Friday, March 16, 2012

Mid-term Prescription Drug Abuse: Does Social Media Play a Role?

Prescription Drug Abuse:
Does Social Media Play a Role?

Much has been written about illicit drug abuse in the United States. There are Public Health programs geared towards preventing and reducing the number of new users, as well as advising active users on resources to help them stop. In addition extensive law enforcement efforts are in place to address the importation, trafficking, and end-user sales. Despite these efforts and expenditures, elicit drug abuse continues to be a troubling and serious problem for Public Health Departments, the Health care system, Law Enforcement officials, all levels of government, and society at large.

From: Paulozzi, p. 1491

In recent years, a growing problem has emerged involving the recreational or illicit use of prescription drugs. As detailed in a report published last year from the Centers for DiseaseControl and Prevention (CDC), over the 10-year period between 1999-2008, “overdose death rates, sales and substance abuse treatment admissions related to opiate pain relievers all increased substantially.” (Paulozzi, 2011) The same study found that in 2008 in the U.S., opiate pain relievers were involved in 73.8% of the 20,044 reported deaths due to prescription drug overdoses. (see Figure 2, right)

Another study published in 2011 by the CDC showed that 20.2% of high school students reported having taken prescription drugs- including OxyContin®, Percocet®, Vicodin®, Adderall®, Ritalin®, and Xanax®.- that were not specifically prescribed to them one or more times in their lives. (Eaton, 2010, p. 19) Much of the scientific literature examining prescription drug abuse by adolescents and young adults tends to focus on analgesics, specifically opiates, because of the alarming increase in deaths due to overdose among these two groups. 

Figure 3
Stimulant drugs, which usually are prescribed for the treatment of ADD/ADHD, are a growing cause for concern as well, particularly for this demographic. The most common sources of non-prescribed use of stimulant drugs such as Adderall® are either from a person with a legitimate prescription for the drug, or  from individuals who feigned the symptoms of ADD/ADHD in order to obtain the drug. (DuPont, 2010) Swanson et al observed, in a 2011 review of stimulant use, that the total number of prescriptions dispensed for this therapeutic category has risen steadily each year. In fact there has been an over eleven-fold increase between 1990 and 2010 (See Figure 3, left). In this same report the authors estimated that 70% of the prescriptions dispensed were actually used for therapeutic purposes, adding "In 2008 the number of prescriptions was 38 million, so our rough estimate of 30% diversion suggests that about 11.4 million prescription might have been diverted to non-medical use in 2008." (Swanson, p. 744) Another study looking at students who had legitimate prescriptions for either type of drug found that 61.7% diverted their stimulants, while 35.1% diverted their analgesics to another person for non-prescribed use. (Garnier, 2010)

Adderall® tablets & capsules
The principle objective of this monitoring project is to explore whether or not data culled from Social Media can be a useful tool in the phenomenology research of non-medical use of certain prescription drugs- specifically the stimulant Adderall®, and the opiate analgesic OxyContin®. It is difficult to empirically establish and/or quantify correlations between Internet usage and prescription drug abuse for a number of reasons. One study attempted to do this by correlating the rates of increased Internet usage with the number of reported hospital admissions for treatment of prescription drug abuse (PDA). This investigation found “that for every 10 percent increase in high speed Internet use at the state level, associated treatment facility admissions for prescription drug abuse rose by 1 percent.” (Jena, 2011)

OxyContin ®   tablets
While these findings are hardly definitive, this study demonstrates the challenges in applying metrics that would accurately reflect the degree to which this should be considered a problem. In spite of these methodological challenges, there were strong statistical correlations found for both opiates (1.09) and stimulants (1.18), with both having p values of less than 0.001 (p. 1197). The obvious inference that could be made is that wider availability of high speed Internet leads to increased Internet sales of the drugs. In turn this results in increased nefarious use, leading to increased numbers of treatment facility admissions. Logical perhaps, but hardly definitive because in spite of the strong statistical correlations, these data lack the specificity required to reliably draw inferences or conclusions.

