The health risks of Botox are hard to underplay but easy to overlook. Few people realize that this widely popular wrinkle smoother is one of the world’s deadliest poisons, and that a drop smaller than a grain of sand is potent enough to kill a 150-pound adult. Two years ago, there were reported deaths among American children who had been treated with Botox for muscle spasms linked to cerebral palsy. Last year, the U.S. FDA required Allergan to put a “black-box” warning on the label of Botox, explaining that the material has the potential to spread from the injection site to other parts of the body…such as the brain. Now there appears to be a new reason to fear Botox, and it’s probably the last thing you’d expect to touch the realm of beauty: terrorism.

There is growing concern that suspect networks across Eastern Europe, Asia, and the Middle East are embroiled in a faux Botox trade. In 2006, a cosmetics salesman in St. Petersburg was sighted hawking limitless vials of an anti-aging drug at suspiciously low prices.  Lab tests on the solution inside the vial turned up a potent clone of botulinum toxin, a neurotoxin produced by bacteria commonly found in spoiled meat...otherwise marketed as Botox. According to a recent article in the Washington Post, U.S. security authorities fear that there may be dozens of international labs manufacturing knock-off poison and feeding a nascent black market for the drug.

This scenario is not just frightening for the fact that faux Botox is unregulated and could be contaminated, thus putting the lives of patients being treated with the muscle relaxer at risk. But it also draws attention to the reality that a Botox-like serum is relatively easy to replicate in a lab. A study by the James Martin Center for Nonproliferation Studies reported that a biologist with a master's degree and $2,000 worth of equipment would be capable of producing a gram of the neurotoxin- sufficient to annihilate an entire population. What if this lethal supply were to fall in the wrong hands?

Al-Qaeda has been suspected of seeking botulinum toxin in the past, but for a more benign purpose than mass killings. Militant groups like Al-Qaeda buy and sell counterfeit drugs for quick cash. According to biodefense experts, this black market is a terrorist's only known profit-making enterprise that could derivatively yield a weapon of mass destruction. The U.S., Russia, and Iraq have all explored the use of botulinum toxin as a biochemical weapon but abandoned their efforts when it proved unstable during delivery- a stumbling block that has plausibly hindered terrorist groups in the past.

Although the global black market for faux Botox may not be based on using the poison to kill, the potential exists for a harrowing convergence. In fact, a bioterrorism manual distributed to cells of the al-Qaeda terrorist network (and intercepted by coalition intelligence agencies in 2001) listed exact formulas for the production of botulinum toxin. It advocated using botulinum toxin in terrorist attacks, such as in lacing food and water supplies to inflict extensive damage.

Considering the multi-billion dollar market for anti-aging potions, a surge of underground suppliers and distributors has surfaced online, where customers don't need a prescription to make a transaction. This anonymous network makes buying and selling raw materials that can be converted into biochemical weapons easier than ever. But now terrorist groups no longer need to buy virulent strains of the toxin-producing bacteria and experiment with expensive equipment in a lab to obtain a lethal weapon. Terrorists can bypass these steps by doing business with existing manufacturers that sell discount Botox over the internet. It appears that most of the companies hawking unauthorized Botox are based in China, though many of their websites are attached to fake addresses.

While raw botulinum toxin is one of the most deadliest substances on earth, prescribed doses of Botox contain only a minuscule amount- so small that a terrorist would have to obtain hundreds of vials (at $400 a pop) to have a lethal quantity. Commercially produced Botox is highly diluted for cosmetic purposes, and only eight companies worldwide are licensed to produce variations of the injectible drug. But if a black market for Botox is circulating a raw form of the toxin, then we all have reason to fear. Assuming that bootleg Botox can be bought in sufficient quantities to cause widespread fatalities, it could one day become a formidable terrorist tool.