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Dark-web deal­ers are quit­ting Class As to push a new kind of stash – pre­scrip­tion med­i­ca­tions – and young Bri­tish men are among their pri­mary tar­gets. With on­line anonymity mak­ing trans­ac­tions eas­ier than ever, can the prob­lem be un­tan­gled? MH re­ports fro

Men's Health (UK) - - In This Issue - Words by Alex Har­ris – Pho­tog­ra­phy by Jonathan Min­ster

It’s a muggy morn­ing, and Men’s Health has a front-row seat at the de­noue­ment of a high-level drugs in­ves­ti­ga­tion. An ex­haus­tive, long-term probe into a thriv­ing or­gan­ised crime net­work has led a group of govern­ment agents and re­gional po­lice to a Pre­mier Inn car park in Sh­effield*. Here, they con­duct the fi­nal brief­ing be­fore the cli­mac­tic drugs bust.

Heavy clouds threaten rain as the team weaves through traf­fic to the raid site. Sev­eral un­marked ve­hi­cles sur­round an or­di­nary-look­ing build­ing – thought to be the gang’s base of op­er­a­tions – on an un­re­mark­able main road. Pedes­tri­ans amble past, obliv­i­ous to what will soon take place. In­side, the perps go about their busi­ness as the team, coiled like a spring, waits for the sig­nal.

Ra­dios crack. Vans dis­gorge of­fi­cers, who sprint across the busy streets and un­cer­e­mo­ni­ously smash doors off their hinges. In one of the re­main­ing cars, a few of­fi­cers wait in si­lence. Then, a phone rings. “They’ve hit the jack­pot,” an an­a­lyst says, end­ing the call. “No money. Just prod­uct. Lots of prod­uct. Let’s get in there.”

Metic­u­lously or­gan­ised on plas­tic shelves are count­less drugs, now be­ing packed into ev­i­dence bags. But there’s no ec­stasy or coke here, and the govern­ment agents me­thod­i­cally sort­ing through their haul with black-gloved hands aren’t or­di­nary narcs: they be­long to nei­ther the Na­tional Crime Agency nor CID. They aren’t spooks or un­der­cover op­er­a­tives. They’re medicine reg­u­la­tors, more in­ter­ested in codeine than co­caine. The so­phis­ti­cated crim­i­nals taken down to­day fall un­der their ju­ris­dic­tion.

Like many drug deal­ers to­day, this gang chose not to sell Class As but med­i­ca­tions. They were il­le­gally peddling erec­tile dys­func­tion (ED) pills, hair-loss tablets, steroids and cancer drugs – and it is the re­spon­si­bil­ity of the Medicines and Health­care Prod­ucts Reg­u­la­tory Agency (MHRA) to stop them reach­ing your doorstep.

We have en­tered a new era of crime, but most peo­ple – in­clud­ing many govern­ment min­is­ters and some po­lice of­fi­cers – have yet to no­tice. To­day, al­most half of all UK crimes are com­mit­ted on­line. Drug deal­ers, in par­tic­u­lar, are adopt­ing cut­tingedge dig­i­tal tech at such a pace that law en­force­ment is strug­gling to keep up. The prod­uct is chang­ing, too. In the past five years, the MHRA has seized al­most £50m worth of ED drugs; mean­while, mil­lions of men­tal health drugs have en­tered the UK black mar­ket. And that’s just scratch­ing the sur­face. “There’s a shift hap­pen­ing,” says Kate Mcma­hon, the an­a­lyst from the car. “Or­gan­ised crim­i­nals are mov­ing pre­scrip­tion meds.” It’s a risk-re­ward thing: in­stead of 40 years in jail, they’re look­ing at just a few years and a pos­si­ble fine.

Gangs have also cot­toned on to our seem­ingly ever-in­creas­ing ap­petite for self-med­i­ca­tion. The shift in method­ol­ogy is, in part, a case of supply ad­just­ing to meet de­mand: peo­ple are will­ing to go to ex­treme lengths to buy off-the-books meds, which means there’s easy money to be made. “Class A drugs might be what peo­ple talk about, but this is really af­fect­ing peo­ple’s lives,” says Mcma­hon.

