In February 2001, an 18-year-old honors student from California died after purchasing Vicodin (hydrocodone/acetaminophen), a commonly abused prescription opioid drug, from a “no prescription” online pharmacy.1 His name was Ryan Haight, and his untimely death led to passage of the 2008 Ryan Haight Online Pharmacy Consumer Protection Act (RHA; HR 6353), a federal law that amended the Controlled Substances Act (21 USC 801). The RHA was specifically designed to respond to the growing use of the Internet to illegally market and sell controlled substances directly to consumers.1 More than 15 years later, nonmedical use of prescription medications is a national epidemic, with the US Centers for Disease Control and Prevention reporting that deaths attributable to prescription opioids have more than quadrupled since 1999.2 This situation has prompted federal and state agencies to both reexamine and revise opioid-related policies and guidance.2-5
Policies aimed at curbing prescription opioid abuse have focused on establishing guidelines to prevent inappropriate prescribing, developing abuse deterrents, regulating “pill mills,” and preventing drug diversion (such as through state prescription drug monitoring programs).1,4,6,7 However, the role of the Internet and its continued promotion of prescription opioid abuse remains inadequately addressed despite the passage of the RHA. Specifically, Internet technology is now ubiquitous (e.g., 84% of American adults use the Internet and 65% use a social networking site), fueling the growth of dubious Internet pharmacy Web sites, now estimated in the tens of thousands globally.8 In a recent report, the National Association of Boards of Pharmacy reviewed more than 11 000 Web sites and found that 96% were not in compliance with state and federal laws or the association’s patient safety and pharmacy practice standards (e.g., they did not require valid prescriptions or issued prescriptions via online consultations or questionnaires only), including 13% that dispensed controlled substances.
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Previous published studies (including investigative reports by the US Government Accountability Office showing that Oxycontin [oxycodone], Percocet [oxycodone/paracetamol], and Vicodin were successfully purchased from online pharmacies without a prescription) have confirmed the public health and patient safety dangers of illegal online sale of prescription opioids.9-13 Also, recent studies have established an association between social media technologies and “no-prescription” online pharmacy drug promotion and access.14-20 Hence, we sought to build on prior research by employing an innovative methodology involving “big data,” machine learning, and Web forensic analyses to identify and characterize social media use by online pharmacies in their efforts to promote the illegal sale of prescription opioid drugs.
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