With these challenges in mind, the current investigation seeks to understand the role of Social Media in various transactions involving two of the prescription drugs cited in the previous paragraphs- the opiate analgesic  OxyContin® and the stimulant Adderall®. The volume and context of mentions on Facebook, Twitter, and Google Plus of each drug will be tracked daily, over the 2 month period of February 16- April 15, 2012. The primary objectives will be:
  • To explore the types of interaction and frequency of mentions; 
  • To identify any patterns of communication related to these drugs that might emerge; and 
  • To explore some of the methodological, ethical, and practical issues that must be considered in this format. 
The data presented in this interim report will examine patterns of total mentions of each drug. In addition this report will explore whether there are any identifiable correlative factors that can inform our thinking about these phenomena.

The charts above compare the absolute volume of mentions (top) and the percent of messages containing the mention, out of the total number of blog posts (bottom). If one were to rely on the bottom chart alone, it would appear that neither of these terms receives significant mention relative to the total "chatter" on the Web. However, paired with the pattern of absolute increased number of mentions, some possible patterns emerge. 

Adderall Total Buzz, Feb. 16- Mar. 15, 2012, Source:
In this chart one can see the daily volume of "Adderall" mentions on the three social networking sites being tracked, as well as sub-categories of "positive" and "negative" tweets, and the category total (burnt orange). Although "positive" and "negative" Tweets have been separated out by, the data provider, closer analysis of the individual Tweets demonstrates that these are not reliable characterizations, for the purposes of this investigation. Rather, these characterizations seem arbitrary, if not pejorative. It is not clear what qualifies a comment as "negative" or "positive". Furthermore, an overwhelming majority of comments were characterized as simply "neutral". [The same is true for the OxyContin® data to be presented in the next section.] The majority of mentions came from Tweets, which may indicate that they are being generated by a younger audience, perhaps college-aged or young adults. The most logical correlation to the peak increase, if one assumes that the use is related to attempts to improve academic performance, is that they coincide with periods that universities are entering the mid-term. In addition, 7 out of 10 of the highest volume "Tweeters" were online pharmacies advertising sale of Adderall® and other drugs without a prescription.

OxyContin Total Buzz, Feb. 16- Mar. 15, 2012, Source:
This chart presents data similar to the Adderall® chart, except in this case monitoring mentions of OxyContin® during the same time period. While there is more variability in the origin of the mentions, the vast majority of mentions come from Twitter. Closer examination of the individual Tweets, as well as temporal peak patterns can be correlated with issues in the news at the time. The first peak occurred in late February and early March. This coincides with intense media coverage of OxyContin® being removed from the Canadian market due to increasing problems with illicit use of the drug. The second peak occurred in the second week of March, following the unfortunate remarks radio talk-show host Rush Limbaugh made about Georgetown Law School student Sandra Fluke. Just as in the case of Adderall®, there were Tweets from online pharmacies advertising sale of the drug without a prescription. However the numbers of these Tweets were dwarfed by the Canadian market and Limbaugh-Fluke related activity.

The final report will provide a more detailed data analysis and include in depth discussion of the findings in the context of the study questions previously outlined.
The author would like to thank for their generous support in providing daily tracking and data computation services free of charge.

Works Cited

DuPont, R. (2010, June). Prescription Drug Abuse: An Epidemic Dilemma. Journal of Psychoactive Drugs , pp. 127-132.
Eaton, D. K. (2010, June 4). Youth Risk Behavior Surveillance — United States, 2009. MMWR, Special Report No. 5 , pp. 1-38.
Garnier, L., Arria, A., Caldeira, K., Vincent, K., & O’Grady, K. (2010, March). Sharing and selling of prescription medications in a college student sample. Journal of Clinical Psychiatry , pp. 262-269.
Jena, A. a. (2011, June). Growing Internet Use May Help Explain the Rise in Prescription Drug Abuse in the United States. Health Affairs , pp. 1192-1199.
Paulozzi, L. J. (2011, November 4). Vital Signs: Overdoses of Prescription Opioid Pain Relievers -- United States, 1999-2008. Morbidity & Mortality Weekly Report , 60 (43), pp. 1487-1492.
Swanson, J., Wigal, T., & Volkow, N. (2011, September). Contrast of Medical and Nonmedical Use of Stimulant Drugs, Basis for the Distinction, and Risk of Addiction: Comment on Smith and Farah (2011). Psychological Bulletin , 137 (5), pp. 742-748.

