Social media markets for prescription drugs: platforms as virtual mortars for drug types and dealers

Is This Safe? Examining Safety Assessments of Illicit Drug Purchasing on Social Media Using Conjoint Analysis

Background: Illicit substance sales facilitated by social media platforms are a growing public health issue given recent increases in overdose deaths, including an alarming rise in cases of fentanyl poisoning. However, little is known about how online users evaluate what features of social media posts convey safety, which can influence their intent to source illicit substances. Objectives: This study adapts conjoint analysis which assessed how attributes of social media posts (i.e., features) influence safety evaluations of mock posts selling illicit substances. 440 participants were recruited online for self-reporting use or purchase of controlled substances or prescription medicines recreationally. The following attributes were tested: drug packaging, drug offerings, profile photo of seller, payment info provided, and use of emojis. Results: Packaging was ranked the most important attribute (Average Importance =43.68, Offering=14.94, Profile=13.86, Payment=14.11, Emoji=13.41), with posts that displayed drugs in pill bottles assessed as the most safe. Attribute levels for advertising multiple drugs, having a blank profile photo, including payment information, and including emojis also ranked higher in perceived safety. Rankings were consistent across tested demographic factors (i.e., gender, age, and income). Survey results show that online pharmacies were most likely to be perceived as safe for purchasing drugs and medications. Additionally, those who were younger in age, had higher income, and identified as female were more likely to purchase from a greater number of platforms. Conclusions: These findings can assist in developing more precise content moderation for platforms seeking to address this ongoing threat to public safety.

Understanding and preventing the advertisement and sale of illicit drugs to young people through social media: A multidisciplinary scoping review

ISSUES

The sale of illicit drugs online has expanded to mainstream social media apps. These platforms provide access to a wide audience, especially children and adolescents. Research is in its infancy and scattered due to the multidisciplinary aspects of the phenomena.

APPROACH

We present a multidisciplinary systematic scoping review on the advertisement and sale of illicit drugs to young people. Peer-reviewed studies written in English, Spanish and French were searched for the period 2015 to 2022. We extracted data on users, drugs studied, rate of posts, terminology used and study methodology.

KEY FINDINGS

A total of 56 peer-reviewed papers were included. The analysis of these highlights the variety of drugs advertised and platforms used to do so. Various methodological designs were considered. Approaches to detecting illicit content were the focus of many studies as algorithms move from detecting drug-related keywords to drug selling behaviour. We found that on average, for the studies reviewed, 13 in 100 social media posts advertise illicit drugs. However, popular platforms used by adolescents are rarely studied.

IMPLICATIONS

Promotional content is increasing in sophistication to appeal to young people, shifting towards healthy, glamourous and seemingly legal depictions of drugs. Greater inter-disciplinary collaboration between computational and qualitative approaches are needed to comprehensively study the sale and advertisement of illegal drugs on social media across different platforms. This requires coordinated action from researchers, policy makers and service providers.

Reasons that lead people to buy prescription medicines on the internet: a systematic review

Aim: This systematic review explores the factors that could influence consumer's decision of purchasing prescription medicines using the Internet. Methods: Relevant databases were searched to retrieve studies published from 2012 to 2021. The studies selected for inclusion were those focused on the consumer's perspective and the purchase of prescription medicines. A narrative synthesis was employed. The Capability Opportunity Motivation-Behaviour (COM-B) and the Theoretical Domains Framework (TDF) were employed as conceptual lenses that guided the analysis. Results: Seventeen studies were included. These studies have adopted various methodologies: qualitative method (n = 4), quantitative method (n = 12), and mixed methods (n = 1). The studies were based in Europe (n = 8), North America (n = 3), Middle East (n = 4), and 2 studies were conducted in several countries (multinational). The analysis of these studies revealed 7 themes that represent the reasons that lead people to buy prescription medicines via the Internet. These themes were the consumers' beliefs about the outcomes of the purchase (perceived benefits and risks of the purchase), consumer's emotions that could influence the purchasing decision, the factors that increase or decrease consumer's level of behavioural control over the purchase (facilitators and barriers of the purchase), consumers knowledge about the purchase, the trusting beliefs that lead consumers to trust the online sellers of medicines, the social influencing factors, and the external environmental factors that could encourage the purchase. Discussion: This study provides a comprehensive review of the breadth of reasons that drive people to buy prescription medicines via the Internet. Identifying those reasons could provide the basis for regulators to design evidence-based awareness campaigns to minimise the purchase of prescription medicines via the Internet. Furthermore, future research directions have been provided in this review to build upon the existing knowledge and address the research gaps in this area.

