Researchers use black-market drug website to gauge public health

Screenshot from streetrx.com website.

On Friday, someone in New Bedford paid a dealer $2 for a 5-milligram hydrocodone pill, a price deemed “cheap” in the busy black market for prescription opioids. That same day in Winchendon, a person spent $5 on a 30-milligram Adderall, rated “not bad” for the popular stimulant.

The sales are illegal. But that didn’t stop buyers and sellers from reporting the transactions on StreetRx.com , a five-year-old website that offers a glimpse into the shadowy world of illicit drug sales at a time when an epidemic of opioid abuse rampages through the Northeast.

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.

Although it peers into the black market, StreetRx is far removed from the street: It bears a respectable dot-com address and an academic pedigree.

And to the unending surprise of its creators, the website is booming.

“Of all the crowd-sourcing projects I’ve been involved with, this is the most successful,” said John S. Brownstein of Boston Children’s Hospital, a cofounder of the site. “It’s not been promoted. It’s a completely grass-roots data entry.”

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.

“It’s an innovative approach to try to harness the information age to advance public health,” said Dr. Caleb Alexander, codirector of the Johns Hopkins Center for Drug Safety and Effectiveness, who is not involved with StreetRx but has used its data in his research.

For example, when the maker of OxyContin changed the formulation so it would be harder to crush for snorting or injection, StreetRx showed that the price of the new OxyContin dropped.

“It really shows the value of these abuse-deterrent formulations. People definitely don’t like them as well,” said Dr. Richard C. Dart, director of the Rocky Mountain Poison and Drug Center in Denver, who helped found StreetRx. On Friday, StreetRx presented data to pharmaceutical companies and federal regulators that compared three types of drug formulations intended to deter abuse, showing which is most effective.

The website is primarily focused on prescription drugs because they come in precise dosages whose prices can be easily compared. Heroin sales are sometimes reported on StreetRx, but quantities and potency can be inexact, making price comparisons difficult.

To use StreetRx, people fill out an online form with the name of the drug, the formulation (such as pill or tablet), price per unit, dose, date, and location of the sale, and source of the price information — whether personal experience or word of mouth.

Anyone can click on others’ purchases to rate the price as “cheap,” “not bad,” “reasonable,” “pricey,” or “overpriced.” People who use the site do not identify themselves, and StreetRx says it has no way of tracing them.

The website also cannot verify the accuracy of any individual post. But an Epidemico study found that, overall, the prices jibe with what is seen in law enforcement surveys and on websites that sell illegal drugs.

StreetRx started with conversations between Dart and the three cofounders of Epidemico, Nabarun Dasgupta, Clark Freifeld, and Brownstein. Dart heads the RADARS System (Researched Abuse, Diversion, and Addiction-related Surveillance), which tracks drug abuse, misuse, and diversion for pharmaceutical companies.

Dart wanted data that were up-to-date and included more drugs, to supplement what RADARS was learning from surveys of law enforcement officials. He was familiar with Epidemico’s work at the forefront of a growing trend to mine online sources for public health purposes.

Epidemico launched StreetRx in 2010. It is part of the RADARS System, which is funded by pharmaceutical companies. The companies pay a yearly subscription fee to track illegal use of their drugs, as a way to meet federal regulations requiring drug makers to ensure that their products’ benefits outweigh the risks. Subscribers are barred by contract from access to the raw data or any role in the website’s design or related research.

StreetRx got off to a slow start. It took more than a year for the site to attract significant numbers. Now, it is slowly expanding into seven other countries.

Why do people post drug prices on StreetRx? “Who knows?” said the site’s project manager, Chris Menone. The people reporting on StreetRx are probably a small subset of those buying drugs on the black market, he said, and there’s no way to know how representative they are. “We can’t know anything about them. We have no demographic information. That’s a challenge; it’s also a necessity,” he said.

Recently, StreetRx started posing questions to users, an experiment to study the link between health behavior and prices, said Dasgupta, the Epidemico cofounder. Today, at the bottom of the form used to enter price information, they are asked, “When did you last see a doctor?”

Those who have seen a clinician recently are more likely to be people who sought treatment for pain, who may have fallen into substance misuse after being prescribed opioid painkillers, health experts believe.

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

Alexander, of Johns Hopkins, traced the connection between drugs sold at pharmacies and those sold on the street.

In an as-yet unpublished study, Alexander and colleagues looked at the prices of 10 drugs that can lead to addiction or abuse. They compared the out-of-pocket costs for the drugs bought in pharmacies with their street prices as listed on StreetRx.

In areas where costs were low in the pharmacies, costs were lower on the street as well. Pharmacy prices also tended to be lower in areas where pharmacies were selling higher volumes of the 10 drugs.

“Our findings add to growing evidence that a key driver of the epidemic [of opioid abuse] is the incredible volume of opioids dispensed in the United States,” Alexander said.

Other researchers see great potential in StreetRx to inform public policy. Dara Lee Luca, a visiting assistant professor at Harvard’s John F. Kennedy School of Government, plans to study how street prices of opioids and heroin changed after Florida abruptly shut down pain clinics that were overprescribing.

And Margie Skeer, assistant professor of public health and community medicine at Tufts University School of Medicine, is seeking funding to open discussion forums on StreetRx. Skeer would pose questions to drug users, such as how they first got involved with drugs — information that could inform prevention efforts.