1. A season in Deep Web forums: A Doctor´s Experience
Dr. Fernando Caudevilla
Family Physician
Energy Control (ABD) Spain
Internet, Unternet and harm reduction. 24th ihrc kuala Lumpur 21/10/15

2. I am Doctor Fernando Caudevilla
I work as FAMILY DOCTOR in a PRIMARY HEALTH CARE CENTER in Madrid, in part-time.
Rest of my professional activity is dedicated to different EDUCATIONAL, RESEARCH and INTERVENTION PROJECTS related to DRUGS.
In general, work in DRUGS is considered to be equivalent to WORK in DRUG DEPENDENCE.
But my field of expertise is not only DRUG DEPENDENCE but also:
HARM REDUCTION
RECREATIONAL USE OF DRUGS
NEW SYNTHETIC PSYCHOACTIVES
THERAPEUTIC CANNABIS

3. International, media and research
Volunteer work
Inclussion, support, training
Work groups
Night
Stands
Safer night
Drug- checking
In-situ
Thin Layer Cromatography
GC-MS
Town council advice
Infoline
Web+phorum
Social webs
Telephone ( )
Offices
International, media and research
Educational center action
Teenagers
Parents
Teachers
Energy Control is a risk reduction project in Spain, working since 1999 that provides:
INFORMATION
ASSESSMENT
DRUG TESTING
for drug users.
We mainly address YOUNG PEOPLE who do recreational drug uses.
Based on PEER TO PEER WORK and OUTREACH ACTIVITIES we manage to be in direct contact with them.
We have several fields of work
Most of our work is SUPPORTED by VOLUNTEER WORK, although financed by EUROPEAN, NATIONAL and LOCAL authorities

9. Deep Web Markets: An opportunity for research
An opportunity for intervention with users
A public health perspective
In my perspective as a Doctor I consider that Deep Web Markets can be analyzed in this triple perspective

10. Internet forums and Health
Analyze information that would be difficult to obtain with other methods
Recruit subjects for studies in low-prevalence phenomena
Internet-based treatments (discussion groups, Apps, chats…) have been used in smoking cessation (Civljak et al, 2013), social anxiety disorder (Schulz et al 2014) or anxiety and depressive disorders (Schultz et al, 1999)
Civljak M, Stead LF, Hartmann-Boyce J, Sheikh A, Car J (2013). ‘Internet-based interventions for smoking cessation.’. Cochrane Database Syst Rev. doi: / CD pub4.
Schulz A, Stolz T, Berger T.(2014) ‘Internet-based individually versus group guided self-help treatment for social anxiety disorder: protocol of a randomized controlled trial. ’BMC Psychiatry Apr 115
Tildesley HD, Conway ME, Deng L, Lee AM, Chan JH, Mazanderani AB, Tildesley HG et al (2015) The effectiveness of Internet intervention on 926 patients with diabetes mellitus for up to 30 months. Can J Diabetes Jun;39(3):

11. This is a screen capture of the Original Silk Road Forum, that was active until the seizure of Silk Road in October 2013.
It was a HUGE forum with more than TWO HUNDRED THOUSAND posts ,THIRTY THOUSAND topics, classified in 12 SECTIONS, with TENS OF THOUSANDS of active users and HUNDREDS of messages every day.
I realized that there was a “Drug Safety” subsection and I decided to start a thread offering scientific information about drugs in a risk reduction perspective, and oriented to drug users
Silk Road forum. URL available in:
Access: 23/9/15

12. So this is the post where I introduced myself.
Most of the persons who have posted in Deep Web forums are anonymous but I decided to use my real identity and my web page , in order to gain credibilityas I had nothing to hide and I was not involved in illegal activities.
I also offered a BTC address to accept free donations for my work. I will comment about this later

13. During the 7 months period I was posting in SR forum I received more than 400 different questions (most of them public, but also as private messages). My thread received more than THIRTY SIX THOUSAND visits during this period.
DoctorX thread about health and drugs was in the “top 10” of all the SR posts of the forum.

14. This is the case of a diabetic person who searches for information about using MDMA and LSD. He want to know specific risks and how to avoid them.

15. This persons asks about long-time effects of psychedelic drugs
This persons asks about long-time effects of psychedelic drugs. He has used different drugs in his life (“I took MDMA and I absolutely loved it”), LSD, mushrooms …an other substances as NBOMEs whose risks are far more dangerous.

