[forums] What Doctors Can Learn From the Dark Web

[Chip (OP)]

source: https://www.theatlantic.com/technology/archive/2019/10/what-dark-web-can-teach-us-about-opioid-crisis/600352/

EDIT: Why the Dark Web in particular ?

What Doctors Can Learn From the Dark Web

Oct 20, 2019

Opioid addicts are turning to online forums for advice about quitting. Their conversations have a lot to teach us about drug use and public health.

Ryan Le Blanc got his first dose of opioids at three months old, after surgery for a unilateral cleft palate. Now in his late 20s, the English-as-a-second-language teacher has gone through about 15 more surgeries of varying severity.

With each operation came new painkillers. At 14, while living in New England, Le Blanc started buying and using illegal opioids for fun. By 16, he was injecting heroin, a habit that he carried from high school through college graduation.

As a teenager, Le Blanc came across Bluelight.org, a drug forum now more than 20 years old. He read post after post—innumerable lines of text and images about the substances he was taking, how to take them safely, and how to quit.

Today these threads aren’t just of interest to the site’s users. As the opioid epidemic worsens, claiming about 130 lives a day in 2018 in the United States alone, a cadre of researchers is looking for solutions to addiction and overdoses in the sprawl of drug forums. The researchers say that drug forums on the dark web—a catchall term for internet hubs that are often encrypted or unavailable through regular search engines—along with more mainstream counterparts such as Bluelight and opioid drug-related threads on the website Reddit, might be medical or research tools in their own right.

For instance, in research published this spring, Stevie Chancellor, a postdoctoral fellow in computer science at Northwestern University, used computational linguistics and machine learning—a subset of artificial intelligence—to find out how forum-goers on Reddit attempt to get sober. “We wanted to unearth the things the doctors didn’t even know about,” Chancellor says.

Chancellor and other academics, as well as advocates of harm reduction (a philosophy that seeks to minimize the negative effects of drug use), believe that drug forums can provide insight into a secretive subset of society. The forums could also provide a route to reach users with potentially life-saving information about drugs.

Working with these communities has presented challenges. Some researchers in this relatively new field have trouble collecting data, particularly when law enforcement busts an illicit marketplace. But both researchers and people who use the forums to quit drugs believe that there’s value in the chatter.


In Chancellor’s machine-learning study, she and her colleagues built a computer program to recognize distinct words and phrases in nearly 1.5 million posts on 63 subreddits where people discussed opioid-addiction recovery. The program found that many Redditors who were trying to quit heroin and fentanyl, a potent synthetic opioid, were using other drugs to do it.

Chancellor was surprised, but the approach is common on the forums, though sometimes discouraged by moderators and other users: People may use alcohol, cannabis, or heavier drugs to quell withdrawal symptoms. Le Blanc was no exception. At 22, he tried to quit opioids using other drugs, although three years later, after a family intervention, he entered a formal methadone program, which uses a lower-grade narcotic to wean users off harder drugs. As of a few months ago, he quit using maintenance drugs, working toward true sobriety to be free of opioids altogether.

Chancellor’s team found other examples of drugs that Redditors leaned on to quit opioids: benzodiazepines such as Valium or Xanax; the anti-diarrheal drug Imodium; ibogaine, a psychoactive plant substance with alleged anti-addiction properties; and kratom, a powdered preparation of a plant that, taken in large enough doses, can cause opioidlike sensations. Others used relatively weak opioids such as codeine to step back from heroin or fentanyl. And the forum-goers also developed elaborate dosing regimens to get through a workday relatively unscathed by withdrawal.

Any benefit from self-administered treatments would need to be verified or tweaked by medical professionals, Chancellor says. Mixing some of these drugs can be deadly. Even Imodium, when taken at recreational doses—more than 15 times the therapeutic dose—can cause severe heart problems.

The fact that people are using such an array of drugs to quit opioids is a clinical and medical blind spot, Chancellor says: “I think there’s a lot of potential for communities to back-inform what could be productive investigations for medical researchers.”

Online forums may provide other useful data and anecdotes for researchers. For Monica Barratt—a psychologist and sociologist at the Royal Melbourne Institute of Technology in Australia, as well as Bluelight’s director of research—they could hold the answer to a complex question: How has the rise of dark-web markets affected public health?

Barratt studies the intersection of drugs and the internet. Through interviews and surveys with these secretive communities, as well as forensic data from local police, she hopes, in part, to discover if the availability of mail-order illicit substances encourages more people to use drugs, or if they would be using them anyway. So far it seems to be the latter, Barratt says.

Indeed, the forums can also be a relatively judgment-free place for users to turn when looking to quit drugs. For some, choosing a DIY detox, including those Chancellor studied, is a matter of preference. But for others, it’s a matter of necessity. In rural areas such as New England, where Le Blanc experienced detoxing firsthand, the few addiction clinics are spread thinly across the region. Patients may travel hours each day for medication.

