StreetRx collects crowdsourced data on street prices of diverted pharmaceuticals to monitor abuse trends. The document analyzes this data, finding that bulk purchases (10+ units) receive significant discounts compared to individual "retail" purchases for many drug classes, including benzodiazepines, muscle relaxers, erectile dysfunction drugs, and opioids. For example, bulk alprazolam purchases receive a 34% discount on average. This data helps identify which drugs face greater diversion risks due to larger bulk discounts.

1. StreetRx Price Comparison
Non-BulkvsBulk

2. StreetRx.com
THE RADARS® SYSTEM
StreetRx has been part of the RADARS System since 2010. The Researched Abuse,
Diversion and Addiction-Related Surveillance collects timely product- and geographically-
specific data on rates of abuse, misuse, and diversion, contributing to the understanding of
trends and aiding the development of effective interventions.
StreetRx (streetrx.com) is a collection of databases, websites, and citizen reports enabling real-time collection,
organization, and display of street price data on diverted pharmaceutical controlled substances. Based on
principles of crowdsourcing for public health surveillance, the site allows users to anonymously submit prices
they paid or heard were paid for diverted prescription drugs.

3. Unique Visitors per Day
130
250
1641
2616
Mobile
Accounts for 80%
of visits
Search
86% of visits come
from organic search
Average daily visitors per year identified by Google Analytics
2012
2015
As of April 27, 2015. Not to scale.

4. Visitor DemographicsBased on 58% of known demographics from Google account users
20%
Male
35+ years-old
43%
Male
18-34 years-old
15%
Female
35+ years-old
22%
Female
18-34 years-old
As captured by Google Analytics. January 1 through March 31, 2015

5. 42,058 Referrals to Health OrganizationsFrom November 1, 2010 through March 31, 2015
Drug Treatment & Harm Reduction
Substance abuse treatment locators,
overdose prevention
Chronic Pain
Advocacy and support organizations
Proper Disposal and Storage
DEA and non-profit organizations
1,750
1,438
1,318
1,420
4,565
1,356
1,432
2,062

6. Percent Discount for ADF Versions
Putative abuse-deterrent formulation versus unprotected formulations with same active ingredient, using statistical comparison that is less influenced by outliers.
Physical Barrier Prodrug(Partial-)
Antagonist
Concerta
Exalgo
OpanaER
OxyContinOP
Zohydro
Vyvanse
codeine
Suboxone
tablet
XartemisXR
p<.01
z -38
p<.01
z -38
p<.01
z -3.0
p<.01
z -3.7
p=.78
z 0.3
p<.01
z -8.6
p<.01
z -13
p=.34
z -0.9
p=.24
z -1.2
TBD
?
OROSOROSINTAC INTAC PolyOx
RitalinLA
p<.01
z -3.9
SODAS
NucyntaER
p=.10
z -1.6
INTAC
HysinglaER
p=0.46
z -0.7
INTAC INTAC

7. Which drugs have greatest volume discounts?On the black market
STEP1
STEP3
STEP2
STEP4
USA Data in USD
Nov 1, 2010 through Mar 31, 2015
Solid oral formulations
Compare bulk (10+ units)
purchases with “retail”
purchases, by active
ingredient
N = 52,849
Price per milligram
Geometric means and 95% CI
Non-parametric Wilcoxan
rank-sum (Mann-Whitney)
tests
Benzodiazepines
Muscle Relaxers
Stimulants
Erectile Dysfunction

8. BenzodiazepinesPercent discount for bulk purchases (10+ at a time)
diazepam
n=507
z=3.7 p<0.01
34%
25%
22%
10%
clonazepam
n=3,161
z=6.1 p<0.01
alprazolam
n=4,583
z=8.7 p<0.01
lorazepam
n=1,271
z=1.8 p=0.07

9. Muscle Relaxers & Neuropathic Pain RelieversPercent discount for bulk purchases (10+ at a time)
pregabalin
n=21
z=1.3 p=0.19
48%
46%
22%
0%
gabapentin
n=146
z=1.2 p=0.25
carisoprodol
n=239
z=3.6 p<0.01
tizanidine
n=47
ns

10. SleepAidsPercent discount for bulk purchases (10+ at a time)
eszopiclone
n=9
z=0.5 p=0.60
59%
30%
24%
zolpidem
n=287
z=3.3 p<0.01
zaleplon
n=8
z=0.5 p=0.61

11. Erectile DysfunctionPercent discount for bulk purchases (10+ at a time)
tadalafil
n=142
z=4.0 p<0.01
73%
61%
0%vardenafil
n=15
ns
sildenafil
n=251
z=3.8 p<0.01

12. Percent Discount for Bulk Purchase
Sleep Aids Erectile DysfunctionBenzodiazepines Stimulants Opioid AnalgesicsMuscle Relaxants
39% 23% 14% 38% 12% 67%

13. Thank You
Boston, MA nabarun@epidemico.com
@street_rx
@epidemico
epidemico.com

14. OpioidsPercent discount for bulk purchases (10+ at a time)
methadone
n=852
z=2.6 p<0.01
oxycodone
n=9,910
z=8.6 p<0.01
hydromorphone
n=1,664
z=2.8 p<0.01
hydrocodone
n=6,062
z=7.0 p<0.01
14%
13%
12%
10%

15. StimulantsPercent discount for bulk purchases (10+ at a time)
modafinil
n=87
z=1.5 p=0.13
32%
15%
8%
3%
methylphenidate
n=1,607
z=1.7 p=0.09
amphetamines
n=13,828
z=9.1 p<0.01
lisdexamphetamine
n=2,038
z=1.8 p=0.07

16. Descriptive Results Abuse/tamper deterrent formulation
Original unprotected formulation
95% Confidence interval of the geometric mean