The illicit medicines trade from within: An analysis of the demand and supply sides of the illicit market for lifestyle medicines

Although the existence of illicit medicines is not new, all sorts of medicines, ranging from antibiotics to weight loss drugs, antimalarial tablets to steroids, are increasingly traded worldwide. The illicit medicines market is generally associated with considerable health risks for its users, as well as with high revenues and a perceived growing degree of criminadl organization. It is therefore important to gain extensive criminological insights into this global market. However, with a few exceptions, little criminological research has been conducted on the supply and demand sides of the illicit pharmaceutical market. The current thesis aims to engage directly with these perceptions as it fills gaps in the literature, by providing in-depth and empirically grounded theoretical insights on the online and offline trade in illicit pharmaceuticals, with particular reference to lifestyle pharmaceuticals. The main focus lies on the dynamics and activities of actors on both the demand and supply sides of the illicit medicines market in the Netherlands, and on the production and transnational distribution of illicit medicines in and from China. The central research question of this thesis is: how are actors involved in the illicit medicines trade, and how is the illicit market structured. In order to understand the dynamic interplay among actors as they operate, compete and develop trust relations, as well as how the illicit market is structured, a mixed-method approach of both qualitative and quantitative data is adopted. This includes the use of interviews with suppliers, consumers and professionals, an online study of vending websites and discussion platforms, an analysis of court cases and a survey study among consumers. This study shows that it is important to distinguish between deceived and non-deceived consumers of illicit medicines; this distinction is associated with important differences in motives for consumption, risk perception, risk management and feelings of shame or failure. In addition, the illicit medicines market can be characterized by the blurring and shifting boundaries among online and offline markets, as well the legitimate, semi-legitimate and illegitimate trade. Consumers and suppliers engage in various forms of risk minimization in order to obtain an acceptable balance between anonymity, deceit, trust and privacy. Furthermore, the illicit medicines trade is characterized by low entry barriers, especially through online distribution channels. As such, although the market has been portrayed as one that organized crime groups control on a large scale, this study shows that there is a large continuum of suppliers, traders and sellers that are involved in the market, which makes the trade in illicit medicines rather unorganized, with shifting roles and highly flexible networks