The il­le­gal dis­tri­bu­tion of med­i­ca­tions is pri­mar­ily a dot-com prob­lem. Al­most any pre­scrip­tion drug can be de­liv­ered to your door via a web­site de­signed to look like that of a le­git­i­mate phar­macy, or through the “dark web” – encrypted, unin­dexed sites that ex­ist be­yond the reach of search en­gines. What you buy here lands through your let­ter box with all the ex­pe­di­ency of an Ama­zon Prime de­liv­ery. And for­get the stereo­types of nerds and hack­ers in­putting neon-green code on a black screen (though those peo­ple love the dark web, too). More or­di­nary Bri­tish men are us­ing it than any­one had pre­vi­ously imag­ined.

Grasp­ing in the Dark

Un­til rel­a­tively re­cently, drugs couldn’t reach the end user with­out some palmto-palm ac­tion. Thanks to the back al­leys of the in­ter­net, how­ever, you can now by­pass risky con­tact al­to­gether. And it seems that we are tak­ing full ad­van­tage of this: ac­cord­ing to the 2018 Global Drug Sur­vey, the UK is the world’s third-big­gest pur­chaser of nar­cotics on the dark web. So alarm­ing is this trend that the Euro­pean Mon­i­tor­ing Cen­tre for Drugs and Drug Ad­dic­tion (EMCDDA) has pub­lished a re­port specif­i­cally tack­ling the is­sue. “It seems likely that on­line mar­kets could dis­rupt drug deal­ing in the same way that ebay, Ama­zon and Paypal have rev­o­lu­tionised the re­tail ex­pe­ri­ence,” says Alexis Goos­deel, the EMCDDA’S di­rec­tor.

Adam Win­stock, psy­chi­a­trist and founder of the Global Drug Sur­vey, ex­plains that it’s coun­tries such as the UK with strict drug laws and a pro­lif­er­a­tion of CCTV that tend to have the most peo­ple scor­ing on­line. Dark-web mar­ket­places are set up to shroud trans­ac­tions, wip­ing de­liv­ery ad­dresses im­me­di­ately af­ter dis­patch. “Iden­ti­fy­ing who the users and sell­ers are is chal­leng­ing,” says MHRA dig­i­tal an­a­lyst John Hickey. Even de­ter­min­ing which deal­ers are based in the UK can prove in­cred­i­bly dif­fi­cult.

“The drugs you buy on the dark web ar­rive with all the ex­pe­di­ency of Ama­zon Prime”

The MHRA of­ten catches crim­i­nals, such as those be­hind the Sh­effield oper­a­tion, by fol­low­ing the money trail. “It’s how we iden­tify the big play­ers, and it’s of­ten how we pros­e­cute,” says Mcma­hon. “We have a team ded­i­cated to fraud and money laun­der­ing.” A con­vic­tion for fi­nan­cial crimes can lead to longer prison terms than pros­e­cu­tion un­der the Mis­use of Drugs Act. But the rise of cryp­tocur­ren­cies such as Bit­coin has com­pli­cated this, too, mak­ing pay­ments un­trace­able.

Among the most wor­ry­ing as­pects of the dot-com medicines cri­sis is how many of the users are nor­mal peo­ple. Thanks to user-friendly browsers such as Tor, which has mil­lions of ac­tive users, the dark web is eas­ily ac­ces­si­ble to even the most techno­pho­bic 21st-cen­tury Lud­dite. “Five years ago, the great ma­jor­ity of peo­ple were very cau­tious,” says Hickey. “But talk­ing to younger guys now, it’s clear they have no fear of the dark web. Cu­rios­ity takes them there. I wouldn’t be sur­prised if a lot of older guys were on there, too.”

Of­ten, th­ese medicines are im­ported from parts of Asia, where poorly reg­u­lated man­u­fac­tur­ers abound. At our bor­ders, the MHRA in­ter­cepts ev­ery­thing from sea con­tain­ers to clothes packed with con­tra­band. The main prob­lem with th­ese un­reg­u­lated knock-offs is pu­rity: they have been found to con­tain rat poi­son, an­tifreeze and other things you wouldn’t want to swal­low. Then there’s the is­sue of strength. Some­thing as be­nign as Ka­m­a­gra – an ED drug – can have such a high level of the base com­pound that it could dam­age your heart.

