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Recognizing Toxidromes From Digitally Accessed Illicit Drugs: New Challenges for Psychiatrists

Recognizing Toxidromes From Digitally Accessed Illicit Drugs: New Challenges for Psychiatrists

Substances available on the Internet and the associated adverse-effect profilesTable 1 – Substances available on the Internet and the associated adve...
Table 2 – Apps and terms frequently used in the online drug tradeTable 2 – Apps and terms frequently used in the online drug trade

In the 21st century, access to illicit drugs has become exponentially easier, especially for youths and young adults—any substance can be obtained from the Internet. In the past, one had to venture out and find someone who would sell the desired substance. Now it’s as easy as a few swipes on a smartphone. Clinicians have been slow to become acquainted with this trend and aren’t necessarily familiar with the methods that patients use to acquire and divert substances; nor do they have much knowledge of the substances themselves.

Since 2009, law enforcement officials in the US have encountered more than 240 new synthetic compounds. Worldwide, the number was reported as 348 in the 2014 United World Drug Report. As quickly as these drugs are regulated through Drug Enforcement Administration Schedules, the formulas change and new compounds are released. These compounds are primarily sold via the Internet and often are imported from China and the Middle East. Despite significant law enforcement efforts, the availability of these substances has not significantly diminished. Table 1 provides a review of several substances that can be obtained in this manner. (View Table 1 in PDF format)

Two sides of cyberspace

Most general search engines provide access to about 1% of the whole of cyberspace. Substances that are regulated by individual states but not the federal government are generally easy to access via the “surface” Web. If one has a gift card or credit card and a mailing address, these substances can be ordered with ease. Several of the substances that are thus available include the newer synthetic compounds. Many of these compounds are appealing to the potential buyer because they tend to be inexpensive, easily concealed, and untraceable on conventional drug screens.

When synthetic cannabinoids (for example, “K2” or “spice”) first came out, they were widely available in the retail market—and even on mainstream online markets. In 2011, they were removed and classified as controlled substances. Other substances of abuse that are not yet federally regulated, such as kratom and salvia, are still available on several mainstream online marketplaces.

Another access point for illicit substances is social media. Dealers and buyers have used different apps to market these substances and arrange the terms of sale. (Table 2 lists apps and defines terms that are frequently used in this process.) Most of the sales via social media tend to be of cannabis, prescription pills, and liquid promethazine-codeine cough syrup. Xanax, Adderall, and oxycodone are among the most popular pills, as well as some synthetic addiction-management treatments such as Suboxone (combination of buprenorphine and naloxone) and Subutex (buprenorphine). MDMA, LSD, and ketamine are also easily accessed.

The owners of these social media sites have tried to decrease drug trade, but it has proved a daunting task. Sales of substances like heroin and cocaine are rare in these arenas, probably because of the harsh penalties associated with trafficking these substances. However, persons who seek access to those substances search the Darknet via browsers that make Internet communications anonymous.


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