With no real option for in-person treatment, internet-savvy drug users who want to detox have few choices: They can detox blindly, or turn to their peers’ collective knowledge online. Barratt argues that the latter can provide “a safe place for people to talk about what’s going on and to ask questions.” The semi-anonymous nature of the markets may also cut down on some of the violence that comes with street-level dealing, such as robbery, theft, and assault, other research has suggested.

Despite the upsides for some people who want to quit opioids, the dark web still poses problems both for law enforcement and users. Alongside the forums for detoxing are others dedicated to taking drugs, as well as marketplaces that sell drugs such as heroin tainted with fentanyl.

Read: The surprising ease of buying fentanyl online

While the drugs are online, the dark web is not a big contributor compared with the broader global illegal drug trade, says Neil Walsh, the chief of the United Nations Office on Drugs and Crime’s (UNODC) cybercrime and anti-money-laundering units. Online sales are similar in amount and cost to those of a street-level dealer—priced to sell in small doses, not in bulk.

Still, Walsh adds, the everyday internet and the dark web can connect large-scale dealers with the laboratories that produce drugs such as fentanyl, or the chemicals needed to make them. The online marketplaces also offer chemicals that aren’t typically found on a street corner. These “designer drugs” or “research chemicals” are intentionally obscure and— until laws change to ban them—chemically different enough from better-known drugs to be technically legal.

Despite the dark web’s relatively small piece of the drug trade, law-enforcement agencies around the world are trying to shut down its markets. By some accounts, the approach is working. According to Walsh, after Operation Bayonet in 2017—an international law-enforcement effort that closed two large markets, AlphaBay and Hansa—there was a noticeable decline in customers buying drugs from the dark web. And according to the UNODC’s World Drug Report 2019, 15 percent of customers reported using the dark web less frequently after the closures, and 9 percent said they stopped buying from the markets entirely.

But many people just move to new markets. With the collapse of the major players in drug-selling crypto-markets, Walsh adds, buyers dispersed to many of the smaller markets scattered across the dark web. And there is also an uptick in some regions, according to the 2019 Global Drug Survey, which reported that the English-speaking world has seen a steady increase in people who have reported using drugs purchased over the dark web for the past six years.


The closure of dark-web drug markets has also had an unforeseen downside, at least in research: The lack of anonymity has led to an erosion of trust. For some researchers, this can make tracking down willing participants difficult. And for some harm-reduction advocates, the looming threat of police crackdowns can be cause for worry.

Angus Bancroft, a sociologist at the University of Edinburgh, is still in the early stages of his research, but it’s already difficult to track down customers willing to talk.

Much like Chancellor, Bancroft hopes to use machine learning to study drug use and recovery in online communities, though mostly he’s looking at the dark web, rather than the forums out in the open.

His team has begun early work on a computer program and preliminary talks with the operators of a few dark-web forums. But police are simultaneously trying to close down the forums, which has made the people who post there wary.

“With the dark web, I think you need a longer engagement to build up trust,” he says.

If Bancroft can get enough participants, his team plans to create a computer program that can recognize shifts in drug habits and the emergence of new chemicals on dark-web markets. He hopes to use the findings to pull in relevant harm-reduction information, and use both dark-web forums and sites like Bluelight as a way to spread it to the users.

Bancroft’s work may be something relatively new to academia, but it follows in the footsteps of other harm-reduction advocates such as Fernando Caudevilla, a family physician based in Madrid, Spain.

Caudevilla may also serve as a cautionary tale. From April to October 2013, he posted on Silk Road’s drug forums as DoctorX, answering 321 public questions about drug use and safety before the FBI closed it down. Silk Road’s operator, Ross Ulbricht, was later arrested.

The next month, the remaining Silk Road staff members started Silk Road 2.0. There, Caudevilla answered 352 public questions before the market, too, was closed down in 2014 by a joint FBI-Europol operation called Operation Onymous. After Caudevilla spoke in defense of Ulbricht at his trial in 2015, backlash from the American media and government caused him to log off the dark web, he says.

But that hasn’t stopped Caudevilla from continuing his work on the regular web. He has shifted his responses to about 250 of the most pertinent questions he answered on the dark-web forums to the website Energy Control, a Spanish harm-reduction organization. The organization also regularly checks samples of drugs purchased off the dark web, which users send in to screen for harmful chemicals such as fentanyl.

In one case in 2018, Energy Control found the source of the fentanyl, and the marketplace banned the seller and the sale of fentanyl and similar drugs. Not everyone on the dark web is evil, Caudevilla says. Some are honest and willing to collaborate with harm-reduction efforts.

Read: The dark web isn’t all dark

“It’s not perfect,” he says. “But I think it can achieve good things.”

Le Blanc, now a moderator on Bluelight, agrees. As a veteran of the cross-section of drugs and the internet, he says he truly believes that there is life-saving information on the forums.

“We’re the ones who say, ‘Okay, we’re gonna tell you how to do this even though it’s really not a smart thing to be doing. Here is the most reasonable way of approaching this situation that you are in,’” Le Blanc says. “That’s harm reduction in a nutshell.”

This post appears courtesy of Undark Magazine.