#Sponseredathlete: the marketing of image and performance enhancing drugs on Facebook and Instagram

This article sets out to investigate the marketing of image and performance enhancing drugs (IPEDs) on the social media platforms Facebook and Instagram. Drawing upon a 'connective' ethnographic exploration of IPED use and supply, the paper first outlines a supplier typology on these platforms, before shedding light on the marketing strategies employed by sellers in order to overcome the inherent distrust of online sales and build a trustworthy brand. Techniques identified include athlete sponsorship, the sharing of bodybuilding fitspiration content, self-objectification, posting images showcasing transformation photos and customer feedback, and seasonal sales and promotions. Analysis encompasses the centrality of product branding, the overlaps between licit and illicit market advertising strategies, and the affordances of the platforms under study. Finally, conclusions relating to the implications of these findings to scholarship, policy, and regulation are offered.

News Media Coverage of the Problem of Purchasing Fake Prescription Medicines on the Internet: Thematic Analysis

BACKGROUND

More people are turning to internet pharmacies to purchase their prescription medicines. This kind of purchase is associated with serious risks, including the risk of buying fake medicines, which are widely available on the internet. This underresearched issue has been highlighted by many newspaper articles in the past few years. Newspapers can play an important role in shaping public perceptions of the risks associated with purchasing prescription medicines on the internet. Thus, it is important to understand how the news media present this issue.

OBJECTIVE

This study aimed to explore newspaper coverage of the problem of purchasing fake prescription medicines on the internet.

METHODS

Newspaper articles were retrieved from the ProQuest electronic database using search terms related to the topic of buying fake prescription medicines on the internet. The search was limited to articles published between April 2019 and March 2022 to retrieve relevant articles in this fast-developing field. Articles were included if they were published in English and focused on prescription medicines. Thematic analysis was employed to analyze the articles, and the Theory of Planned Behavior framework was used as a conceptual lens to develop the coding of themes.

RESULTS

A total of 106 articles were included and analyzed using thematic analysis. We identified 4 superordinate themes that represent newspaper coverage of the topic of buying prescription medicines on the internet. These themes are (1) the risks of purchasing medicines on the internet (eg, health risks and product quality concerns, financial risks, lack of accountability, risk of purchasing stolen medicines), (2) benefits that entice consumers to make the purchase (eg, convenience and quick purchase, lower cost, privacy of the purchase), (3) social influencing factors of the purchase (influencers, health care providers), and (4) facilitators of the purchase (eg, medicines shortages, pandemic disease such as COVID-19, social media, search engines, accessibility, low risk perception).

CONCLUSIONS

This theory-based study explored the news media coverage of the problem of fake prescription medicines being purchased on the internet by highlighting the complexity of personal beliefs and the range of external circumstances that could influence people to make these purchases. Further research is needed in this area to identify the factors that lead people to buy prescription medicines on the internet. Identifying these factors could enable the development of interventions to dissuade people from purchasing medicines from unsafe sources on the internet, thus protecting consumers from unsafe or illegal medicines.

Reasons That Lead People to End Up Buying Fake Medicines on the Internet: Qualitative Interview Study

BACKGROUND

Many people in the United Kingdom are turning to the internet to obtain prescription-only medicines (POMs). This introduces substantial concerns for patient safety, particularly owing to the risk of buying fake medicines. To help reduce the risks to patient safety, it is important to understand why people buy POMs on the web in the first place.

OBJECTIVE

This study aimed to identify why people in the United Kingdom purchase medicines, specifically POMs, from the internet, and their perceptions of risks posed by the availability of fake medicines on the web.

METHODS

Semistructured interviews were conducted with adults from the United Kingdom who had previously purchased medicines on the web. Purposive sampling was adopted using various methods to achieve diversity in participants' experiences and demographics. The recruitment was continued until data saturation was reached. Thematic analysis was employed, with the theory of planned behavior acting as a framework to develop the coding of themes.

RESULTS

A total of 20 participants were interviewed. Participants had bought various types of POMs or medicines with the potential to be misused or that required a higher level of medical oversight (eg, antibiotics and controlled medicines). Participants demonstrated awareness of the presence and the risks of fake medicines available on the internet. The factors that influence participants' decision to buy medicines on the web were grouped into themes, including the advantages (avoiding long waiting times, bypassing gatekeepers, availability of medicines, lower costs, convenient process, and privacy), disadvantages (medicine safety concerns, medicine quality concerns, higher costs, web-based payment risks, lack of accountability, and engaging in an illegal behavior) of purchasing medicines on the web, social influencing factors (interactions with health care providers, other consumers' reviews and experiences, word of mouth by friends, and influencers' endorsement), barriers (general barriers and website-specific barriers) and facilitators (facilitators offered by the illegal sellers of medicines, facilitators offered by internet platforms, COVID-19 outbreak as a facilitating condition, and participants' personality) of the purchase, and factors that lead people to trust the web-based sellers of medicines (website features, product appearance, and past experience).

