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Web Sites with Misinformation about Illicit Drugs

From the New England Journal of Medicine
(see also: HealthScoutNews article)

The following letter was published in the New England Journal of Medicine on August 9, 2001. There are
several mentions of Erowid throughout the text, both named and unnamed. The primary author of the article also
talked to several reporters and named Erowid in the interviews. We sent a response letter to the editors of the NEJM
which was refused due to "space limitations". We are disappointed and concerned by their refusal to publish a
response letter from an organization which was directly and inaccurately criticized in the original letter.
-- Erowid

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

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
edward.boyer@tch.harvard.edu

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.
6.Harrington RD, Woodward JA, Hooton TM, Horn JR. Life-threatening 
   interactions between HIV-1 protease inhibitors and the illicit drugs MDMA and 
   -hydroxybutyrate. Arch Intern Med 1999;159:2221-2224.[Medline]
7.O'Connor A, Cluroe A, Couch R, Galler L, Lawrence J, Synek B. Death from 
   hyponatraemia: induced cerebral oedema associated with MDMA ("Ecstasy") use. N 
   Z Med J 1999;112:255-256.[Medline]
8.Zimmerman HJ. Chemical hepatic injury. In: Haddad LM, Shannon MW, 
   Winchester JF, eds. Clinical management of poisoning and drug overdose. 3rd 
   ed. Philadelphia: W.B. Saunders, 1998:149-74.
9.Osborn HH. Sedative-hypnotic agents. In: Goldfrank LR, ed. Goldfrank's 
   toxicologic emergencies. 6th ed. Stamford, Conn.: Appleton & Lange, 
   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 
   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.[Abstract/Full Text]