Self-med­i­cat­ing with­out a doc­tor’s guid­ance is, of course, a fool’s game. In a re­cent high-pro­file case, sev­eral peo­ple died af­ter over­dos­ing on fen­tanyl, a po­tent syn­thetic opi­oid, which they had bought on the dark web. They were cus­tomers of a man named Kyle Enos, who had dis­trib­uted the drug from his flat in Wales, some­times of­fer­ing buy-one-get-one-free deals. Enos is now serv­ing an eight-year prison sen­tence. (In­ves­ti­ga­tors could not prove con­clu­sively that Enos had sup­plied the spe­cific drugs that killed them.) His wares came from China.

But not ev­ery­thing orig­i­nates over­seas. The UK has a prob­lem that the MHRA clas­si­fies as the “di­ver­sion of medicines”: a term for when drugs are si­phoned from the le­gal supply chain and sold on. It could be at the man­u­fac­turer’s end, in tran­sit, or, as is of­ten the case, from cor­rupt phar­ma­cists. That may sound like some­thing out of Break­ing Bad, but the prob­lem is all too real for reg­u­la­tors. Be­tween 2013 and 2016, £200m worth of medicines dis­ap­peared from the supply chain, to be sold on the black mar­ket.

Many dif­fer­ent drugs are moved, but a pop­u­lar choice is men­tal health medicines. “We’re talk­ing about drugs like di­azepam [of­ten taken for anx­i­ety] and temazepam [for in­som­nia],” says Mcma­hon. “Pack­ets of di­azepam are be­ing sold for £40 or £50. Some of th­ese medicines are highly ad­dic­tive, which can have cat­a­strophic re­sults. Tack­ling this is one of our top pri­or­i­ties at the mo­ment.”

The Chill Pills

The mis­use of men­tal health meds is hard to quan­tify and even harder to in­sti­gate ac­tion against. The dark web makes track­ing sales a Sisyphean task, and bring­ing mean­ing­ful sta­tis­tics to politi­cians can be more dif­fi­cult than rolling boul­ders up Lon­don’s Par­lia­ment Hill.

It was for this rea­son that Cy­lab, a pri­vacy and security re­search in­sti­tute at Carnegie Mel­lon Univer­sity in the US, at­tempted to quan­tify what it could within the now de­funct dark-web mar­ket­place Silk Road (which, be­fore its clo­sure, pro­cessed more than $1.2bn in sales). The re­searchers found that the four most pop­u­lar sales cat­e­gories were drug re­lated – nine of the top 10. That Silk Road was osten­si­bly a drugs mar­ket­place wasn’t sur­pris­ing. But what was sur­pris­ing were the types of drugs be­ing bought.

Weed was num­ber one, as you’d ex­pect. At sec­ond place were mis­cel­la­neous “drugs” – those that the seller hadn’t fur­ther clas­si­fied. Num­bers three and four were the real humdingers: “pre­scrip­tion” and “ben­zos”, re­spec­tively, the lat­ter a col­lo­qui­al­ism for ben­zo­di­azepines: med­i­ca­tions such as Val­ium and other anti-anx­i­ety drugs. Th­ese came far above co­caine, at num­ber eight, and MDMA, at num­ber 12.

Af­ter Silk Road was dis­man­tled, other dark-web mar­ket­places were quickly es­tab­lished, with ev­ery shop shut down seem­ingly re­placed by an­other two. Re­searchers have cast the net wider, and the stats are alarm­ing. The UK, the Ox­ford In­ter­net In­sti­tute found, is sec­ond only to the US as a black-mar­ket con­sumer of the anti-anx­i­ety drug Xanax, and more than a fifth of Xanax trades on the dark web are in the UK. Over­doses of the drug can be fa­tal. While some of its pop­u­lar­ity can be at­trib­uted to the use of ben­zos by rap­pers (the artist Lil Peep died from an over­dose of Xanax and fen­tanyl last year), it is also con­sid­ered a symp­tom of an over­stressed, anx­ious pop­u­lace look­ing for an es­cape.

“In just three years, £200m worth of meds en­tered the UK’S black mar­ket”

The US is al­ready treat­ing the spi­ralling use of il­licit men­tal health drugs as an emer­gency. Now, many MPS are warn­ing of an emerg­ing cri­sis in the UK – but we’re al­ready well be­yond that stage. We know that 130 mil­lion benzo drugs have en­tered the UK black mar­ket since 2014, but the dark web’s secrecy makes the real num­ber hard to pin down. It is doubt­less far higher.

