Two men were convicted last week for selling counterfeit botulinum neurotoxin (BoNT), known commercially as Botox. The fake Botox was sold via the website: onlinebotox.com. The fake drug originated in Turkey and was sold throughout the Missouri area. Scientists and other experts have always feared widespread and unlicensed manufacture and use of this deadly toxin.

Botox is the first microbal toxin to become licensed for treatment of human diseases like cercivic torticollis, a muscular disorder of the neck. The most common use of Botox is cosmetic. When injected in small amounts, Botox can prevent the development of wrinkles by paralyzing certain muscles in the forehead and face The FDA requires a warning label advising that, if injected, the toxin may spread from the injection site to other areas of the body, causing symptoms similar to those of botulism poisoning.

Fake Botox made national headlines in 2004, when four people developed symptoms after receiving Botox injections at a medical clinic in Oakland Park, Fla. The four victims were hospitalized with severe botulism poisoning that included temporary paralysis. The FDA’s Office of Criminal Investigations (OCI) traced the fake Botox to a California laboratory that sold botulinum toxin for research purposes. OCI investigated the fake Botox for another four years, which resulted in 31 arrests and 29 convictions.

Legitimate sales of Botox exceed $2 billion a year–a large market that attracts counterfeiters who typically sell over the Internet. In 2012, the FDA warned doctors about Botox being sold online through CanadaDrugs.com. The drug offered for sale was an unapproved foreign version. In 2013, a Missouri doctor was sent to prison for lying to Federal agents about buying a foreign-made version online.

Weapon of Mass Destruction

Botulinum is an acutely lethal toxin and an infection with the bacterium may result in botulism, which is usually fatal. Just a speck of pure toxin, smaller than a grain of sand, can kill a 150-pound adult. Botox is also easy to manufacture, making it an ideal weapon of mass destruction. A biologist with a Masters degree and a few thousand dollars worth of equipment could make enough pure toxin to theoretically kill thousands of people.

It’s use as a weapon of mass destruction happened in March, 1995. The Aum Shinrikyo sect used an aerosolized BoNT (sarin) in a subway attack against the Japanese population, but the attack failed because its scientists mistakenly cultured a low toxin-producing strain. Nonetheless, thirteen people died and thousands were injured after cult members used umbrellas to pierce plastic bags containing the toxin on five subway trains. At the end of the Iraq war in 1991, 19,000 liters of BoNT were seized and destroyed.