La médecine génomique en santé internationale : le rôle des projets internationaux de science ouverte en génomique

Certaines applications thérapeutiques de la médecine génomique sont susceptibles de mener à une amélioration considérable de la santé des populations des pays en développement dans les années à venir. La mise en place de politiques d’innovation efficaces demeure toutefois cruciale afin d’assurer la réalisation des promesses de la révolution génomique. Dans le domaine biomédical, la commercialisation des fruits de la recherche s’est établie comme le paradigme dominant au sein du système d’innovation. Plusieurs études récentes ont cependant démontré que l’emphase mise sur la commercialisation et la protection de la propriété intellectuelle a donné lieu à des résultats décevants. Certains acteurs du système d’innovation avancent donc désormais qu’il est nécessaire d’aller au-delà de la commercialisation de la recherche et de mettre en place des politiques basées sur le paradigme de la valorisation de la recherche, qui favorise l’atteinte d’objectifs sociaux ainsi qu’économiques. L’objectif de notre mémoire est de documenter l’impact des politiques d’innovation de projets internationaux de science ouverte en génomique médicale sur le développement des capacités en recherche et développement en génomique et l’accès à la médecine génomique dans les pays en développement. Nous avons ainsi réalisé une étude de cas impliquant quatre projets internationaux de science ouverte en génomique médicale. Les résultats de notre étude de cas ont démontré que ces projets jouent un rôle important dans le développement des capacités en recherche et en développement en génomique dans les pays en développement, mais qu’ils y jouent un rôle beaucoup plus limité sur le plan de l’accès aux applications de la médecine génomique.Some therapeutic applications of genomic medicine are likely to lead to considerable improvement in the health care of developing countries in the coming years. However, the establishment of efficient innovation policies remains vital in order to ensure the progress of the genomic revolution. In the biomedical field, the commercialisation of the results of research has established itself as the dominant paradigm in the innovation system. However, many recent studies have demonstrated that this emphasis on commercialisation and the protection of intellectual property has led to deceiving results. Some stakeholders of the innovation system thus argue that it is now necessary to go beyond the commercialisation of research and implement policies based on the research valorisation paradigm, which supports the achievement of social as well as economic objectives. The objective of our thesis is to document the impact of international open science genomic medicine projects’ innovation policies on research and developement in genomics capacity building and access to genomic medicine in developing countries. We have thus developed a case study involving four international open science genomic medicine research projects. The results of our study have demonstrated that these projects play an important role in research and development in genomics capacity building in developing countries, but play a more limited role with regard to access to genomic medicine in these countries

Effect of restricting the legal supply of prescription opioids on buying through online illicit marketplaces: interrupted time series analysis

Objective: To examine the effect on the trade in opioids through online illicit markets (“cryptomarkets”) of the US Drug Enforcement Administration’s ruling in 2014 to reschedule hydrocodone combination products. Design: Interrupted time series analysis. Setting: 31 of the world’s largest cryptomarkets operating from October 2013 to July 2016. Main outcome measures: The proportion of total transactions, advertised and active listings for prescription opioids, prescription sedatives, prescription steroids, prescription stimulants, and illicit opioids, and the composition of the prescription opioid market between the US and elsewhere. Results: The sale of prescription opioids through US cryptomarkets increased after the schedule change, with no statistically significant changes in sales of prescription sedatives, prescription steroids, prescription stimulants, or illicit opioids. In July 2016 sales of opioids through US cryptomarkets represented 13.7% of all drug sales (95% confidence interval 11.5% to 16.0%) compared with a modelled estimate of 6.7% of all sales (3.7% to 9.6%) had the new schedule not been introduced. This corresponds to a 4 percentage point yearly increase in the amount of trade that prescription opioids represent in the US market, set against no corresponding changes for comparable products or for prescription opioids sold outside the US. This change was first observed for sales, and later observed for product availability. There was also a change in the composition of the prescription opioid market: fentanyl was the least purchased product during July to September 2014, then the second most frequently purchased by July 2016. Conclusions: The scheduling change in hydrocodone combination products coincided with a statistically significant, sustained increase in illicit trading of opioids through online US cryptomarkets. These changes were not observed for other drug groups or in other countries. A subsequent move was observed towards the purchase of more potent forms of prescription opioids, particularly oxycodone and fentanyl

The international darknet drugs trade - a regional analysis of cryptomarkets

This chapter presents a descriptive analysis of illicit drug trading conducted via cryptomarkets, ‘eBay’ style marketplaces operating on the darknet (Martin 2014a, 2014b). Over the past seven years, cryptomarkets have emerged as a significant new vector for the retail and delivery of illicit drugs. One of the least understood aspects of cryptomarket-facilitated drug trading concerns the location of vendors who use the darknet to trade illicit drugs across national borders. While previous quantitative papers in this area have noted the locations of vendors selling drugs on cryptomarkets (eg Christin 2013; Soska & Christin 2015), these previous studies have not differentiated between vendors who are prepared to sell drugs to international or domestic-only clientele. The aim of this research is to fill this gap in knowledge and determine which countries are the most active, in terms of both domestic-only and internationally oriented drug vendors, as well as which countries dominate the trade in particular drugs, specifically cannabis, ecstasy-type products, cocaine, methamphetamine and opioids

How accurate are drug cryptomarket listings by content, weight, purity and repeat purchase?