Take It Like a Man

It’s un­likely to be a co­in­ci­dence that all of this comes at a time when re­ported cases of men­tal ill health have in­creased by a third in just four years. Prom­i­nent among the ris­ing con­di­tions are three that are in­trin­si­cally male: big­orexia (body dys­mor­phia among men), im­po­tence and per­for­mance anx­i­ety. All are per­ceived to have a phar­ma­ceu­ti­cal so­lu­tion.

Body dys­mor­phia is an all-con­sum­ing con­di­tion that of­ten re­sults in one un­to­ward pur­chase or an­other. Aside from the hu­man ap­petite for cheats and quick fixes, the boom in steroid use can be linked to in­dus­trial de­cline and the loss of more tra­di­tion­ally “mas­cu­line” jobs. “Even when you’ve lost con­trol over as­pects of your life, you still have con­trol over your body,” says Jim Mcveigh, di­rec­tor of the Pub­lic Health In­sti­tute. “Th­ese aren’t crazy peo­ple tak­ing de­ci­sions with no ba­sis in logic. For many, it makes sense in their minds. Un­til we go be­hind the head­lines to see how in­tel­li­gent they are and ac­tu­ally try to un­der­stand their mo­ti­va­tions, we won’t be able to en­gage with them.”

The Sh­effield gang shifted steroids by the buck­et­load, along­side growth hor­mone and breast cancer med­i­ca­tion, which some men use to cut fat from the pecs area. It’s not by chance that so many are find­ing th­ese drugs. The fake on­line phar­ma­cies are de­signed to play on our big­gest in­se­cu­ri­ties, or, per­haps, our hon­est mo­ti­va­tions.

“Crim­i­nals are us­ing an­a­lyt­ics to tar­get vul­ner­a­ble peo­ple – those search­ing for things like ‘lose weight fast’ or ‘cheap diet pills’,” says MHRA spokesper­son Joseph Groszewski. “We’re see­ing a level of so­phis­ti­ca­tion where they can track your in­ter­ests, then trick you with le­git­i­mate-look­ing ad­verts.” Steroids? Add them to your bas­ket. And how about some hair-loss meds with that?

“It’s not un­com­mon to find steroids be­ing sold on the same web­sites as, say, ED meds,” says Hickey. “They use func­tions sim­i­lar to those you see on Ama­zon – if you bought this, then you might like this. It’s like an on­line su­per­mar­ket for drugs.”

Hard Truths

It’s well doc­u­mented that steroid use can cause erec­tile prob­lems, and many users take ED pills as part of their stack. Less well known is the ex­tent to which such prob­lems are pro­lif­er­at­ing among the gen­eral pop­u­la­tion. The MHRA’S £50m haul of ED pills is likely only a frac­tion of what is be­ing shifted il­le­gally in the UK; the num­ber of drugs that slip through the net is any­one’s guess. And if we know that fake phar­macy users are gen­er­ally younger than the con­ven­tional ED age bracket of 60-plus, then an im­por­tant ques­tion arises: who is tak­ing them?

ED suf­fered by mil­len­ni­als is woe­fully un­der­ser­viced and un­der-re­ported, due in no small part to the shame that many feel about their con­di­tion. But, ac­cord­ing to a study in the Jour­nal of Sex­ual Medicine, a quar­ter of new ED pa­tients are un­der the age of 40. It’s un­likely that there has been a sud­den surge of phys­i­o­log­i­cal dif­fi­cul­ties in men in their teens and twen­ties – were that the case, we’d be see­ing an epi­demic of re­lated is­sues, such as heart dis­ease. Some ex­perts posit in­stead that the in­crease is re­lated to a psy­chogenic dis­or­der called porn-in­duced erec­tile dys­func­tion. The the­ory – and it re­mains a the­ory, as peer-re­viewed test­ing is

pend­ing – is that the vol­ume of (and easy ac­cess to) pornog­ra­phy in the dig­i­tal age is burn­ing us out. There are num­bers to back this up: men are vis­it­ing porn detox sites such as Re­boot Na­tion and Your Brain on Porn in their hun­dreds of thou­sands.

