Earlier this month, the United States Food and Drug Administration (FDA) held its third Online Opioid Summit, a day-long event convening representatives from prominent technology and social media companies, academic researchers, and experts from public health nonprofits, including NABP, to discuss ways to collaborate to reduce the availability of opioids on the internet.

Introduced in 2018, the first summit focused on what then-FDA Commissioner Scott Gottlieb, MD, described as one of the greatest risks facing Americans – the availability of counterfeit opioid products and other illicit pharmaceuticals on the internet. In his opening remarks, Gottlieb noted, “Increasingly people are going online to illegally buy opioids like Vicodin or Percocet or OxyContin, but what we believe they’re really getting is pressed fentanyl. At doses that can be lethal.” Gottlieb called for “specific, proactive measures that Internet stakeholders, in collaboration with FDA, can take to reduce the availability of opioids online.”

Since then, internet stakeholders have gradually taken steps to curb the illegal sale of opioids and illicit drugs on their platforms. Weeks prior to the 2018 summit, Google announced a new policy to deindex websites cited in FDA warning letters. Shortly thereafter, social media platforms, including Facebook and Instagram, began redirecting users looking to purchase opioids on their platforms to the Substance Abuse and Mental Health Services Administration National Helpline. And at the 2019 summit, FDA announced the launch of a collaboration with three major registries and the National Telecommunications and Information Administration to conduct a pilot program to suspend or block websites failing to respond to warning letters of illegal sales of prescription opioids and narcotics on their sites. As a result of the program, 30 websites were blocked from public access.

At this year’s summit, Acting FDA Commissioner Janet Woodcock, MD, applauded these positive steps, but with annual overdose deaths in the US at an all-time high and the majority involving synthetic opioids, she also acknowledged that much more must be done. Presentations at this year’s summit highlighted how the coronavirus disease 2019 (COVID-19) pandemic has exacerbated the opioid crisis by isolating many at risk of substance abuse disorders and accelerating Americans’ growing interest in buying medicines online, including opioids, despite widespread and dangerous misconceptions about the prevalence of illegal online drug sellers. Speakers also provided numerous examples of the ease with which drug dealers continue to use the internet and social media platforms to move illicit drugs into and throughout the country. According to research conducted by The Partnership for Safe Medicines, overdoses due to counterfeit opioids have now been reported in all 50 states across the US. Another recurring theme throughout this summit was the growing number of young adults and teens, some as young as 14 years old, who have fallen victim to drug dealers peddling fake prescriptions through social media platforms, such as Snapchat. In Arizona, a drug trafficking task force has now dedicated 30% of its time to Snapchat surveillance and describes efforts to track dealers on the platform as virtual whack-a-mole.

This year’s Online Opioid Summit also comes at a time of heightened public scrutiny of online platforms, including the lack of transparency around content moderation and inconsistent enforcement of user policies. In September 2021, the Wall Street Journal released the findings of an investigation into internal Facebook documents, revealing that “Facebook Inc. knows, in acute detail, that its platforms are riddled with flaws that cause harm,” but in many cases, Facebook does not take action to address clear violations of its policies. And days prior to the summit, a group of parents who lost children to counterfeit pills sold on Snapchat signed a letter to the CEO calling for the company to establish a transparency committee to oversee the actions they take to investigate and prevent the sale of illicit drugs on their platform, citing apparent resistance from Snapchat to law enforcement’s requests for information.

Unlike previous summits, this year’s did not end with specific commitments to action, but when asked what internet and social media companies could be doing to further protect users and reduce the availability of illegal opioids on their platforms, participants provided several suggestions:

  • Partner with nonprofits, such as NABP and their #BuySafely initiative, to proactively educate users at the point of click or search about the risks of purchasing medications online;
  • Partner with academic researchers to develop technology to more efficiently identify, track, and take action against users that violate terms of use; 
  • Proactively notify law enforcement of evidence of illegal drug dealing; and
  • Increase transparency of actions taken against illegal online drug dealers.

NABP stands ready to collaborate with any and all internet and social media companies that wish to take proactive steps to combat illegal drug sales on their platforms and to educate users about the harms of purchasing medication from rogue online sources.