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Due to a growing awareness of the consumption of performance and image enhancing drugs (PIEDs), and the stated adverse health effects that come with it, PIEDs have increasingly come to be viewed as a serious public health problem. A main concern of authorities is that the majority of PIEDs are not legally obtained through a physician, by means of a prescription, but rather are being illegally purchased on the black market. Sport officials and state authorities suggest that the illegal PIED market is being driven by economically motivated individuals and dangerous groups often associated with ‘organized crime’. This presentation seeks to explore these claims by documenting the ways in which PIED dealing networks form and develop within and between the Netherlands and Belgium. In addition, I will explore how varying PIED policies are impacting upon these markets. While Belgium adopts a zero-tolerance stance, emphasizing enforcement measures, the Netherlands, by contrast, advances a ‘pragmatic approach’ in which limited attention is given to health care and prevention. What we will see is that both countries fail to disrupt the PIED market, but rather are facilitating a self-fulfilling prophecy by increasing public health risks and attracting economically motivated criminal groups.