Illicit Trade of Prescription Medications Through X (Formerly Twitter) in Japan: Cross-Sectional Study

• Published in: JMIR formative research 2024-05, Vol.8, p.e54023
• Main Authors: Hakariya, Hayase, Yokoyama, Natsuki, Lee, Jeonse, Hakariya, Arisa, Ikejiri, Tatsuki
• Format: Article
• Language: English
• Subjects: Antipsychotics; Benzodiazepines; Cross-sectional studies; Drug abuse; Drug administration; Generic drugs; Illegal drug operations; Nonprescription drugs; Original Paper; Pharmaceuticals; Prescription drugs; Social networks; Surveillance
• ISSN: 2561-326X; 2561-326X
• DOI: 10.2196/54023

Nonmedical use of prescription drugs can cause overdose; this represents a serious public health crisis globally. In this digital era, social networking services serve as viable platforms for illegal acquisition of excessive amounts of medications, including prescription medications. In Japan, such illegal drug transactions have been conducted through popular flea market applications, social media, and auction websites, with most of the trades being over-the-counter (OTC) medications. Recently, an emerging unique black market, where individuals trade prescription medications-predominantly nervous system drugs-using a specific keyword ("Okusuri Mogu Mogu"), has emerged on X (formerly Twitter). Hence, these dynamic methods of illicit trading should routinely be monitored to encourage the appropriate use of medications. This study aimed to specify the characteristics of medications traded on X using the search term "Okusuri Mogu Mogu" and analyze individual behaviors associated with X posts, including the types of medications traded and hashtag usage. We conducted a cross-sectional study with publicly available posts on X between September 18 and October 1, 2022. Posts that included the term "Okusuri Mogu Mogu" during this period were scrutinized. Posts were categorized on the basis of their contents: buying, selling, self-administration, heads-up, and others. Among posts categorized as buying, selling, and self-administration, medication names were systematically enumerated and categorized using the Anatomical Therapeutic Chemical (ATC) classification. Additionally, hashtags in all the analyzed posts were counted and classified into 6 categories: medication name, mental disorder, self-harm, buying and selling, community formation, and others. Out of 961 identified posts, 549 were included for analysis. Of these posts, 119 (21.7%) referenced self-administration, and 237 (43.2%; buying: n=67, 12.2%; selling: n=170, 31.0%) referenced transactions. Among these 237 posts, 1041 medication names were mentioned, exhibiting a >5-fold increase from the study in March 2021. Categorization based on the ATC classification predominantly revealed nervous system drugs, representing 82.1% (n=855) of the mentioned medications, consistent with the previous survey. Of note, the diversity of medications has expanded to include medications that have not been approved by the Japanese government. Interestingly, OTC medications were frequently mentioned in self-administration posts