Background: Cryptomarkets – online, anonymous marketplaces for illicit goods and services that mostly specialise in drugs – account for a small but rapidly growing share of the illicit drug market in many countries. Policy responses so far are generally based 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 and 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: We suggest it is likely that cryptomarkets will increase both the amount and the range of substances that are sold. But we argue that the effects on harms will depend on 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: We alert readers to an emerging and rapidly growing evidence base connected to the macro and micro harms and benefits of cryptomarkets for drug users. We point out the importance for future researchers of using appropriately matched comparative designs to more firmly establish the differential harms and benefits of sourcing drugs online and offline. We conclude that while it is unlikely that the online drug trade can be completely eradicated; cryptomarkets will respond to regulation and enforcement in ways that have complex, and sometimes unanticipated, effects on both harms and benefits.