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    The Price We Pay on the Black Market for Prescription Downers

    Photo via Flickr / CC. 

    If the proverbial street does not lie, then what about all the semi-faceless people locked in handshake drug deals in the bombed-out middle of the block? Do they not lie too?

    A grasp on price and potency is critical to our understanding of why people are or are not using particular substances. It's those very people, the people buying and selling and using the goods, who for now, at least, still hold the keys to a more detailed, nuanced picture of American drug use. Can we take their word? Even if they are faithfully calling it how it is, when it comes to the price and pharmalogic potentcy of, say, over a half dozen black-market opioids, just how accurate is the crowd? 

    As it turns out, very. New research suggests not only that crowdsourced data can provide a fairly precise projection of going street prices for drugs, but that the black market, an amorphous, yet decidedly digital underground the reseachers say is "ostensibly free", can accurately predict just how potent those substances are. In this case, it's a slate of common prescription opioids that have been diverted to the illegal markets. 

    The research was recently published in the Journal for Internet Research, and used crowdsourced street data from StreetRx, the Silk Road online drugs marketplace, and reference data from the Researched Abuse, Diversion and Addiction Related Surveillance, or RADARS, a drug-diversion program out of the Rocky Mountain Poison and Drug Center that scoops up data on a quarterly basis from roughly 280 law enforcement agencies in 49 states. And while information about street deals are indeed gathered by local and regional police and then shaken out by projects like RADARS, the study notes that only occassionally have these data "been reported at a national level", and that's only on the rare instances that they are actually "made available for public health research". 

    Remember the Department of Justice's National Drug Intelligence Center? You know, the go-to federal source for these kinds of figures? No? That's probably because the NDIC is no longer an actual thing. The Center was shuttered in June 2010, a line-item cut in a sweeping rearrangement of federal drug policy that now offers no promise of making this sort of data available for the forseeable future. 

    It's an information gap as old and wide as drug prohibition itself. The workaround, to hear the researchers tell it, lay in harnessing the knowledge of the masses.

    "Crowdsourcing is a rapid and cost-effective way to gather information about sales transactions," the study's researchers write. "We sought to determine whether crowdsourcing can provide accurate measurements of the street price of diverted prescription opioid medications."

    From the study

    Here's how it worked. The team used StreetRx, a street-level research site, to call for data regarding how much money site users shelled out for diverted prescription opioids in the front half of 2012. In the end, the effort netted 954 price reports from StreetRx, the results of which the researchers compared with 737 such reports gleaned from surveys of RADARS law enforcement officers, and also with 147 reports of transaction prices on the Silk Road.

    They say they rolled 95 percent confidence levels into the calculations that allowed them to compare per-milligram domestic drug prices in USD. The study even included a secondary analysis, a side-by-side comparison of per-milligram rates of a morphine equivalent done through equianalgesic dose conversions.

    What they found is that the correlations between the three data sources were "highly linear". Across seven distinct opioids, they found only one siginificant discepancy within data from the three pools: Morphine had a RADARS price of USD$0.67/mg, and a Silk Road tag of US$0.42/mg (95% CI 0.37-0.48). Beyond that, the crowdsourced data quite accurately predicted the "relative pharmacologic potency of opioid molecules.

    Don't just take my word for it. Check out the findings for yourself. It's worth remembering, too, the growing divisions between those on, say, methadone and those on buprenorphine maintenace. This is something my colleague Kelly Bourdet has reported on extensively. 

    But if anything, the study shores up the potential truth in the crowd. We've got the Price of Weed, sure, and we've already seen the value of crowdsourced data when it comes to tracking rates as diffuse as the global illegal wildlife trade and the incidence of infectious disease. With the meteoric rise of so-called new psychoactive substances standing to be priced and analyzed through crowdsourcing data, as well, the ghost of the NDIC has no reason to keep believing the lie. 

    @thebanderson

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