A recent article in the Washington Post cited StreetRx, stating crowdsourced data that indicates that

individual pills of hydrocodone or oxycodone can be had for as little as $1 depending on which city you’re in.

Similarly, a recent article in the St. Louis Post-Dispatch, stating:

according to crowdsourced street drug pricing sites like streetRx, it is possible — albeit rare — to find a single pill of some prescription drugs for [one dollar]

 

In our work with StreetRx, Epidemico strives to provide rare and rapid public health insights while supporting the needs and well-being of people who transact in diverted pharmaceutical medicines. The values of transparency, innovation, and beneficence are at the core of what we do at Epidemico, and we are encouraged to see those virtues reflected in ProPublica’s recent response to discoveries about their Prescription Checkup tool.

After creating a tool that sheds light on the prescribing behaviors of doctors around the US, ProPublica learned that it was being used to find providers who might be more likely than their peers to prescribe controlled substances. Some organizations might have reacted by hiding these findings or restricting access to the tool in order to prevent an unintended use of their service. ProPublica’s decision to not only disclose their findings, but to enhance their site with information on drug-related risks and resources available to people who face them, demonstrates a laudable response to the challenges posed by unintended uses of open data systems.

We often receive questions about StreetRx voicing concern about providing information to people seeking diverted prescription medicines. Our response is that the tools are designed such that visitors cannot coordinate transactions nor implicate themselves in criminal activity. Additionally, we recognize a unique opportunity to engage with visitors seeking information about black market drug prices, and respond by pairing pricing information with resources on relevant health and social services.

We applaud ProPublica for their transparent and thoughtful response to unintended use of their tools, and believe that when you build a tool that attracts the attention of vulnerable and marginalized populations, taking the opportunity to meet them where they are at with supportive resources is just the right thing to do.

This post is authored by Mike Gilbert, a Senior Project Manager at Epidemico and avid proponent of applying harm reduction approaches to public health informatics.

Data from StreetRx and the RADARS® System show how much lower the black market street prices are for abuse-deterrent formulation (ADF) prescription opioids and stimulants. For example, OxyContin was 18% lower, Opana 35% lower, Hysingla 51% lower, and Concerta 52% lower.

These data show that people who are buying prescription drugs on the black market are willing to pay more for versions of products that are easier to snort, crush, or chew. Pharmaceutical companies are interested in reducing these unintended uses, and ADFs are one way they try to control how people use their products.

Oxymorphone
The original extended release Oxymorphone product is almost 35% more expensive than its ADF version

Amphetamine
The ADF version of Amphetamine costs about half as much as the original product

Though you might think that cheaper ADFs lead to more misuse of prescription drugs, the data indicate there is actually less demand for products that are harder to snort, crush, or chew. Emerging Epidemico research is exploring how people’s drug use preferences and behaviors change when ADFs enter the market. For more information visit StreetRx.

People who buy prescription drugs on the black market know that the prices vary depending on what you’re buying and where you’re buying it, but that information tends to be localized to their town or social network. StreetRx offers a wider lens for understanding the relationships between product, place, and price, making that information available in real time. This information can be used to better understand the drug abuse epidemic, such as studying whether abuse-deterrent formulations are sold at lower prices on the black market than non-abuse-deterrent formulations, indicating decreased demand and that the abuse-deterrence mechanism is effective.

Differences in black market prices for prescription drugs raise important questions about how these markets function and how that influences people’s health and wellbeing. For instance, the prices of alprazolam (e.g. Xanax, anxiety medication) and hydromorphone (e.g. Dilaudid, pain medication) are higher in Vermont than in New Hampshire. Conversely, methylphenidate (e.g. Ritalin, ADHD medication) and methadone (Methadose, pain and narcotic addiction medication) are cheaper in Vermont than in New Hampshire. Despite a porous border between those states, there seems to be a clear difference in what people will charge and pay for prescription drugs on the black market.

Could this be an effect of Prescription Drug Monitoring Programs influencing prescriber behavior? Maybe there are differences in the availability of other opioids or benzodiazepines in each state that drive down prices. These are important questions to answer, and StreetRx provides us with a first look at the shape of black markets in our communities.

Average street price of prescription drugs
Data collected 11/1/10 – 3/31/16

If you have any questions about how these data are created and analyzed, let us know at info@streetrx.com, or visit StreetRx, which was visited over one million times in the past year!

StreetRx is part of the RADARS System.

RADARS System has released their 2015 Q2 technical report, which uses StreetRx data to determine that the street prices of crush-resistant formulations of OxyContin ER and Opana ER are significantly lower than their crushable equivalents across multiple tablet strengths. As the report states,

These data suggest that buyers of diverted prescription opioids find crush resistant formulations less desirable and support their role in curbing opioid abuse.

Figure 1

Figure 1

Figure 2

Figure 2

In addition, the report notes that, according to StreetRx data, price per mg decreased as tablet strength increased. This may represent a quantity discount phenomenon, by which buyers receive a lower price per mg for larger purchases as sellers minimize distribution risks. As the report states,

These data are the first to report quantity discounts for diverted prescription opioids, which furthers our understanding of the complexities of the diverted opioid market.

Dr. Nabarun Dasgupta recently presented the latest data on black market street prices for drugs for The Researched Abuse, Diversion, and Addiction-Related Surveillance (RADARS) Scientific Advisory Board, and at the 2015 RADARS Annual Meeting.

The data shows that crowdsourcing, systematic efforts to collect information from a wide audience (especially online tools) to mutually benefit participants and activity sponsors, serves as an effective way to evaluate drug abuse in the community, and that the black market can help predict which abuse-deterrent formulations are most successful.

Dasgupta’s presentations include the latest black market street prices for: Lyrica (pregabalin), Neurontin (gabapentin), Zanaflex (tizanidine), Lunesta (eszopiclone), Lunesta (zaleplon), Ambien (zolpidem), Cialis (tadalafil), Viagra (sildenafil), Levitra (vardenafil), Vicodin (hydrocodone), OxyContin (oxycodone), Valium (diazepam), Xanax (alprazolam), Klonopin (clonazepam).

You can find more information in the below presentations:

RADARS SAB

2015 RADARS Annual Meeting

Researchers use black-market drug website to gauge public health

streetrx

Anyone can visit StreetRx to learn about drug prices, and anyone can post information and rate the deals. Hundreds of people around the country contribute reports every day — voluntarily and anonymously.

Researchers are using StreetRx data to gauge the effectiveness of public policy, track changes in the market, and learn more about the people who obtain drugs this way, in the hope of helping them and deterring others. Law enforcement officials check the prices to inform officers buying undercover.

StreetRx is one of several projects by Epidemico, an informatics company established in 2007 by disease-trackers and data scientists from Children’s, Harvard Medical School, and the Massachusetts Institute of Technology.

The website, which includes links to resources such as treatment programs and drug-disposal sites, receives 2,500 unique visitors each day and logs 4,000 to 5,000 drug-price reports per month.

StreetRx’s growing trove of data has caught the attention of public health researchers hungry for information about an otherwise inaccessible population.