Online pharmacies and opioids: education is the defense

Most of the US is still waiting for the Trump Administration to follow through on its ambitious goals for confronting opioid abuse; in the meantime, efforts from private industry and advocacy groups are proliferating. The Healthcare Distribution Alliance has joined with a variety of caregiver organizations in Allied Against Opioid Abuse; the Coalition to Stop Opioid Overdose brings together healthcare providers; and there are many local or regional efforts to coordinate public-health and emergency-care providers.

In late May, FDA announced a challenge program for medical devices that either monitor opioid usage, or provide alternative pain-management methods to opioid prescriptions; submissions are to be provided to FDA by sponsors between June 1 and Sept. 30, with winning applicants announced in November. Those applicants will receive “enhanced interactions” with FDA reviewers, along with Breakthrough Device status for some, which expedites review and approval.

Most of these programs (and others) directly or indirectly involve the pharma and device manufacturers themselves. But one group, at least, is very specifically avoiding pharma input: The Center for Safe Internet Pharmacies (CSIP). CSIP has joined with the Partnership for Drug-Free Kids to start a comprehensive educational effort, and to coordinate activities with local and state community and law enforcement groups, in an effort called MedicineSafe. “Consumer education is key,” says Marjorie Clifton, CSIP's executive director, “and to maintain our credibility, we need to keep away from pharma involvement.”

Consumer education has long been a part of CSIP, which originated as major search engines and financial services firms joined forces to raise awareness of unregulated (and often illegal) online pharmacies arose in the past decade. Together with the Partnership and local and state community and law enforcement groups, MedicineSafe seeks to provide educational tools to consumers, parents and caregivers on safe prescription use and disposal and gain access to treatment programs. Various surveys have shown that for many opioid abusers, the problems started with raiding family medicine cabinets for legally prescribed opioids.

Dark web

Illicit online pharmacies have been a source of opioids in the past, but much of that activity has dwindled in recent years as law enforcement cracked down. CSIP sponsored a study with LegitScript, a private company that surveys online-pharmacy activity, in 2016, and is about to announce a 2018 study. The new study finds that “Paid ads for opioids on the surface web are functionally nonexistent,” but that “illicit online pharmacies may look for unpaid ways to market their products, such as SEO, unregulated social media platforms, and anonymous forums on the surface web.”

Indeed, the so-called “dark web” (as opposed to the “open” web commonly accessed through search engines) is looming as a channel for opioid trade to occur, but that traffic in the dark web is relatively small, and there do not appear to be many sites offering high-volume shipping of narcotics. Other findings:

• Dark web traffic is flat overall. Although volatile, dark web traffic has not changed significantly in the past few years. (As of March 2018, the estimated average number of daily users appears to be about the same as it was in 2014.)

• Dark web usage is narrow. Few people use the dark web compared to the surface web (tens of people per every million Internet users). Illicit drug commerce on the dark web is a legitimate problem but may cater to a narrow demographic within the wider population of opioid abusers.

• The dark web can be troublesome to use. The current technical barriers to entry on the dark web may slow mainstream expansion. However, there may be an increase in usage as the wider public embraces cryptocurrencies.

• Dream Market is king — for now. Silk Road was the original name in dark web marketplaces, then it was AlphaBay. Right now, Dream Market dominates the dark web e-commerce space (of the top 12 marketplaces we surveyed, it had 56 percent of the drug listings). Should Dream Market get shut down by authorities or engage in an exit scam, another will certainly take its place as the preferred marketplace.

• Cannabis and ecstasy are the drugs of choice. Opioids accounted for only about 8% of the drug listings we surveyed on dark web marketplaces. Heroin accounted for about two-thirds of the opiate listings.

Pharma marketers may figure that opioid abuse, the dark web and other such activities are an insignificant concern to them (especially if the company does not deal in opioid-based drugs), but there always seems to be a carryover into other types of drugs when illicit trade is concerned. These days, there is a concern that drugs and consumer products like loperamide (brandname: Immodium, a diarrhea medication), clonidine (brand: Catapres, a hypertension treatment), carisoprodol (brand: Soma, a muscle relaxant) are just some of the drugs being abused. Thus, the future course of society’s dealing with drug abuse remains an open subject.