we estimate the size of the lifetime prevalence injecting drug use population at 302710 people, compared to 67474 in 1988. Those who have injected drugs in the previous year are estimated at 108750 people in 1998. Amphetamines have displaced heroin as the most popular drug to inject among the general population. Those who have ever injected are more likely to be male, young, unemployed and to possess fewer educational qualifications. A variety of factors are discussed which may account for increases in injecting drug use. \[McAllister I, Makkai T. The prevalence and characteristics of drug users in Australia. Drug Alcohol Rev 2001;20:29-36]     

戒毒所内对吸毒人群进行艾滋病干预的效果研究

目的：评价在戒毒所进行艾滋病咨询及心理干预对吸毒人群戒毒的效果。方法采用自行设计的问卷,以面对面询问方式,对戒毒所内的吸毒人员进行干预前后调查。结果261名吸毒者接受了干预前问卷调查,其中132例自愿参与咨询、接受心理干预,并做了干预后调查。干预后吸毒人群对艾滋病防治、性传播疾病、自愿咨询检测知识知晓率均明显提高;自愿咨询检测利用率、性病就诊行为好转率均有明显提高。结论在戒毒所开展咨询与心理干预,可以提高吸毒人群艾滋病的防治知识,改变相关危险行为,在戒毒所对吸毒人群开展艾滋病咨询与心理干预是预防艾滋病在吸毒人群中传播的有效途径。     

门诊退药情况分析

目的:探讨我院门诊退药情况及防止措施.方法:选取2006年1月～2009年1月间我院门诊处方共65 427张,分析退药处方298张.结果:本组退药原因中药品不良反应65例(21.81%),依次为患者入院或者改医嘱46例(15.44%),开药过多或重复开药36例(12.08%),患者拒绝用药34例(11.41%),不合理用药28例(9.40%),医保费用因素22例(7.38%)等.本组退药种类中药品抗生素75例(25.17%)最多,依次为抗病毒药50例(16.78%),消化系统药32例(10.74%),呼吸系统药28例(9.40%),解热镇痛药26例(8.73%),抗心衰药24例(8.05%)等.结论:加强医患沟通,加强医生行为规范,提升药师专业素质,完善医院退药制度,保障患者用药安全.