My wife Jackie has severe asthma. Thanks to the ridiculous state of health care in the United States, I was recently forced to commit a crime in order to get her the medicine she needs to live.
Jackie has to use a maintenance inhaler twice per day, every single day, and will continue to use it for the rest of her life. Even with that maintenance inhaler, she sometimes still needs to use a different rescue inhaler to make it through the night when her asthma symptoms can be more pronounced. Without using these two types of medicine every day she could have an asthma attack, be hospitalized, or die.
Given that a person with severe asthma could literally die without these inhalers, you would expect insurance companies to price them low enough for anyone to afford. It would be pretty unethical, or at the very least irresponsible, to charge a premium for them. Right?
Many common medicines that people need (such as those prescribed for ADHD, anxiety, depression and many, many other things) are made very affordable, according to an insurer's drug tier list. Asthma inhalers, however, are not.
Several months ago, Jackie found that her maintenance inhaler was running low. We had just obtained health insurance through Kentucky's health care exchange and, while it wasn't the most expensive plan, it certainly wasn't cheap. Our monthly bill was high, but we thought the coverage was worth it.
I should mention that Jackie specifically picked a plan with low prescription co-pays.
Imagine our surprise when the total for her inhaler, with insurance applied, turned out to be around $300.
Money was very tight at that time; we just couldn't afford the inhaler without falling behind on other necessities like utilities and groceries.
It was Jackie's idea to check on the dark net.
The dark net is a part of the internet that isn't indexed in search engines and can't be reached by using a normal browser. Some of the most popular sites on the dark net are basically online black markets, where a range of (mostly illicit) goods can be purchased with the digital currency Bitcoin and shipped right to your door.
It hadn't occurred to me to look for an inhaler on the dark net until Jackie suggested it
I've always found the dark net markets to be fascinating and I spend more time than I should browsing the markets and the communities that have been built around them. Because of this fascination, I knew that there were vendors who offered prescription drugs that don't get you high. Drugs such as antibiotics, allergy pills, and most importantly, asthma inhalers.
These markets have gained a pretty nasty reputation because of the items they sell. Ross Ulbricht, the man who ran the Silk Road dark net market, just received a sentence of more than two lifetimes in prison; before his sentencing, family members of people who died from overdosing on drugs bought on Silk Road wrote letters to the judge asking for justice.
However, I would argue that the dark net markets are a mostly positive force for making drug use safer, and providing an affordable way for people like me to obtain needed medicine. While most of the drug commerce on the dark web is for recreational use, there is a healthy business in medicine for its intended purpose. You can buy a whole range of prescription medicine for things like depression, anxiety, high blood pressure, and even restless leg syndrome at a fraction of the usual cost.
There has been extensive testing on the illegal drugs for sale on the dark web, which were found to be overwhelmingly pure and true to advertisement. This was repeatedly confirmed on the Silk Road by vigilante reviewers calling themselves the LSD Avengers, who bought drugs on the site and tested them in a lab. "At least 56 samples of [ecstasy, cocaine, heroin, LSD, and others] have been laboratory-tested, and, of these, 54 have shown high purity levels of the drug the item was advertised to be on Silk Road," an FBI special agent wrote in an affidavit.
Not as much testing has been done on prescription drugs for sale on the dark web, but the limited findings suggest they are equally trustworthy—although not as trustworthy as drugs sold in a regulation pharmacy.
"When you buy in a real pharmacy with an official prescription, the chance of adulteration or scam is null. This risk is increased in deep web," Dr. Fernando Caudevilla, also known as DoctorX, who assisted with medical questions about drug use on the Silk Road forums, said in an email.
Dr. Caudevilla also works at an NGO that tests street drugs and monitors drug use at music festivals for safety. He said it's not ideal to buy prescription drugs on the dark web, but that some users have no choice.
"In general, generic commercial brands from labs from Eastern Europe, India or Brasil that are served in blisters have very low rates of falsification," he wrote. "Powders without identification, bulk pills in a sachet, new articles without feedbacks or reviews… are more suspicious of [being] fake. We have not analyzed too many prescription drugs (around 20 samples in a year) and 90% are right."
It hadn't occurred to me to look for an inhaler on the dark net until Jackie suggested it. She doesn't really know much about the markets beyond things I've told her, but she asked me one night if you could buy inhalers on them. I got online, opened the Tor browser that is the gateway to the darknet, and pretty soon I found exactly the same maintenance inhaler—same brand, completely identical—that we needed to replace. The price was $30 with shipping.
Naturally, I was somewhat skeptical. I wasn't surprised by the low price, since I knew inhalers could be purchased in other countries very cheaply—Jackie had bought a rescue inhaler from a pharmacy in Milan for 4 euro during our honeymoon last year. But how could I be sure that the vendor was selling real medicine?
The truth is, you can't really be 100 percent positive you aren't being scammed, but most vendors aren't out to get you. A little research goes a long way toward avoiding both fake products and losing money to scams. The markets have built-in review systems where buyers can rate vendors and describe the product and service they received. A vendor's rating and number of sales on the market will give you an immediate idea of how reputable they are. Beyond reviews on the market, there are also several dark net market communities (such as the darknet markets subreddit and DeepDotWeb) where buyers discuss vendors and warn about scams. These sites as well as the market's own forums are great resources for researching a vendor.