Purpose: Drug cryptomarkets increase information available to market actors, which should reduce information asymmetry and increase market efficiency. This study aims to determine whether cryptomarket listings accurately represent the advertised substance, weight or number and purity, and whether there are differences in products purchased from the same listing multiple times. Design/methodology/approach: Law enforcement drug purchases – predominantly cocaine, methamphetamine, MDMA and heroin – from Australian cryptomarket vendors (n = 38 in 2016/2017) were chemically analysed and matched with cryptomarket listings (n = 23). Descriptive and comparative analyses were conducted. Findings: Almost all samples contained the advertised substance. In most of these cases, drugs were either supplied as-advertised-weight or number, or overweight or number. All listings that quantified purity overestimated the actual purity. There was no consistent relationship between advertised purity terms and actual purity. Across the six listings purchased from multiple times, repeat purchases from the same listing varied in purity, sometimes drastically, with wide variation detected on listings purchased from only one month apart. Research limitations/implications: In this data set, cryptomarket listings were mostly accurate, but the system was far from perfect, with purity overestimated. A newer, larger, globally representative sample should be obtained to test the applicability of these findings to currently operating cryptomarkets. Originality/value: This paper reports on the largest data set of forensic analysis of drug samples obtained from cryptomarkets, where data about advertised drug strength/dose were obtained

New psychoactive substances (NPS) on cryptomarket fora: An exploratory study of characteristics of forum activity between NPS buyers and vendors

Background The continual diversification of new psychoactive substances (NPS) circumventing legislation creates a public health and law enforcement challenge, and one particularly challenged by availability on Hidden Web cryptomarkets. Methods This is the first study of its kind which aimed to explore and characterise cryptomarket forum members’ views and perspectives on NPS vendors and products within the context of Hidden Web community dynamics. An internal site search was conducted on two cryptomarkets popular with NPS vendors and hosting fora; Alphabay and Valhalla, using the search terms of 40 popular NPS in the seven categories of stimulant/cathinone; GABA activating; hallucinogen, dissociative, cannabinoid, opioid and other/unspecified/uncategorised NPS. 852 identified threads relating to the discussion of these NPS were generated. Following exclusion of duplicates, 138 threads remained. The Empirical Phenomenological Psychological method of data analysis was applied. Four themes and 32 categories emerged. Results 120 vendors selling NPS were visible on Alphabay, and 21 on Valhalla. Themes were ‘NPS Cryptomarkets and Crypto-community interest in NPS’ ‘Motives for NPS use’ ‘Indigenous Crypto Community Harm Reduction’ and ‘Cryptomarket Characteristics underpinning NPS trafficking’, with two higher levels of abstraction centring on ‘NPS vendor reputation’ and ‘NPS transactioning for personal use’. NPS cryptomarket characteristics centred on generation of trust, honesty and excellent service. Users appeared well informed, with harm reduction and vendor information exchange central to NPS market dynamics. GABA activating substances appeared most popular in terms of buyer interest on cryptomarkets. Interest in sourcing ‘old favorite’ stimulant and dissociative NPS was evident, alongside the sequential and concurrent poly use of NPS, and use of NPS with illicit drugs such as MDMA. Conclusion Continued monitoring of new trends in NPS within Surface Web and cryptomarkets are warranted. A particular focus on the rising market in prescribed benzodiazepine and Z-hypnotic drugs should be included. © 2016 Elsevier B.V

Delivery dilemmas: How drug cryptomarket users identify and seek to reduce their risk of detection by law enforcement

