There Is An Emerging Black Market in Healthy Poop for Medicinal Use

We have all probably watched a television show or movie where a clandestine drug deal occurs. In movies a nervous buyer often meets a nervous seller in a seedy part of town. Money and products are exchanged with both hoping the other is not a cop. Either party could try to steal what the other has without keeping their end of the bargain. This is probably mostly fiction, but clandestine exchanges of drugs do occur.

Buying and selling illicit drugs is a dirty business, but Slate magazine describes new levels of filth: selling human poop for medicinal use.

In late 2023, Alexandra, a 66-year-old retired woman in D.C., was defrosting a piece of human feces that she purchased over the internet. Her goal was to reduce the stool into a sloshy, biologically rich mixture, which could then be easily transferred past her rectum and into her colon. HumanMicrobes, the mysterious and legally questionable website that Alexandra purchased the poop from, recommended a turkey baster for the job. Alexandra opted for an enema bottle. “I gave myself a plain water enema first,” she told me. “Just to clear everything out.”

Then she tried it with the poop. For a while, she laid there allowing her homebrew liquid-fecal elixir to seep into her innards, where she hoped it would bloom new life into her troubled guts.

The subject of the anecdote has a variety of health complaints including irritable bowel syndrome. She had been unable to get relief from her doctors and decided to take matters into her own hands. She is hardly alone. Years ago, OpenBiome, a fecal bank in Boston, supplied material for fecal microbiota transplants (FMT) to doctors across the country. The process was initially considered questionable. Many hospitals would not allow fecal transplants and the U.S. Food and Drug Administration had not approved the procedures. Doctors who performed them were considered on the fringes of medical science. The condition most commonly treated with fecal transplants is clostridioides difficile (c. diff.), an infection of the gut. The treatments have become mainstream now, although people with irritable power syndrome are not considered candidates because they don’t have c. diff. Thus, a black market of sorts stepped in to fill the need.

When [Alexandra] described her symptoms to them, they gave their blessing to seek out a “fecal microbiota transplant,” or FMT. In other words, they wanted her to implant someone else’s poop in the hope that it would quell whatever was ravaging her body.

Basically, some people have gut bacteria that irritates their colons, while others have a healthy mix that doesn’t. Perhaps I’m oversimplifying but the process involves trying to repopulate a gut with healthy bacteria.

FMTs have been around for a while. The first recorded instance of a fecal-based remedy occurred in ancient China, and today, they’re one method used to treat Clostridioides difficile (C. diff), a bacterial infection that causes fever, nausea, and diarrhea, which can occur after antibiotics have inadvertently scoured a patient’s bowels of healthy microbes. Sahil Khanna, a gastroenterologist at the Mayo Clinic, uses a gardening metaphor to describe the process.

“To fix the problem, you need to kill the dandelions, and then steal good grass from your neighbor’s backyard and plant it there.” The good grass from your neighbor—that’s the poop. This approach, fighting C. diff with healthy stool, is currently the only governmentally certified use of FMT.

People with Crohn’s, irritable bowel syndrome and other conditions of the gut often want to try FMT because it seems to work for some people. With an approved treatment for c. diff. now available  but unapproved for those whose condition is not diagnosed as c. diff., patients have to look elsewhere for medicinal feces.

Harrop started HumanMicrobes in 2020 in order to match fecal “super-donors” with buyers willing to spend a premium price to ingest it. Harrop refers to the website as a business and his primary commercial enterprise. The poop he sells costs around $1,000 per “dose,” and is distributed in either capsule form (for the “upper route”) or split into pieces packed in dry ice (for the “lower route”). The resulting revenue is split evenly between Harrop and whoever the stool previously belonged to. Unlike the FMT treatments you might receive at the Mayo Clinic, there is not a specialist prepping the poop for you. Harrop never handles the feces directly. This is an ad hoc, online-only operation, delivered peer-to-peer, with Harrop functioning as something like an international middleman for poop. (Yes, they ship worldwide.)

The process is not without risks. Improperly screened feces injected into immunocompromised people can be deadly. Another concern is there is an emerging alternative medicine industry trying to convince people that all manner of maladies can be cured with a stranger’s poop. I will spare you the gory details, but the entire article is worth reading.