Wednesday, March 14, 2012

w8r, Part 3: The Groundswell Transforms Attaining Social Maturity

Part 3: The Groundswell Transforms
Attaining Social Maturity

In the final chapter of the book, Groundswell: Winning in a World Transformed by Social Technologies, authors Li and Bernoff bring all the concepts presented in the previous chapters together. As the title above indicates, this chapter highlights how organizations can incorporate Social Media into their business plans and have this communication channel as part of their overall organizational structure. The result is an outline of a cohesive process for organizations to adopt and develop Social Media business strategies that will support their success now, and in the future.

This final chapter begins with the story of how home improvement retailer-Home DepotSocial Media strategy evolved. The catalyst for Home Depot's foray into Social Media was a mandate issued in 2007 by the company's new CEO, Frank Blake. This statement was in response to a furry of overwhelmingly negative comments that were posted on an MSN article, severely criticizing the giant retailer. The article, entitled Is Home Depot Shafting Shoppers?, and written by Scott Burns, was a scathing rebuke of Home Depot's treatment of its customers.  After articulating a list of complaints in detail, Burns summarized, "The result is that a once iconic, wonderfully American store has become an aggravation rather than a blessing." He concluded his piece by calling on Home Depot to increase its staffing and stop trying to improve their bottom line "by stealing our time at the check out counter or elsewhere."

As a result of declining sales, customer dissatisfaction, and generally poor corporate performance, Home Depot CEO Blake made a very public mea culpa. He admitted the company's past mistakes during a March, 2007 appearance on MSN following the publication of Burns' article. Blake also acknowledged the negative feedback in response to the MSN article, and went on to say, "We have dispatched a dedicated task force- working directly with me- that is ready and willing to address each and every issue raised on the [comment] board. Please give us the chance." (Li, p. 251) Social Media applications were a key component to the company's "repair" strategy, and have since evolved into an integral part of its business plan going forward. Social Media did not turn things around for Home Depot. Decisive, responsive management, led by the CEO, and a renewed focus on customer service are what shifted the tide for the company. By embracing the groundswell Home Depot revitalized their business, increased shareholder value, and- most importantly- restored consumers' confidence in the company as a leader in home improvement. 

Today Social Media is an integral component of  Home Depot's business strategy.  The company has its own channel on YouTube (for example, click on figure above) with over 22 million visitors to date, and features easy to follow "how-to" videos. They also can be found on Twitter @HomeDepot and Facebook, where they have almost 600,000 followers. In the wake of their recent 'reincarnation' they have developed the acronym FIRST (find, inquire, respect, solve, thank), to remind their associates of their renewed customer-service focus. (Li, p.253)

The Home Depot story illustrates how companies can successfully incorporate Social Media into their business plans, no matter what the impetus is to embrace the groundswell. The book Groundswell: Winning in a World Transformed by Social Technologies, presents a conceptual framework in which to track an organization's Social Media development. The table below, taken from the companion slides for this book illustrates these stages (pp 256-265).
How a company embarks into the groundswell, how smoothly they transition, and how quickly they progress through these stages vary widely. Some of these variables can be within a company's control, while many most likely will not be. This loss or surrendering of control can be disruptive to the corporate power structure and environment, at least in the short term. This is because it is a departure from the way most organizations generally operate. Traditionally organizations like to maintain control of every possible aspect of their business. In this age of Social Media, the ground has shifted and the "social" part of Social Media is in the driver's seat. The result is, as the often-paraphrased John Allen Paulos once said, "Uncertainty is the only certainty there is, and knowing how to live with insecurity is the only security."

Li and Bernoff observe that there are five stages of social maturity for companies who adopt Social Media into their business plans: listening, talking, energizing, supporting, and embracing. Among these "the easiest applications to implement are listening applications, since they don't require companies to become visible." (p. 261) Figure 13-2 (p. 263) illustrates the variability with which organizations progress through these stages.

As this discussion has highlighted, Social Media has matured to the point of having some loosely defined constructs that are based on trial and error, real life experience on the Web, and events in the marketplace. Eventually as Social Media solidifies its place among integral business tools, any organization whose existence relies on on outside resources or customers will have to embrace the groundswell. Not to do so would be tantamount expecting a business to operate without a telephone in the twentieth century.

