All photos by Nate 'Igor' Smith
On any given day there's a
good chance you're going to come across a "natural" sex supplement.
Packaged as
pills, liquids, or raw herbs (or added to everything from coffee to
chewing gum), and sold under ridiculous names like
"Sex Man" or "Stiff Nights" with cryptic, hokey labels—these cheap and plentiful products promise to improve your sex drive, stamina, sensation, and, if you have a penis, give you
a granite-hard erection. You can find this crap everywhere, from sex shops, gas
stations, and corner stores to the pop-up ads and emails clogging up your spam filter. Part of a bustling trade in limp-dick quick fixes that stretches back
through time immemorial, these products are so ubiquitous (and silly) that we
rarely even notice them on the shelves.
Yet in October this smarmy
background noise came to the fore when former NBA-star and Kardashian consort
Lamar Odom was found passed out at a Nevada brothel. Odom had been using hard
drugs, but reports linked his collapse in part to his consumption of
ten "Reload" pills, an "herbal Viagra," over the course of three days. Supposedly a
natural supplement, the United States Food and Drug Administration had long
warned that "Reload" actually contained the same pharmaceutical ingredients found
in erectile dysfunction medications, which when consumed in conjunction with
other drugs can be dangerous. This case wasn't an outlier. According to a study conducted by scientists from the Centers for Disease Control and Prevention, Chenega Government Consulting, and the FDA that was
published in The New England Journal of Medicine in October, up to 617 people visited emergency rooms each year between 2004 and 2013 thanks to ostensibly herbal (but likely contaminated) sex supplements. Within the past decade, sex supplements have been implicated in over a dozen deaths—one of the most publicized recent cases being the 2013 death of a Kansas City man who keeled over after popping a "Stiff Nights" pill, a brand alleged to regularly contain prescription ED drugs.
(VICE tried to reach out to "Stiff Nights" to discuss allegations of contamination in their products, but has received no comment as of yet. As such, we can't confirm that the "Stiff Nights" we contacted was the one cited; names and manufacturers of these supplements may drift. Nor has VICE received a response from any of the nine other sex supplement distributors or manufacturers, some accused of contamination and some not, whom we tried to reach out to for this story.)
Sex supplements have always
been mildly risky to consume,
but it seems as if trade in
them has grown larger and more dangerous over the past couple of decades. Although findings vary, multiple studies suggest that contaminations with sometimes-massive amounts of pharmaceuticals (or analogues, chemically altered yet unstudied variants of existing pharmaceuticals) affect well over half of all products on the market—tabulations range from
66 to 81 percent. No one's sure how this worrying trend started or why. But many suspect it's a simple byproduct of increasing demand,
weak regulation, and hustlers' ingenuity. Although there've been attempts to
clamp down on and reverse this shift in supplement risk levels, it appears
as if regulatory efforts to date are only scratching the surface of the
ever-evolving, robust trade.
It's seemingly impossible to
trace the market for natural sex supplements to its origin. It's probably
as old as civilization.
Most men throughout history have, at some point in their lives, struggled with tumescence and sought randy remedies accordingly. Ancient snake oil
salesmen, doctors, and writers alike
promoted any number of foods and herbs as aphrodisiacs—sometimes with nothing behind them
but the placebo effect, sometimes with cause. Although some early aphrodisiacs
were
mundane, these early
rosters included
many bizarre products
still marketed today, such as Spanish Fly.
Perhaps the most famous "herbal Viagra," thanks to 20th century comedians (including
Bill Cosby,
who in a 1969 routine talked about using it to dose women's drinks),
Spanish Fly is derived from a chemical secretion of blister beetles. An incredibly
inflammatory substance that can blister skin, when ingested in small doses
and pissed out it causes swelling in the penis, which is often mistaken for a
raging, painful hard-on. Perceived as functional, people have managed to get
their hands on this and other natural products for centuries.
And you can bet
as soon as folks could package and sell them
en masse, the invisible rosy-palmed hand demanded they do so.
There have always been some risks
in natural sex supplements. Spanish Fly, for instance, if over-consumed, can
basically attack your organs and kill you. That's allegedly what
killed the 1st century B.C. poet Lucretius, sickened a small legion of French soldiers in Nigeria in 1869, and got the Marquis de Sade in
trouble for attempted murder after he reportedly accidentally poisoned some
prostitutes with Fly-laced chocolates. Some are dangerous enough that
governments have put serious restrictions on them, even if they are "natural products." Some poorly manufactured substances could be
contaminated with things like
metals, pesticides, and paint, as well. But until doctors and authorities became aware of the potential dangers in recent years, the products' adverse effects were believed to be minor, severe harm was rare (or at least rarely reported), and most users' biggest fear was that the pill they dropped a few bucks on
wouldn't have any herbs in it or would do
absolutely nothing.
