In the Journals

Restriction of hydrocodone tied to spike in illegal online drug market

The U.S. Drug Enforcement Administration's decision to restrict prescription drugs containing hydrocodone in 2014 was linked to a significant increase in illicit trading of opioids through online markets, according to study findings published in BMJ.

Data showed the percentage of total drug sales attributable to prescription opioids doubled from 6.7% to 13.7% in the U.S. during the study period between October 2013 and July 2016.

“The general efficacy of supply side interventions in drug markets is ... under-researched,” James Martin, PhD, department of social sciences, Swinburne University, Australia, and colleagues wrote. “Although understanding has been limited by a lack of detailed information connected to illicit drug supply, knowledge has improved in recent years with the emergence of online illicit marketplaces, or cryptomarkets,” they continued. “The internet has facilitated the sale of licit and illicit drugs for more than 15 years, but when the first cryptomarket ... came online in 2011, illicit drugs began to be traded in large quantities. ... Since 2011, cryptomarkets have been analyzed through the digital traces they leave online.”

Martin and colleagues conducted an interrupted time series analysis to evaluate the effect on the opioid trade through illicit cryptomarkets after the DEA ruled to restrict hydrocodone combination products. Researchers looked at data from 30 of the world’s largest cryptomarkets operating from October 2013 to July 2016 to determine the proportion of total transactions and the advertised and active listings for prescription opioids, sedatives, steroids and stimulants, and illicit opioids. They also examined the composition of the prescription opioid market between the U.S. and other countries.

Analysis showed that the sale of prescription opioids through U.S. cryptomarkets rose after the reclassification of hydrocodone in 2014; however, there were no significant changes in sales of sedatives, steroids, stimulants or illicit opioids, according to the press release. Sales of opioids through cryptomarkets represented 13.7% (95% CI, 11.5-16) of all drug sales in July 2016 compared with a modelled estimate of 6.7% (95% CI, 3.7-9.6) of all sales if the new schedule had not been introduced in the U.S.

This corresponds to a 4% yearly rise in the amount of trade attributed to prescription opioids in the U.S. market, the release said. However, there were no corresponding changes for the sales of other drugs or prescription opioids sold outside the U.S. In addition, the authors observed a change in the type of drugs purchased after reclassification, with oxycodone purchases dropping and fentanyl purchases increasing. Although fentanyl was the least purchased product in the U.S. in mid-2014, it became the second most frequently purchased product bought from cryptomarket sellers in July 2016, the researchers found.

“Although our results show an increase in sales of prescription opioids on cryptomarkets after the schedule change, contemporaneous factors might also have played a causal role,” Martin and colleagues wrote in the full study. “These could include the effect of other public policies enacted over the same period; however, we do not know of any other policies that were implemented as widely as the [DEA’s] schedule change.”

Scott Hadland, MD, PhD
Scott E. Hadland

These results highlight the fact that the opioid epidemic will probably worsen if supply-related interventions are not combined with evidence based-measures to cut demand and reduce harm, Scott E. Hadland, MD, MPH, from Boston Medical Center and Boston University School of Medicine, and Leo Beletsky, JD, MPH, from Northeastern University and UC San Diego School of Medicine, wrote in a related editorial.

“Demand for opioids in the U.S. will decrease sustainably only when high quality, evidence-based prevention and treatment programs are broadly implemented, robustly funded and universally accessible,” they wrote. “The U.S. scheduling scheme inexplicably holds such disparate substances as cannabis, heroin and psilocybin to be equally dangerous. It is high time to rethink how, why and when this regulatory framework is deployed to curb drug-related harms.” – by Savannah Demko

Disclosures: The authors report no relevant financial disclosures. Beletsky reports sitting on the advisory board of a data analytics company with an interest in the U.S. opioid crisis.

The U.S. Drug Enforcement Administration's decision to restrict prescription drugs containing hydrocodone in 2014 was linked to a significant increase in illicit trading of opioids through online markets, according to study findings published in BMJ.

Data showed the percentage of total drug sales attributable to prescription opioids doubled from 6.7% to 13.7% in the U.S. during the study period between October 2013 and July 2016.

“The general efficacy of supply side interventions in drug markets is ... under-researched,” James Martin, PhD, department of social sciences, Swinburne University, Australia, and colleagues wrote. “Although understanding has been limited by a lack of detailed information connected to illicit drug supply, knowledge has improved in recent years with the emergence of online illicit marketplaces, or cryptomarkets,” they continued. “The internet has facilitated the sale of licit and illicit drugs for more than 15 years, but when the first cryptomarket ... came online in 2011, illicit drugs began to be traded in large quantities. ... Since 2011, cryptomarkets have been analyzed through the digital traces they leave online.”

Martin and colleagues conducted an interrupted time series analysis to evaluate the effect on the opioid trade through illicit cryptomarkets after the DEA ruled to restrict hydrocodone combination products. Researchers looked at data from 30 of the world’s largest cryptomarkets operating from October 2013 to July 2016 to determine the proportion of total transactions and the advertised and active listings for prescription opioids, sedatives, steroids and stimulants, and illicit opioids. They also examined the composition of the prescription opioid market between the U.S. and other countries.

Analysis showed that the sale of prescription opioids through U.S. cryptomarkets rose after the reclassification of hydrocodone in 2014; however, there were no significant changes in sales of sedatives, steroids, stimulants or illicit opioids, according to the press release. Sales of opioids through cryptomarkets represented 13.7% (95% CI, 11.5-16) of all drug sales in July 2016 compared with a modelled estimate of 6.7% (95% CI, 3.7-9.6) of all sales if the new schedule had not been introduced in the U.S.

This corresponds to a 4% yearly rise in the amount of trade attributed to prescription opioids in the U.S. market, the release said. However, there were no corresponding changes for the sales of other drugs or prescription opioids sold outside the U.S. In addition, the authors observed a change in the type of drugs purchased after reclassification, with oxycodone purchases dropping and fentanyl purchases increasing. Although fentanyl was the least purchased product in the U.S. in mid-2014, it became the second most frequently purchased product bought from cryptomarket sellers in July 2016, the researchers found.

“Although our results show an increase in sales of prescription opioids on cryptomarkets after the schedule change, contemporaneous factors might also have played a causal role,” Martin and colleagues wrote in the full study. “These could include the effect of other public policies enacted over the same period; however, we do not know of any other policies that were implemented as widely as the [DEA’s] schedule change.”

Scott Hadland, MD, PhD
Scott E. Hadland

These results highlight the fact that the opioid epidemic will probably worsen if supply-related interventions are not combined with evidence based-measures to cut demand and reduce harm, Scott E. Hadland, MD, MPH, from Boston Medical Center and Boston University School of Medicine, and Leo Beletsky, JD, MPH, from Northeastern University and UC San Diego School of Medicine, wrote in a related editorial.

“Demand for opioids in the U.S. will decrease sustainably only when high quality, evidence-based prevention and treatment programs are broadly implemented, robustly funded and universally accessible,” they wrote. “The U.S. scheduling scheme inexplicably holds such disparate substances as cannabis, heroin and psilocybin to be equally dangerous. It is high time to rethink how, why and when this regulatory framework is deployed to curb drug-related harms.” – by Savannah Demko

Disclosures: The authors report no relevant financial disclosures. Beletsky reports sitting on the advisory board of a data analytics company with an interest in the U.S. opioid crisis.