Valium, Rogue Patients, and Mental Health

Histories of buyers' clubs and patient activism can shed light on the present.

Posted Dec 10, 2019

The British Broadcasting Corporation recently reported that some 1.3 million diazepam (also known as Valium) tablets were intercepted by the UK’s Border Force in 2018. And this marked a 100 percent increase from the previous year. 

The article also stated that the drugs in question could be counterfeit as well as extremely dangerous if used improperly. British citizens, it suggested, “turn to rogue online pharmacies and dealers to buy it when they are unable to — or do not want to — get it from a doctor.” 

The reporting about the use and seizure of illegal diazepam tablets in the UK misses the larger point entirely and demands greater contextualization. Painting patients and “rogue” pharmacies as the villains in this story is a convenient way to avoid some tough truths about pain, policy, and mental health in contemporary society. It also enables health leaders to skirt the issue of access, cost, and personal choice in the medical marketplace. 

And, from an even broader vantage point, it’s important to recognize that patients may, in fact, be pushing regulators and health authorities to develop better policies.

Buyers’ Clubs

Original buyers’ groups, as depicted in the film “Dallas Buyers Club,” were established in the 1980s to import experimental drugs not approved by U.S. authorities when AIDS treatments were underdeveloped, and HIV/AIDS was often fatal.

Wikipedia commons
Theatrical Poster
Source: Wikipedia commons

Some of the drugs imported from Mexico and further afield were useless and harmful. As I have written elsewhere, Peptide T was ineffective (although not harmful) and it was never approved by the FDA. Another example was Compound Q, a drug that was linked to a number of deaths during clinical trials. This prompted the FDA to crack down on the drug and, indeed, most buyer’s clubs across the country pulled it.

Today, a new generation of drug buyers’ clubs in Europe, Australia, and North America like those created during the AIDS epidemic is seeking to combat new HIV infections by providing access to cheap generics of a breakthrough prophylactic, Pre-exposure prophylaxis (PrEP). For many patients in the U.S., for instance, the price ($1,000 for a 3-month supply) of the brand name version is prohibitive.

According to Sonia Elks, the buyers’ clubs provide details of trusted online pharmacies and manufacturers based in countries such as India, which sell generic drugs for as little as 19 pounds ($24) per month. Patients who went this online route called the option a “game-changer.”

In early December, though, the Trump administration announced a plan to distribute PrEP free to individuals without prescription drug insurance coverage. The program, called Ready, Set, PrEP, was made possible, in part, by a donation from Gilead Sciences.

Patient-consumers, in short, have often sought out alternative sources for their medications. And, on occasion, policies that improve wider access follow on from these actions in the medical marketplace. That is, patients have acted as activists to guide the health system.

Maple Peril

In the 1990s, American consumers looked to purchase their drugs abroad. These bargain-hunters shopped online, through internet-pharmacies, and also the old-fashioned way, by taking bus trips across the border to fill prescriptions in Canadian pharmacies. 

As I write in my 2019 book Strange Trips, U.S. health officials and the drug industry itself argued that the practice of buying generics was hazardous to Americans' health and destabilized companies’ ability to finance crucial research and development (R&D). The argument is still being made

This type of medical tourism was not the same as HIV/AIDS activists sourcing experimental drugs in Mexico, because American patient-consumers were not seeking out underground, alternative medicines. They wanted statins and beta-blockers — just less pricey ones. At times, Americans were saving upwards of 70% by filling prescriptions in Canada.

However, counterfeiting was quite real. In one instance, it was found that 11,000 websites purported to be Canadian — often displaying the maple leaf flag — when in fact there were just 214 Canadian pharmacy websites.   

This burgeoning cross-border trade in pharmaceuticals undermined the American’s closed distribution system, a point of pride for Big Pharma, law enforcement agencies, and the FDA. At the same time, the dangers of these drugs were surely exaggerated — that is, Canadian drugs were demonized — to deter American consumers from purchasing cheaper pharmaceuticals and lend legitimacy to the authority of federal regulators. 

One commentator, in articulating the high price of American drugs, suggested that Canadian drugs were made out to be a “maple peril.”

The Mind

Mental health has become one of the intractable issues of the day. Given the World Health Organization’s recent warnings that mental illness will become the planet’s most common illness in the next two decades, it is not surprising that mainstream, preventative, and alternative approaches to mental illness are attracting attention, both good and bad. Depression, social anxiety disorders, and PTSD all appear on the rise. 

Unsplash/Melissa Spencer
Source: Unsplash/Melissa Spencer

In 2018, the UK-based Wellcome Trust Foundation, advocated a “radical new approach” to mental health treatment because “different disciplines use different measurement scales, there are inconsistent approaches to diagnosis and treatment, and there’s a lack of shared data.”

The BBC’s reporting about diazepam overlooks the fact that only one in five people receive appropriate treatment for either depression and anxiety. It fails to address the longer history of self-medicating and patient activism in the absence of sound health and enforcement practices.  

The real danger, one not underlined, in the story of illegal diazepam in UK, has to do with failing to understand structural inadequacies, inappropriate mental health interventions, and the lack of forward-thinking health care initiatives.