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Exploring the digital ripple effects of an attempt to address a public-health problem.
Image has been cropped and resized. Courtesy of Nialldawson, Wikimedia Commons.
Illicit drug sales on the dark web increased after the Drug Enforcement Administration implemented stricter controls on opioid prescriptions in 2014, according to a new study published in the BMJ.
In the study, a team of researchers used data from online drug markets to track inventory and transactions and found that the proportion of sales and listings of illicit prescription opioids increased after the DEA ruling was implemented, with no equivalent change for other drug categories.
“Our results are consistent with the change in the law being the cause,” said Judith Aldridge, one of the study’s authors, and a professor in criminology at the University of Manchester.
Even so, it’s impossible to say with certainty that the DEA move was the cause, she said.
Deaths from opioid overdoses have been on the rise in the United States for close to two decades, but since 2011 the increase in deaths attributed to prescription painkillers has leveled off, while deaths related to more potent substitutes, like heroin, climbed, according to data from the CDC. In 2014, deaths from fentanyl, a synthetic and extremely potent substitute, began to skyrocket.
That same year, the DEA restricted the supply of hydrocodone, one of the most frequently prescribed prescription painkillers, by categorizing it as a Schedule II drug.
The researchers analyzed data from online drug markets, from October 2013 to 2016, and found that a significant change occurred after the schedule change. The proportion of illicit sales of prescription opioids (defined as substances that are available as prescription drugs but can also be sourced illegally, including fentanyl) increased after the change, while there was no equivalent increase in other prescription drugs, or in illicit opioids like heroin.
In addition, the shift to more prescription opioids occurred only among US-based sellers, supporting the idea that it was a US phenomenon. While there are no data on where the drugs were sent, the researchers used US-based sellers as a proxy for sales in the country, as most online illicit drug sales don’t cross borders.
Not only did the total share of prescription opioids increase, but the kinds of opioids sold shifted as well. The researchers found that hydrocodone peaked several months before the rule change and then slipped; oxycodone sales spiked after the change and then dropped, but they remained above pre-rule change levels; and fentanyl sales kept on climbing, going from the opioid with the fewest sales in 2013, to second only to oxycodone in 2016.
This is consistent with what’s known as the iron rule of prohibition, which states that clamping down on supply without addressing demand drives people to higher potency substances. “Once they get pushed into the black market they tend to access higher potency substitutes,” James Martin, the lead author of the report, said on a BMJ podcast. “Instead of hydrocodone, demand for oxycodone went up, then fentanyl went up.”
In fact, the shift from hydrocodone to oxycodone and then to fentanyl appeared to be demand-led, said Aldridge. The researchers tracked listings for illicit drugs and transactions, finding that first transactions went up, followed by listed inventory, suggesting that suppliers reacted to buyers’ demands.
“We hope that people will take away from our study that it's important to engage in both demand- and supply-side initiatives when trying to affect change,” Aldridge said.