As an ‘old timer’ in the field, I remember the seismic shift that followed the emergence of ‘legal highs’. Policy, however, stayed frozen in shock, while the drugs changed and began their migration to online sales. And what of the suppliers? Only a handful of research papers have attempted to understand their motivations and practices, so I thought it would be interesting to contact some of them myself to hear the view from the ‘shop floor’. This resulted in some fascinating conversations and two big questions. How had COVID-19 affected their business, and would they be willing to help me reduce harm to their consumers?
Their answers to the first question mirrored what large-scale surveys and reports such as the Global Drug Survey had already told us. Essentially, drug use had developed its own version of the 5:2 diet – with shortages of product being followed by bulk orders encouraged through special deals and offers. As others have pointed out, crypto-markets are weathering the storm rather well and a range of unfamiliar substances were available if your favourite chemical was not – Alpha-PHP anyone?
The answer to the second question may come as a surprise. They were happy to engage with me in delivering safety messages on their page or in their packaging, including information on dangerous interactions with other drugs. It became evident that they saw themselves as business people with a genuine passion for what they were selling, and had used and enjoyed a range of substances themselves. Though the acquisition of wealth was a driving force, so were positive experiences with the chemicals they were selling. This is an interesting twist on the popular narrative of the dealer as purely motivated by money, and also reminds us that the distinction between user and dealer is often paper thin.
Clearly, ‘my’ sellers may not be representative of the whole sector and as recent research has pointed out, crypto-market suppliers can be seen as being on the frontline of the ‘gentrification’ of the drug business. However, these conversations show that some sellers recognise the importance of a healthy, happy customer base.
It is a small exploratory piece of work to assess whether it may be possible for larger studies to be conducted – it merely explores and questions the assumption that suppliers of illicit drugs are not willing to engage in health-related activity. Over an extended period, I had regular conversations with two sellers and a series of messages ensued. These messages used methods of communication that have previously been used in researching this cohort – email and asynchronous and end-to-end encrypted messaging.
Understanding the market
Over time I was able to disclose that I was a health professional who was interested in understanding the market and assessing the potential for harm reduction, rather than a customer. It is important to stress that Suffolk Police had oversight of this work and no laws were broken. Both sellers were eventually tolerant of this approach and accepted the potential benefit of including messages around safer use. They also both offered insights into how they had adapted following the emergence of COVID-19.
Both individuals were UK based, both sourced their supply directly from China, and both appeared to have other professional careers. While one seller has now ceased trading (to become a delivery driver of course!) there are indications that the other seller has become quite a significant presence on crypto markets – he is listed on a number of market places, which requires a level of organisation and administration that would be beyond a casual or opportunistic supplier, and has recently started selling in larger amounts. He stated that he had recently completed a single sale that accrued £1,800 profit, and that his annual income was in six figures.
During our discussions, it seemed clear that both saw themselves as vendors of products that were risky but also offered pleasure, similar to a supermarket selling alcohol. Both suppliers mentioned that they had ‘preferred customers’ who they trusted and could be said to have become ‘friends’. They would share information on purity and optimal routes of administration as well as general ‘news’ with these clients.
The first seller was by far the most accepting of my position and was willing to participate in the dissemination of harm reduction advice. He sold a range of NPS including analogues of some medications. In collaboration with key partners, a number of packages were purchased and sent for analysis to the Tic Tac database at St Georges Hospital (DDN, January 2014, page 14). Invariably, he was able to accurately list the active ingredients in his products.
He was also very interested in products that would be viewed as positive by his customers and not cause obvious harm – this again runs counter to the notion of a dealer who will sell any drug indiscriminately. This was illustrated by his request for ‘testers’ of his products to provide feedback on their effects. He was willing to include important harm reduction messages within the packaging – for example, each product distributed would include a short message, written by myself, listing basic harm reduction advice.
The other was initially very reluctant to engage but eventually accepted that I did not represent a threat. As the pandemic developed, he was asked about how it was impacting on his bulk deliveries from China. He responded that, ‘My deliveries are still getting through, just taking longer.’
During another exchange he was asked how the current situation was impacting on the quality or quantity of his products. Interestingly, his strategy appeared to be one of buying in advance and selling in bulk rather than dealing in small amounts, suggesting that availability of product was continuing unabated. He was also asked about any changes to the ‘menu’ of products available and whether COVID-19 had limited the number. Again, surprisingly he stated that new substances such as 4f-mar and ‘Isophenidate’ were being acquired. This probably refers to isopropylphenidate hydrochloride, a recently synthesised compound with little history of human use.
Lastly he was asked if he would be willing to add some harm reduction advice related to drug use and COVID-19 to his market page. He stated that he would participate if important new information needed dissemination, but advice was already posted on crypto-market sites and on ‘dark.fail’ – a dark web site that lists current crypto-markets and whether they are open for business.
These interactions show that it is possible to communicate effectively with some dealers of illicit drugs, and it is reasonable to assume that many suppliers are concerned about the welfare of others – a feature of drug culture that could potentially be harnessed by organisations that wish to promote public health.
In relation to COVID-19, these interactions suggest that supply of newer synthetic compounds has continued unabated as has the invention and production of novel psychoactive research chemicals. Perversely, it would appear that logistical difficulties and interruptions to the postal system may encourage vendors to order in advance, source larger amounts of product and sell in bulk.
Clearly, bulk purchasing and sale could lead to negative impacts for end users. But in contrast to the ‘evil dealer’ narrative, gaining a better understanding of the motivations and mindset of drug suppliers may mean it’s possible to reduce risks by further interaction between individual sellers and health promotion agencies in key harm reduction areas such as drug alerts, naloxone and needle exchange distribution. With drug-related deaths and drug harms soaring, it may be time to ask ourselves if we should be engaging better with our online ‘drug supermarkets’.
Renato Masetti is training co-ordinator for Health Outreach NHS/EPUT