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.
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(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:
“[It] 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 [FBI] 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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