After doing my research, it was clear that the vendor I planned to purchase from had an excellent reputation. I decided to message him on the market to ask about the inhaler. He greeted me in a friendly and professional manner and assured me that he could get a maintenance inhaler with the dosage that Jackie needed. I was convinced to go forward with the plan at this point.
Let's not forget that this type of transaction is illegal: I was buying a prescription drug without a prescription and having it shipped across state lines, not to mention not paying taxes on it. But I felt that my hand had been forced. It wasn't a choice for me. Jackie's health is the most important thing, and I didn't particularly care what I had to do to keep her healthy. Besides, I didn't think the DEA would waste the time and resources to bust a guy buying an asthma inhaler. With my mind made up, I went through the fairly complicated process of actually buying something on one of these markets.
I had done my research and knew how to safely and anonymously complete the order. Despite those preparations, I was still feeling a bit anxious so I took every precaution. I went through a site called LocalBitcoins to purchase Bitcoin face-to-face with cash from a surprisingly nice and normal guy. Using cash allowed me to avoid purchasing the Bitcoin online with a credit card and tying my identity to the transaction. He transferred the Bitcoin to a wallet that I had set up in advance, which had no connection to my real identity. In order to further protect my anonymity, I decided to use the Tails operating system because it is a privacy-focused OS that can fit on (and be booted from) a flash drive. Tails doesn't access your computer's hard drive or store any information from your session permanently. After booting up Tails on my laptop, I used a public Wi-Fi network and the Tor browser bundle to anonymously access the Bitcoin wallet and transfer the digital currency to the market. My anxiety had melted away by this point and was replaced by excitement about the process I was going through.
The only difference was the price, and the fact that a crime had to be committed to get it
I was feeling like the nerdiest badass ever by the time the Bitcoin arrived in my market account. I was finally ready to order, and it couldn't have been simpler. I navigated to the inhaler listing and simply chose the quantity and shipping method from drop down boxes then clicked the "Buy" button. It took me to a page where I had to provide my shipping information. I used PGP (Pretty Good Privacy) to encrypt my name and address so only the vendor would be able to decrypt the message. That was it. Order complete. The vendor had everything he needed and my bitcoin was in escrow (to be released once I received the package). The vendor shipped it the next day and just like that we had saved a ton of money.
The only problem is that the vendor shipped from another country and international shipping takes a few weeks. Jackie had maybe one week's worth of her medicine.
While we waited, Jackie had to stretch out her inhaler's remaining doses. One option was to use her rescue inhaler rather than the maintenance one, but overuse of the rescue inhaler is bad for the heart and could land her in the hospital. In order to avoid using her maintenance inhaler, Jackie has to use the rescue inhaler 10 to 20 times per day. Compare that to zero to two uses per day with her usual maintenance dose.
The other option is to use a machine called a nebulizer, which vaporizes a super-concentrated form of her asthma medicine so it can be breathed into the lungs. The process of setting up and using the nebulizer takes around 15 minutes and the machine itself is incredibly loud. There's no watching TV or listening to music while it's on; our dogs flee at the sight of it. Jackie compares it to an iron lung. Beyond the inconvenience, which is manageable, there are side effects. After using the nebulizer, Jackie's body visibly shakes like someone experiencing the chills that accompany a high fever. She is typically unable to stand up for several minutes after using it, and it causes anxiety. Neither of these options are ideal, but they allowed her to stretch the maintenance medicine a little further.
The inhaler finally arrived intact after a couple weeks. It was in a completely unremarkable cardboard box. The only reason we recognized it as the inhaler was because of the country listed in the return address. It was hidden within multiple layers of packaging in the box to hide it from prying eyes. I honestly feel that a more illicit substance could easily have slipped through customs by being packaged the same way. The inhaler itself was completely legitimate and identical to what our local pharmacy would have given Jackie. The only difference was the price, and the fact that a crime had to be committed to get it.
Fortunately, Jackie has since found a way to obtain her maintenance inhaler without breaking the bank or the law, thanks to a helpful doctor and, of course, not our insurance company. However you feel about health care in the United States, I hope we can all agree that life saving medicine should be affordable. I make a pretty decent salary and we have good health insurance. I shouldn't have to commit a crime to get the medicine my wife needs, and there are plenty of people with severe asthma who are in a much worse place financially than we are and yet still wouldn't qualify for Medicaid. The majority of those people have never even heard of a dark net market and certainly wouldn't know how to use one. What are they supposed to do?
When life saving medicine is out of reach to those who need it, something has to change. I don't see that change coming anytime soon unfortunately. All I know is that health care is broken in this country and until it's repaired, maybe it's not such a bad thing that dark net markets exist.
Modern Medicine is a series on Motherboard about how health care and medical technology can move forward so rapidly while still being stuck in the past. Follow along here.