When asked about sex stimulants' effectiveness, Stephen Barrett, a retired psychiatrist who now runs the medical hokum clearinghouse Quackwatch.org, told VICE, "If you look at the vast number of herbal products," including over-the-counter aphrodisiacs, "the majority of them will neither harm you, nor help you."
But according to FDA
spokeswoman Lyndsay Meyer, the agency picked up on a new systematic risk in sex
supplements around 2007: contamination with PDE5 inhibitors, the active
ingredients in ED drugs like Cialis, Levitra, and Viagra. Unlisted on
supplement boxes (
which rarely contain warnings of any sort), the hidden presence of these drugs
makes it
impossible for consumers to titrate their doses, predict interactions with
other medicines, or accurately notify their doctors of the substances that
might be in their systems. When PDE5s
interact with the drugs many people take to treat everything from diabetes
and high blood pressure to cholesterol and heart diseases, they can cause a
dangerous and potentially fatal drop in blood pressure. Given that some of
these supplements seem to contain multiple active ingredients each, at
doses
up to 31 times
beyond recommended therapeutic levels,
they can even be potentially lethal on their own. You can find that
same variability with other substances as well, but PDE5 inhibitors are among the most
common and risky.
The few studies on these products in aggregate, like one
released by Pfizer (the manufacturer of Viagra) in 2013 that analyzed 58 random supplements, seem to suggest that, in some regions or cases at least, over three quarters of
sex supplements likely contain a noticeable quantity of pharmaceuticals. Some might be skeptical of claims published by a pharmaceutical giant with a vested interest in reducing the market for supplements and increasing sales of its own products, but a study
published this January in the Journal of Pharmaceutical and Biomedical Analysis by university researchers found that over half of the sex supplements they analyzed were tainted with prescription ED drugs, which helps to bolster Pfizer's findings. So every time you buy a fuck pill at a gas station, there's a high probability that what you're buying is not just an herbal product, but actually a counterfeit drug or untested analogue. Depending on how it's contaminated or what drugs you're already taking, swallowing one of these pills might lead to a very bad night.
By the time the FDA caught on in 2007, sex supplement contamination was already an entrenched reality in the marketplace. Dr. Brian Donnelly, a member of Pfizer's Global Security
team who became aware of and started investigating "herbals" around the same
time that the FDA put the issue on its radar, recalled to VICE the scale of the first
case he looked into for the pharma giant:
" was called 'Boom' ...
This was a manufacturing operation in the United States where they were
actually mixing the active pharmaceutical ingredient with cocoa powder, like a
chocolate powder, in a cement mixer inside of a storage container in New
Jersey... I think the was able to confirm that they'd done it over a number
of years. That would have given you a starting point of around 2001... They'd
made upwards of a million doses and they'd sold the product not only in the
United States, but throughout Europe, Israel, and some other places as well."
Meyer says that the FDA can't
definitively pinpoint when these types of contaminants made it onto the market,
or track how they spread, up to 2007. No one else I spoke to could come up with
a firm answer either. In one sense, this isn't surprising.
The adverse effects
of sex supplements
pale in comparison to the scope and potential risks of other sketchy dietary supplements.
(
Think ephedra, the
dangerous stimulant found in many weight loss supplements in the early 2000s.)
Given the limited resources of regulatory agencies and the tens of thousands of
individual supplement products on the market, it's logical that sex supplements
wouldn't have been a major concern until they posed a proximate, lethal danger.
But it's still disconcerting that, according to Dr. Donnelly, many in the
medical world weren't aware of the rising contaminant trend until the turn of
the last decade when groups like Pfizer and the FDA started to raise the
critical concern alarm.
Despite the trend's murky
origins, we can still hazard a few educated guesses about the rise of ED
drug-contaminated "herbal" sex supplements. The
1998 release of Viagra, combined with the popular impact of a 1994 study on
the ubiquity of ED, brought impotence to the global forefront and showed people
that there were
very reliable ways to address it. Those with conditions or on medications that precluded
the use of Viagra and its competitors, or without the cash to pay for them,
likely turned toward already
cheap, seemingly safe, and bountiful herbals, boosting the market. Others too embarrassed
to seek a legitimate prescription simultaneously created a market for (also
cheap) counterfeit and analogue drugs.
Barrett of Quackwatch suspects that these counterfeits came onto the market in
1998 or almost immediately thereafter.
Counterfeits and analogues
likely worked their way into herbals relatively quickly because weak regulatory
laws make it easy to sneak such drugs into the United States in
supplements. The saga that got us here is a bit complex, but in 1994 Congress
neutered a bid to strengthen the FDA's oversight on supplements, crippling the
regulator after an effective campaign by major supplement makers. As a result, today
"herbals" don't really need to inform regulators what's inside of them, meet proper drug testing standards, or ensure that their packaging, warnings, or marketing
are accurate. And the FDA can't crack down on them until they're already
causing problems for people. This assumption that supplements are safe until proven
otherwise helped to
massively expand the herbals market in general (including the sex supplements market) from 1994 onwards, clearing the road for the
increased scope, scale, and contamination dangers that we're witnessing in sex
supplements now.