Saturday, March 3, 2012

week7o, The Delicate Art of un-Ringing a Bell

The Delicate Art of 
un-Ringing a Bell

Time Feb. 2, 1998, President Clinton greets Monica Lewinsky at a WH event
How many people go through adolescence and young adulthood without making a fool out of themselves, at least once? Who among us does not have something in their past they wished they’d done differently? Can you think of anyone you know who can honestly say that, if they had it all to do over again, they’d do it in exactly the same way? I can count on one hand the number of people I have known in my lifetime who can make any of those claims. Fortunately, for most people memories fade into the background, attentions are diverted, and life goes on. 

Self portraits 'tweeted' by disgraced former
Congressmen Weiner (left) and Lee (right)

There are politicians, like the snap-happy, former Congressmen Anthony Weiner, (D-NY) and Christopher Lee (R-NY), whose scandals forced them out of office. Both men resigned in disgrace after  half-naked images of them- that each had tweeted to women who were not there wives- turned up on the Internet. Their tarnished images only began to fade from the headlines and the public's memories when they did too.

There are a few people whose notoriety makes an indelible mark on the collective social conscience. Their escapades are so scandalous, they become a permanent piece of the infamy of the day. Some of these legendary characters that come to mind are: ax-wielding Lizzie Bordon (see video, below), White House Intern Monica Lewinsky (top, left) and mega-ponzi-schemer Bernie Madoff.

As our culture has been transformed by the broad expanse of telecommunications, the Internet, and the Information Economy, new opportunities have opened up for John Q Public to realize the proverbial American Dream. On the same token, being wired to the web holds at least as many opportunities to burn bridges as it does to build them. Some will find that this downside can turn out to be the very thing that stands between them and reaching their pinnacle. The closed door may be just a few clicks away, buried in the buzz of Social Media.

As Liz Harvey, senior director of online products at, outlined in a 2009 article on the company's website, "In this difficult job market, online networking is an important piece of the puzzle for workers wishing to build professional relationships, and ultimately connect with their next great job." (accessed 3/3/2012)

Recruiters and HR professionals who have rejected candidates based on data found online vs. consumers who think
online data affected their job search From: cross-tab Research: Online Reputation in a Connected World. 2010. (p. 5)
2010 survey commissioned by Microsoft, titled Online Reputation in a Connected World, found that "79 per cent of U.S. hiring managers and job recruiters routinely review online reputational information when reviewing job applicants." (accessed 3/3/2012) In the same survey, 70 per cent of U.S. and 41per cent of U.K. recruiter respondents admitted to having rejected candidates based on information they found online, starkly contrasting the respective seven- and nine- percent of consumers who thought online data could affect their job search. (Table pictured above) 

Aspiring college applicants should also take note. Kaplan, the educational resource and training giant, publishes an annual Test Prep Survey. The September, 2011 analysis found, "Nearly a quarter (24%) of respondents from the schools surveyed have gone to an applicant's Facebook or other social networking page to learn more about them, while 20% have Googled them." (accessed 3/3/2012) The Kaplan survey also noted that although there were potential pitfalls to be found in an applicant's social networking page, respondents were also looking for strengths, such as creativity and effective communication in a forum "in which teens are comfortable or expert." .

So, how do candidates keep their youthful folly and periodic lapses in judgement from popping up years later on the information super-highway? The most obvious answer is not to put it on the Internet in the first place. Privacy Now TV has a very good 3-minute video with helpful advice on protecting your online reputation. For those who have already 'rung' that proverbial bell, there are steps that can be taken to limit potential future impact on your reputation. The first step, according to communications consultant Lindy Kyzer's website, is "Google yourself. Always my all-time favorite tip for understanding how others might view or find you online." (accessed 3/3/2012).

A google search using the term "cleaning up Internet profile" yielded 84.6 million results, with everything from do-it-yourself advice to large consulting firms who will scour and cleanup your Internet profile, for a fee. After reviewing the first few result pages, the one that seemed to offer the most comprehensive and helpful information was Squidoo. (accessed 3/2/2012) This site outlines what is on the Internet and how to find it. It then gives step by step instructions on accessing, cleaning up and changing the setting on each site to optimize what people may find when they google you.

Benjamin Franklin said over 200 years ago, "It takes many good deeds to build a good reputation, and only one bad one to lose it." The world is a very different place than it was in the Founding Father's era, but this tenet is as true and relevant today as when he said it.