WEB SITES WITH MISINFORMATION ABOUT ILLICIT DRUGS

To the Editor: As part of our research on the relation between the Internet
and substance abuse, we have identified several Web sites that promulgate
information about illicit drugs. These "partisan" Web sites are easily
identified by common search engines if one uses the names of illicit
substances as search terms.1 With some pages viewed more than 160,000 times
per day, partisan sites appear to be effective in reaching adolescents and
young adults. In a recent study, 24 percent of college students used the
Internet to obtain information on illicit substances, and 27 percent of
Internet-using college students reported that Internet use increased the
likelihood that they would use drugs.2

The popularity of partisan Web sites may arise from their plausible
descriptions of the preparation, dose, administration, and psychoactive
effects of drugs (Table 1). Partisan sites also offer recommendations for
management of the adverse effects of illicit drugs. As one partisan site
says, "it is up to the drug user to stay out of [the physician's] hands."11
To evaluate the quality of such information, we conducted a survey of seven
partisan Web sites. With high interobserver reliability (kappa=0.81)
between experts unaware of the source of the information, we found that
every partisan site made potentially harmful recommendations for the
management of the adverse effects of illicit drugs. Information from
partisan sites has been linked to adverse outcomes: some partisan sites
have described their own role in the deaths of drug users and some have
been implicated in poisoning from 1,4-butanediol.12,13

Table 1. Features of Partisan Web Sites as of May 24, 2001. See URL:
http://www.mapinc.org/nejmtbl.htm

Unfortunately, Internet-based efforts to prevent drug use may not deflect
visitors from partisan Web sites. We performed five separate searches using
identical key words ("GHB" [[]-hydroxybutyric acid], "ecstasy"
[methylenedioxymethamphetamine or MDMA], and "psychedelic mushrooms") over
a period of 10 months. Our first two searches listed 8 partisan and 2
federal antidrug Web sites in the top 10 results. The third search
identified nine partisan sites and one federal site, whereas the final two
searches identified eight partisan and no federal sites. In all searches,
antidrug sites from the federal government failed to appear as often as the
partisan sites, which dominate the search results. Moreover, sites of the
Federal Website Initiative, part of a billion-dollar multimedia program for
the prevention of drug abuse, did not appear in any of the search results.
These data suggest that the U.S. government, despite extensive and costly
efforts, currently does not provide effective alternative sources of
information about drugs on the Web, where partisan sites still get the
attention of both search engines and users.

Edward W. Boyer, M.D., Ph.D. Michael Shannon, M.D., M.P.H. Patricia L.
Hibberd, M.D., Ph.D. Children's Hospital Boston, MA 02115

References

1) Nelson LS. A guide to clinical toxicology resources available on the
Internet: drugs of abuse. J Toxicol Clin Toxicol 2000;38:85-86.

2) Wax P, Reynolds N. Just a click away: student Internet surfing for
recreational drug information. J Toxicol Clin Toxicol 2000;38:531-531.abstract

3) Mueller PD, Korey WS. Death by "ecstasy": the serotonin syndrome? Ann
Emerg Med 1998;32:377-380.[Medline]

4) Toxic Exposure Surveillance System. Massachusetts Poison Control Center
Data, 2000. Am J Emerg Med (in press).

5) Boyer EW, Quang L, Woolf A, Shannon M, Magnani B. Dextromethorphan and
ecstasy pills. JAMA 2001;285:409-410.

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8) Zimmerman HJ. Chemical hepatic injury. In: Haddad LM, Shannon MW,
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9) Osborn HH. Sedative-hypnotic agents. In: Goldfrank LR, ed. Goldfrank's
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1998:1001-22.

10) Dyer JE, Roth B, Hyma BA. GHB withdrawal syndrome: eight cases. J
Toxicol Clin Toxicol 1999;37:650-650.abstract

11) Cohn M. GHB mini FAQ. 1998. (http://www.lycaeum.org [Web site may not
be currently available.])

12) Second reported 2C-T-7 death. Erowid, 2001. (Accessed July 24, 2001, at
http://www.erowid.org/chemicals/2ct7/2ct7_death2.shtml.)

13) Zvosec DL, Smith SW, McCutcheon JR, Spillane J, Hall BJ, Peacock EA.
Adverse events, including death, associated with the use of 1,4-butanediol.
N Engl J Med 2001;344:87-94.