© 2016 Background Cryptomarkets represent an important drug market innovation by bringing buyers and sellers of illegal drugs together in a ‘hidden’ yet public online marketplace. We ask: How do cryptomarket drug sellers and buyers perceive the risks of detection and arrest, and attempt to limit them? Methods We analyse selected texts produced by vendors operating on the first major drug cryptomarket, Silk Road (N = 600) alongside data extracted from the marketplace discussion forum that include buyer perspectives. We apply Fader's (2016) framework for understanding how drug dealers operating ‘offline’ attempt to reduce the risk of detection and arrest: visibility reduction, charge reduction and risk distribution. Results We characterize drug transactions on cryptomarkets as ‘stretched’ across time, virtual and physical space, and handlers, changing the location and nature of risks faced by cryptomarket users. The key locations of risk of detection and arrest by law enforcement were found in ‘offline’ activities of cryptomarket vendors (packaging and delivery drop-offs) and buyers (receiving deliveries). Strategies in response involved either creating or disrupting routine activities in line with a non-offending identity. Use of encrypted communication was seen as ‘good practice’ but often not employed. ‘Drop shipping’ allowed some Silk Road vendors to sell illegal drugs without the necessity of handling them. Conclusion Silk Road participants neither viewed themselves as immune to, nor passively accepting of, the risk of detection and arrest. Rational choice theorists have viewed offending decisions as constrained by limited access to relevant information. Cryptomarkets as ‘illicit capital’ sharing communities provide expanded and low-cost access to information enabling drug market participants to make more accurate assessments of the risk of apprehension. The abundance of drug market intelligence available to those on both sides of the law may function to speed up innovation in illegal drug markets, as well as necessitate and facilitate the development of law enforcement responses

Nonmedical prescription psychiatric drug use and the darknet: A cryptomarket analysis

Nonmedical prescription psychiatric drug use (NMPDU) is an increasing global health problem, with recent concern focusing on darknet cryptomarkets as sources of procurement. There is a shortage of evidence regarding comparative worldwide NMPDU trends, due in part to data collection difficulties. This problem is particularly marked for non-opioid drugs, particularly those psychiatric drugs which act on the central nervous system (CNS) and have high misuse potential and are associated with high levels of dependency and fatal overdose. This paper therefore has two goals: 1) to report on the kinds of psychiatric prescription drugs available on cryptomarkets, and 2) to use this data to uncover temporal and geographical trends in sales of these products, potentially informing policy regarding NMPDU more generally. Method Digital trace data collected from 31 cryptomarkets in operation between September 2013 and July 2016 was analysed by country of origin descriptively and for trends in the sales for 7 psychiatric drug groupings, based on their main indication or intended use in psychiatric practice. Results Sedatives (such as diazepam and alprazolam) and CNS stimulants (mainly Adderall, modafinil and methylphenidate) had the greatest share of sales, but usage and trends varied by location. The UK has high and rising levels of sedative sales, whilst the USA has the greatest stimulant sales and increasing sedative rates. Sales of drugs used in the treatment of opioid dependency are also substantial in the USA. The picture is less clear in mainland Europe with high sales levels reported in unexpected Central and Northern European countries. There is evidence of a move towards the more potent sedative alprazolam – already implicated as a source of problematic NMPDU in the USA – in Australia and the UK. Sales of drugs such as antidepressants, antipsychotics, mood stabilisers and antidementia drugs – all drugs with limited abuse potential – were negligible, indicating minimal levels of online cryptomarket procurement for self-medicating mental health problems. Conclusion Predominantly, psychiatric drugs with potent sedative, stimulant or euphoriant effects are sold on cryptomarkets and this varies by country. With some caveats regarding the limitations of cryptomarket digital trace data taken into account, the study of trends of these products sold online over time may offer a novel and increasingly important window onto wider drug purchasing habits

Will growth in cryptomarket drug buying increase the harms of illicit drugs?

Background and aim Cryptomarkets—on?line, anonymous market?places for illicit goods and services that specialize mainly in drugs—account for a small but rapidly growing share of the illicit drug market in many countries. Policy responses so far are based generally on the assumption that their rise will only increase drug harms. In this contribution for debate, we question this assumption. Methods We provide a narrative review of the emerging literature connected to drug cryptomarkets. We use MacCoun & Reuter's formula to understand the effect of population?level increases in use on total harm as depending on the level of harm associated with each unit of use. We then consider the potential for cryptomarkets to increase or decrease the harms and benefits related to each unit of drug use, with specific attention to the quality of drugs sold and the non?drug?related harms and benefits for customers. Results It is likely that cryptomarkets will increase both the amount and the range of substances that are sold. However, we argue that the effects on harms will depend upon whether cryptomarkets also increase the quality and safety of products that are sold, provide harm?reducing information to consumers and reduce transactional conflict involved in drug purchasing. Conclusions There is an emerging and rapidly growing evidence base connected to the macro and micro harms and benefits of cryptomarkets for drug users. Future researchers should use appropriately matched comparative designs to establish more firmly the differential harms and benefits of sourcing drugs both on? and off?line. While it is unlikely that the on?line drug trade can be eradicated completely, cryptomarkets will respond to regulation and enforcement in ways that have complex, and sometimes unanticipated, effects on both harms and benefits