CONCLUSIONS

In-depth insights into what drives people in the United Kingdom to buy medicines on the web could enable the development of effective and evidence-based public awareness campaigns that warn consumers about the risks of buying fake medicines from the internet. The findings enable researchers to design interventions to minimize the purchasing of POMs on the web. A limitation of this study is that although the interviews were in-depth and data saturation was reached, the findings may not be generalizable, as this was a qualitative study. However, the theory of planned behavior, which informed the analysis, has well-established guidelines for developing a questionnaire for a future quantitative study.

'Choice' of social media platform or encrypted messaging app to buy and sell illegal drugs

Social media is increasingly being utilized to facilitate the buying and selling of illegal drugs, particularly by young people. However, the range of social media and messaging platforms means people must make 'choices' around which platforms they will use to conduct drug transactions. Polymedia theory suggests that people use different media to manage their social relationships, 'choosing' appropriate channels or platforms based on platform features and the social context of the relationship. This paper uses polymedia theory to explore how buyers and sellers navigate platform 'choice' for drug trading, and how this bears similarities to the ways in which they move between different platforms in their daily lives. We conducted anonymous online interviews with thirty-three people who buy and/or sell drugs via social media and encrypted messaging apps in New Zealand to explore the factors shaping their selection of platforms for drug transactions. Our findings highlight the importance of the relationship between the buyer and seller in shaping how interviewees weighted the relative importance of platform security and convenience. Though more commercial drug sellers exercised considerable influence in directing buyers of drugs towards a given platform, this pattern was less characteristic of how platform 'choice' was navigated in contexts of drug supply between friends. In social supply contexts, platform 'choices' were often not explicitly made, but rather exchanges were channelled through platforms already in use within the social group. We highlight the tensions that arise between seller preferences for a more secure platform and buyer preferences for greater convenience in contexts of friendship. Our findings highlight the importance of understanding social media drug market engagement as shaped by broader patterns of social media engagement, and the distinctions between different social contexts and personal relationships, consistent with polymedia theory.

Ordinary people, criminals, addicts and recreational users: Swedish court of law descriptions of persons sentenced for online drug purchases

Background: The aim of this study was to analyze how Swedish courts describe persons sentenced for purchasing illicit drugs online. Methods: Qualitative analysis of naturally occurring data through 201 sentences that included 248 individuals sentenced for having purchased drugs online between January 1 2010 and January 1 2020. Results: The analysis resulted in the construction of four ideal types regarding the described characteristics of the sentenced persons; the ordinary person, the recreational user, the addict and the criminal. The courts operate with a notable dichotomy between traditional drug markets and online drug markets, that can be understood in relation to descriptions of Bourdieusian capital forms, specifically street capital and digital capital. Conclusion: Descriptions relating to street capital were of larger interest to the courts compared to digital capital, although there were examples of when the courts argued that uses of digital capital should be viewed as an aggravating circumstance. The courts largely held a dichotomous view of online and offline drug markets that focus on street-based criminality, which may have implications for how emerging digital drug markets are responded to by drug law enforcement and judicial systems.

Predictors of using social media to purchase drugs in New Zealand: Findings from a large-scale online survey

BACKGROUND

There are increasing reports of social media being used to buy and sell illegal drugs internationally. Studies of social media drug markets to date have largely involved general explorations of social media drug transactions in select countries. Social media drug markets may operate differently for different drug types and in different country contexts.

AIMS

To identify predictors of the use of social media to purchase cannabis, methamphetamine, LSD and ecstasy/MDMA in New Zealand using a large-scale online survey sample.

METHODS

The annual New Zealand Drug Trends Survey (NZDTS), an online convenience survey promoted via targeted Facebook™ campaign, was completed by 23,500 respondents aged 16+. Logistic regression models were fitted to identify demographic, drug use and drug market predictors of reporting the use of social media to purchase cannabis, methamphetamine, LSD and ecstasy/MDMA.

RESULTS

Fifty-one percent of the sample had purchased cannabis, methamphetamine, ecstasy/MDMA or LSD in the past six months, of which 22% had done so via social media (n = 2,650). Cannabis was the drug type most purchased from social media among drug purchasers (24%), followed by ecstasy/MDMA (13%). Sixty percent of social media purchasers had used Facebook™, 48% Snapchat™, and 20% Instagram™. The leading advantages of social media purchasing were "high convenience" (74%), and "fast transaction speed" (43%). Younger age was a significant predictor of social media purchasing for all drug types (particularly among 16-17 year olds). Purchasing from someone identified as a "drug dealer" was a predictor of social media purchasing among respondents for all drug types.

CONCLUSION

Social media drug markets may have significant implications for drug purchasing by youth through providing greater access to supply and breaking down age-related barriers between social supply and commercial drug markets. Our findings highlight the importance of incorporating social media platforms into youth drug prevention and harm minimisation strategies.