Abstract
BackgroundNonmedical prescription psychiatric drug use (NMPDU) is an increasing global health problem, with recent concern focusing on darknet cryptomarkets as sources of procurement. There is a shortage of evidence regarding comparative worldwide NMPDU trends, due in part to data collection difficulties. This problem is particularly marked for non-opioid drugs, particularly those psychiatric drugs which act on the central nervous system (CNS) and have high misuse potential and are associated with high levels of dependency and fatal overdose. This paper therefore has two goals: 1) to report on the kinds of psychiatric prescription drugs available on cryptomarkets, and 2) to use this data to uncover temporal and geographical trends in sales of these products, potentially informing policy regarding NMPDU more generally. MethodDigital trace data collected from 31 cryptomarkets in operation between September 2013 and July 2016 was analysed by country of origin descriptively and for trends in the sales for 7 psychiatric drug groupings, based on their main indication or intended use in psychiatric practice. ResultsSedatives (such as diazepam and alprazolam) and CNS stimulants (mainly Adderall, modafinil and methylphenidate) had the greatest share of sales, but usage and trends varied by location. The UK has high and rising levels of sedative sales, whilst the USA has the greatest stimulant sales and increasing sedative rates. Sales of drugs used in the treatment of opioid dependency are also substantial in the USA. The picture is less clear in mainland Europe with high sales levels reported in unexpected Central and Northern European countries. There is evidence of a move towards the more potent sedative alprazolam – already implicated as a source of problematic NMPDU in the USA – in Australia and the UK. Sales of drugs such as antidepressants, antipsychotics, mood stabilisers and antidementia drugs – all drugs with limited abuse potential – were negligible, indicating minimal levels of online cryptomarket procurement for self-medicating mental health problems. ConclusionPredominantly, psychiatric drugs with potent sedative, stimulant or euphoriant effects are sold on cryptomarkets and this varies by country. With some caveats regarding the limitations of cryptomarket digital trace data taken into account, the study of trends of these products sold online over time may offer a novel and increasingly important window onto wider drug purchasing habits.
Highlights
Nonmedical prescription psychiatric drug use (NMPDU) is an increasing global health problem, with recent concern focusing on darknet cryptomarkets as sources of procurement
We focus on non-opioid drugs that act on the central nervous system and are commonly used in psychiatric practice, for reasons of focus, interest and that opioid rates have been reported in detail in other works (Martin, Cunliffe, Decary-Hetu et al, 2018) – drugs used for the treatment of opioid dependency will be still be included
With analysis left to focus on the hypnotics & anxiolytics, CNS stimulants and opioid dependency products, Table 2 presents the global market share and within country market share trends for each of these product categories for the 9 countries with the highest overall market share, plus Netherlands and China due to their theoretical importance
Summary
Nonmedical use of prescription drugs: an emerging global health and policy challenge. The majority of the work will focus on those countries that show the largest number of cryptomarket drug sales (as reported in numerous previous pieces of work) but will focus on India and China, due to their emerging reputation as source countries for either generic (non-branded) or clandestine production of prescription drugs (Kmietowicz, 2015; UNODC, 2017a) By situating this analysis within the wider cryptomarket literature, and with an awareness of the broader cryptomarket trading characteristics, the secondary aim of the investigation is to establish to what extent the cryptomarket data can be informative regarding the nature of the illicit market for psychiatric drugs more generally. At the most general level, it is hoped that this work can further demonstrate that, with the appropriate limitations and nuances being included, cryptomarket digital trace analysis can be used as resource to understand wider trends in drug usage rates
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