17. It may sound conceited or vain showing you posts like this but I really have the impression that this represents the feeling and the reception of the SR community to Doctor X collaboration. Most of the feedback have been positive commentaries

18. Another positive commentarie, in this it is interesting the last sentence “I have to pay my “taxes” on recent purchases with another donation”
As I said before, I offered a BTC address for donations. I offered this service for free but it requires time and dedication.
Surprisingly to me, I started to receive donations from users (and even from vendors)

19. This is another suprising case
This is another suprising case. It is a man who lived in a Eastern European country who had detoxified heroine on his own.
He had been suffering “pain in bones” and fever during night for 1 month. He had been told that these were symptoms of abstinence (he says “the doctor did not even listened to me, he said that everythings was normal without doing any exam”)
“Night fever” is not a symptom of abstinence but can indicate different haematological problems, in this case I insisted in the necessity of doing blood test, than finally revealed a leukaemia

20. TABLE 1: QUESTIONS CLASSIFIED BY DRUG
MDMA 43
Methylphenidate 6
Barbiturates 1
Cannabis 31
Mephedrone
4-MMC
Cocaine 27
Anabolic steroids
Diethylether
LSD 21
MDPV 5
Etilphenydate
25-n-NBOMe 19
DMT 4
DOM
Amphetamine 18
Sildenafil
TMA-6
2C-B 12
PCP 3
Armodafinil
Ketamine
Tobacco
DXM
Methamphetamine 11
PMA
Ibogaine
Heroin
4 AcO DMT
Tramadol
Psilocybe 9
Fentanyl
AMT
Benzodiacepines 8
Oxicodone
2C-E
GHB
Methylone 2
2C-T-2
Alcohol 7
4-FA
2C-T-7
Methoxetamine
Melatonin
5-MeO-DMT
I reviewed all the questions answered in 7 month period in this work for a Congress in Spain, here are the questions classified by drugs.
Caudevilla F. Reducción de riesgos on-line: una experiencia en los foros de Silk Road.
IV Jornadas de Reducción de Riesgos de Catalunya. Barcelona, 28/11/2013

21. QUESTIONS CLASSIFIED BY SUBJECT
These are the questions classified by subject
Caudevilla F. Reducción de riesgos on-line: una experiencia en los foros de Silk Road.
IV Jornadas de Reducción de Riesgos de Catalunya. Barcelona, 28/11/2013

22. QUESTIONS ABOUT INTERACTIONS BETWEEN
RECREATIONAL AND PRESCRIPTION DRUGS
And this is another detail about interactions between recreational and prescription drugs. Ritonavir + MDMA, GHB + benzodicepines or opiates,
Caudevilla F. Reducción de riesgos on-line: una experiencia en los foros de Silk Road.
IV Jornadas de Reducción de Riesgos de Catalunya. Barcelona, 28/11/2013

24. Number of questions (public) Number of questions
SUMMARY OF ACTIVITY IN AN ON-LINE HEALTH SERVICE FOR DEEP WEB DRUG USERS
Market
Dates
Number of questions (public)
Number of questions
(private)
Total visits
Silk Road
Apr- Oct 2013
321 67
36.438
Silk Road 2.0
Dic Nov 2014
352
103
52.725
Evolution Marketplace
Dic March 2015
291 57
51,784

25. Drug-Checking Service
Colorimetric
tests
Thin Layer
Cromatography (TLC)
Gas Cromatography/Mass Spectrophotometry(GC/MS)
Techniques:
Objectives:
Contact users and
provide information
Improve knowledge of
drugs market
Spread information
I spoke you before about the DTS of Energy Control, it is one of our most valuable and appreciated services.
Sometimes this service is MISUNDERSTOOD, we are not to say “this drug is good for you, this is not good”.
We perceive it as an opportunity to contact users and provide them information, to improve knowledge about drug markets and to spread information (we are part of the TEDI TRANSEUROPEAN DRUG INFORMATION NETWORK and the EARLY WARNING SYSTEM of EMCDDA)

26. So we have decided to create an specific INTERNATIONAL DRUG TESSTING SERVICE with similar objectives, focused in Deep WebMarkets

28. International Drug Testing Service: Results
18 months period (March 2014-September 2015)
285 samples analyzed
52 different substances
77,19 % common recreational drugs
14,04% prescription drugs
8,77% NPS
 Sample n
Only main compound detected
Purity b
Mean ± SD
Range
Cocaine
103
51.5% (53/103)
71.6 ± 19.4%
5-99%
LSD 15
100.0% (10/10)
123.6 ± 40.5µg
53-195µg
MDMA crystal 13
100.0% (13/13)
88.3 ± 1.4%
76-99%
MDMA pills 11
100.0% (11/11)
133.3 ± 38.4mg
83-188mg
Amphetamine 10
40.0% (4/10)
51.3 ± 33.9%
10-98%
Ketamine 6
50.0% (3/6)
71.3 ± 38.4%
27-95%
Cannabis resin 5
100.0% (5/5)
THC: 16.5 ± 7.5% CBD: 3.4 ± 1.5%
THC: % CBD: %