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There is a growing global market in illicit pharmaceutical drugs. In the UK the largest demand is for so-called lifestyle medicines consumed through personal choice rather than illness, used for non-health matters or matters lying at the margins of health and wellbeing. Factors contributing to their demand include the appeal of performance and image enhancement, the expansion of online pharmaceutical consumption, the widespread medicalisation of non-medical issues, and the recreational use of prescription pharmaceuticals. Often the consumption of these drugs is as an inherent aspect of commodified leisure pursuits. Drawing on extensive ethnographic fieldwork in both online and offline contexts, this paper examines illicit pharmaceutical consumption as a form of deviant leisure. The paper frames the discussion in an ultra-realist analysis that situates the consumption of illicit lifestyle drugs in the broad contexts of an interconnected global economy administered by deregulatory neoliberal politics, an attendant commodified culture lacking ‘symbolic efficiency’ and thus reinforcing competitive, individualistic and harmful subjectivities, and an increasingly sophisticated and accessible technology and communications infrastructure.