"They know it's hard for us
to keep track," Meyer of the FDA told VICE. "They know if they market... or label
their products as dietary supplements, they don't have to go through pre-market
approval."
Some products are wholly manufactured from abroad, while other sex stimulants are made in America, often using ingredients shipped in from elsewhere. And similar cases of illness from and contamination in these supposed sexual enhancers have been reported in places like Singapore, too, making this a global rather than just American problem. Professor Pieter Cohen of
Harvard University claimed
in an editorial published in the Journal of the American Medical Association in May, 2013 that herbal makers may embrace drug contamination in their products to try to make their often weak
products seem more effective, garnering repeat customers on the cheap. The products remain
available even after crackdowns due to the work of diffuse, emergent, and shifting networks cobbling
together ingredients that constantly surface and vanish. Sometimes the same
product will show up under many different names at the same time or
sequentially. Other times, the makers of one
product, sensing trouble, will pack up shop, move to a new storage locker or
basement, and make a slightly different product to the same ends. Sometimes
products will emerge on the market with no listed manufacturer whatsoever.
The networks behind today's
sex stimulants are so complex and fluid that the FDA admits it
can't keep up
with each new product, much less get a holistic sense of the market and its size as it
stands now, has evolved in recent years, and may evolve in the future. It doesn't help that, as Cohen's paper points out, the number of new analogues
has exploded over the past decade—not unlike
other synthetic drugs—and each one requires a learning curve to detect. Low reporting by shy victims means that our sense of the medical impact of these
herbals-cum-drugs is probably woefully understated as well. Donnelly and his
team at Pfizer want to start trying to map contaminant patterns in herbals to
better understand and tackle detrimental products and the networks behind them, but that's still more of a
thought than a reality.
Since 2007, the FDA's done
what it can to try to stymie the market through consumer alerts cautioning
against the consumption of specific herbals
and recalls.
Meyer says there've been 674 notifications issued since 2007; one
came out on December 11, just before we first spoke, for a product called "Fuel Up." Working with border control officials and their own
investigators, they've gotten better at catching contaminants or contaminated
products as they come into the country. They've even had a bit of success
prosecuting some manufacturers; starting in January they'll also have more
power to destroy confiscated shipments rather than ship them back to senders,
as they've had to do in the past.
But even with all these
efforts, many manufacturers and other folks in the supply chain still manage to
ghost, pivot, and reposition themselves in the market. Through constant
innovation in their networks, business models, and production and distribution
tactics, as well as through the sheer scale of their operation, they constantly
pop back up, arguably as potent as ever.
"It's kind of like a game of
whack-a-mole," says Meyer.
Donnelly says that it's
impossible to tell whether anyone's made a serious dent in the market. "All I can say is that
products are certainly in the stores," he says. "A high percentage of these
products are still tainted."
It's even possible that the
market for such herbals is expanding, despite all the public education about
their risks and the crackdowns. According to speculation by some researchers, health alerts on the active ingredients in
supplements could actually convince some men to try them as a cheap and reliable
way of getting ED drugs, though no hard data is currently available to prove such claims.
Demand for such cheap drugs
will likely never vanish. It's an extension of the demand for aphrodisiacs
that's been with us as long as we've been able to correlate our consumption
habits with our cocks. But observers believe there are a number of ways that we
could make it much harder and costlier to wantonly contaminate the herbal sex
supplement market.
First and foremost, Donnelly thinks that regulators should probably start
requiring herbal products to demonstrate the authenticity of their ingredient
and dosage listings, given the problems vagueness in this realm has created. From there he hopes that regulators and watchdog groups can fund and pursue more aggressive tracking and
prosecution policies to wipe detrimental products out of the market faster and
make the business costly for no-goodniks. Short of that, Barrett suggests that regulatory agencies try to restrict the advertising channels and
retail venues through which these tainted products are sold. But all of that
would require massive changes in the way America treats the herbal industry,
which officials don't seem to have the will
or inclination to push.
At present, the best most
observers feel they and others can do is to raise
awareness. Informing doctors about contaminants and their risks can mitigate
deaths from today's sex supplements. Making consumers aware of the risks
involved in taking them may reduce demand somewhat, blunting the market or
directing it back toward purely herbal, uncontaminated products. It can also
help consumers to understand which products to avoid—you can find a solid list
of warning signs identified by the FDA
here.
From there, all they can
do is hope that a barrage of publicity and slow regulatory chipping at the
market can change popular attitudes, shifting regulations and the calculus of
herbal manufacturers far enough to spur a new stage of evolution in this
strange, ancient industry. They'll never totally eliminate the
risks of sex supplements, which have always been there. But if the risks of popping a boner pill can come back down to the rarity of a Spanish Fly overdose through a market where most products available are weak, ineffective, or fake and harmless, then fornicaters everywhere will likely be better off—granite-hard erection or not.
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