“There are thou­sands of sites sell­ing ED meds,” says Hickey. “A lot of men are buy­ing them, whether that’s be­cause they’re on other drugs, or they’re too em­bar­rassed to dis­cuss it with their GP.” To com­bat this, Vi­a­gra – which used to re­quire a red-faced chat with a doc­tor who prob­a­bly knows your wife and fam­ily – can now be bought over the counter. But it still re­quires speak­ing to phar­ma­cists, most of whom are fe­male. “I haven’t no­ticed a drop-off in [il­le­gal] sales be­cause of it,” says Hickey.

It seems that many men are in­tent on con­tin­u­ing to shop il­le­gally for drugs on­line, putting their lives at risk. Pro­fes­sor Win­stock con­sid­ers it the nat­u­ral next step for a so­ci­ety spoiled by con­ve­nience and the ex­pec­ta­tion of a large prod­uct range for ev­ery­thing. When it comes to meds, un­re­al­is­tic ideals are driv­ing us to­wards th­ese phar­ma­ceu­ti­cal so­lu­tions. Men have unattain­ably high ex­pec­ta­tions of them­selves and even higher ex­pec­ta­tions of sex, and it’s get­ting us down. We need to talk more about body dis­sat­is­fac­tion and our anx­i­eties. We need to start look­ing at steroid users as peo­ple with men­tal health dis­or­ders, treat­ing them with em­pa­thy, rather than la­belling them

as freaks. It stands to rea­son that th­ese prob­lems are un­der­pin­ning many of the un­safe on­line medicine sales.

Lead­ing Lights

Dark-web deal­ers are be­com­ing ever more dan­ger­ous and elu­sive. Fight­ing dot-com drug deal­ers is like bat­tling the Hy­dra: Silk Road is gone but, since its demise, there has been a three­fold in­crease in the il­licit sale of drugs on­line. The “sur­face web” is no less elu­sive. “Web­sites are wis­ing up to our meth­ods,” Mcma­hon says. Crim­i­nals are be­com­ing ever more so­phis­ti­cated, which is a chal­lenge to all law-en­force­ment agen­cies – whether they are tack­ling cy­ber-fraud or cy­ber-chemists. “How do you po­lice the in­ter­net?”

In Por­tu­gal, which de­crim­i­nalised il­le­gal drugs 17 years ago, just three in ev­ery mil­lion peo­ple die from an over­dose, com­pared to the EU av­er­age of 17.3. The dark web’s trade in med­i­ca­tions, how­ever, re­quires a dif­fer­ent so­lu­tion: af­ter all, you can’t de­crim­i­nalise drugs that are also pre­scribed legally. Per­haps we should look to the US for point­ers. There, some of th­ese med­i­ca­tions have been democra­tised in the pri­vate sec­tor, and start-ups are help­ing to ed­u­cate peo­ple about the is­sues and al­low them to shop safely. Hims, an on­line com­pany that of­fers anony­mous, doc­tor-dis­pensed ED and hair-loss meds, has been such a suc­cess that a re­cent val­u­a­tion pegged it at $800m. There’s clearly a hunger for sim­pler, sub­tler trans­ac­tions for drugs that many peo­ple are too em­bar­rassed to buy openly. With­out such a change, men will con­tinue to weigh safety against dis­cre­tion and make the wrong de­ci­sion.

The mo­ti­va­tions be­hind the pur­chases of de­pres­sion and anx­i­ety meds are less clear, but the prob­lem is in­dica­tive of the wider web in which male men­tal health is en­tan­gled. For many men, there are few places to seek help with­out feel­ing shame. Anonymity is, per­haps, at the heart of it all – the lack of which is driv­ing men away from the GP’S of­fice and into the hands of on­line drug deal­ers. Un­til we dis­man­tle the need­less stigma sur­round­ing men­tal ill health, anx­i­ety and other par­tic­u­larly male prob­lems, the dark web’s prom­ise of go­ing incog­nito will con­tinue to lure vic­tims – and the fu­ture won’t just be dark on­line, but in the real world, too.

“The deal­ers are be­com­ing ever more tech-savvy. Can we po­lice the in­ter­net?”

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