The “Okusuri Charm” movement in Japan: Prescription drug accessories emerging on X (Twitter)

Abstract

Background

In this digital age, social networks may offer an avenue for individuals to obtain drugs illicitly beyond the prescribed amount. Users on X (Twitter)® have ingeniously fabricated fashionable accessories that employ prescription drug sheets, termed “Okusuri Charm”.

Methods

This cross‐sectional study scrutinized the emerging “Okusuri Charm” trend, by searching the term in Japanese on X (Twitter)® and analyzing related posts.

Results

Alongside illegal prescription drug trading, individuals crafted accessories from drug sheets, particularly prescribed psychiatric drugs, and dealt with other users, leading to a growing trend this year.

Conclusions

A positive outlook toward this trend is the emergence of a new artistic movement, but a pessimistic viewpoint is the creators' misuse of prescription drugs, potentially fostering illegal drug dealings.

We identified an emerging movement surging from 2023 onwards, termed “Okusuri Charm”, wherein X (previously known as Twitter) users ingeniously fabricate fashionable accessories employing blister sheets (also known as PTP sheets in Japanese) of prescription drugs.

1. INTRODUCTION

An overdose of prescription drugs may include critical risks that detrimentally impact human health both physically and mentally. The precise modality through which individuals acquire prescription drugs in quantities far surpassing their real requisites, which are prescribed in medical facilities according to a doctor's prescription, remains unclear. Nevertheless, within this contemporary digital age, social networking services may present a viable option for such transactions. ¹ , ² , ³ , ⁴ In fact, a unique circumstance was previously revealed wherein Japanese individuals were conceivably engaging in trading of prescription drugs on the X (Twitter)® platform, united under the distinctive hashtag “Okusuri Mogu Mogu”. ⁵ Authors of the research substantiated that some Japanese individuals made posts indicating the overdose of and illegal dealing of prescription drugs. During investigation of the keywords, we discovered a captivating movement in which X (Twitter)® users traded fashionable accessories termed “Okusuri Charm”, crafted from blister packaging (also known as press‐through package (PTP) sheets) of prescription drugs. Herein, we briefly report our latest findings—the emergence of the “Okusuri Charm” movement, in which X (Twitter)® users ingeniously fabricate commercially appealing and fashionable accessories employing blister sheets of prescription drugs (Figure 1A).

FIGURE 1.

Representative image of an “Okusuri Charm” accessory and its posting trend over the years. (A) “Okusuri Charm” means an accessory made from blister packaging (also known as press‐through package (PTP) sheets) of prescription drugs. One of the authors fabricated this sample. (B) “Okusuri Charm” posts in X (Twitter)® surged in 2023.

2. METHODS

We searched X (Twitter)® posts using the term “Okusuri Charm” in Japanese. “Okusuri” means medication, and “Charm” refers to an accessory. We selected this term on the X (Twitter)® platform because several surveillance and studies reported that the term is used to trade in medications on the social networking service. One surveillance in popular was led by grants from the Japanese regulatory authority, the Ministry of Health, Labour and Welfare (MHLW). ⁶

First, we quantified the volume of posts and summarized them chronologically by year, beginning from the earliest post that could be traced. Subsequently, we systematically investigated posts originating from January 2022 onwards. We collected the following data in a Google Spreadsheet®: complete texts in the post, their respective dates, mentioned names of drugs, whether the post featured images of “Okusuri Charm” accessories, the drug name in the accessory image, and whether the post accompanied the hashtag “Okusuri Mogu Mogu”. This data collection was performed from July 1–9, 2023. Out of these posts, the number of hashtags as well as the prevalence of “Okusuri Charm” images was quantified. We also counted the number of medication names in the text and in the “Okusuri Charm” images. Lastly, we categorized all the retrieved posts into the following four categories: Transactions, fashion and crafting, heads up for illegal trading, and others (Table S1). To validate the categorization, posts were distributed to two individual blinded researchers, and they categorized each extracted post, followed by the comparison of the categories between researchers. Posts that had inconsistent categorization between researchers were excluded from the analysis.

3. RESULTS

The oldest “Okusuri Charm” post we found dated back to 2014. From 2014 to 2021, we observed 76 posts in total (Figure 1B). Interestingly, from 2022, the number of posts drastically increased: 40 posts in 2022, and 281 posts in the first half of 2023. Next, we characterized these 321 posts made from 2022 onwards (Table S2). Almost half of 154 posts (48.0%) accompanied “Okusuri Charm” accessory images, and 196 posts (61.1%) included at least one hashtag. Of note, 138 posts (43.0%) mentioned the specific hashtag of “Okusuri Mogu Mogu”.

To better understand what kind of medications are prevalent, we quantified the names of drugs that were mentioned in the texts, as well as those listed as “Okusuri Charm” images (Table 1). Out of 321 posts, a total of 112 cases in texts, and 288 cases in images were observed (Table 1). To explore the relevance with the “Okusuri Mogu Mogu”, we extracted the mentioned names of drugs in posts that contained the hashtag “Okusuri Mogu Mogu” (n = 138) (Table 1). The top‐five list of medication names is shown in Table 1. Of note, the most frequently named medications were prescription drugs, such as Etizolam, Pregabalin, Flunitrazepam, Zolpidem, etc. Additionally, we discovered that 75.5% (155 of 200 cases) of the top‐five medication names observed in the “Okusuri Charm” images were mentioned in posts that contain the hashtag “Okusuri Mogu Mogu”. The fact reflects the relation in the mentioned name of medication types between “Okusuri Mogu Mogu” and “Okusuri Charm”.

TABLE 1.

Top‐five lists of medication names by number of cases observed in all posts (A) or in posts that include the hashtag “Okusuri Mogu Mogu” (B).

	Generic name mentioned as texts	Cases	Generic name observed in images	Cases
A a
1	Etizolam	22	Pregabalin	52
2	Pregabalin	22	Zolpidem	48
3	Methylphenidate	14	Etizolam	43
4	Flunitrazepam	14	Flunitrazepam	39
5	Zolpidem	12	Rebamipide	18
	Others	30	Others	88
Total number of cases		114		288
B b
1	Etizolam	20	Pregabalin	42
2	Pregabalin	17	Zolpidem	37
3	Methylphenidate	13	Etizolam	37
4	Bromazepam	10	Flunitrazepam	21
5	Flunitrazepam	9	Rebamipide	18
6	Zolpidem	8
	Others	8	Others	51
Total number of cases		85		206

^a All posts identified by the search term “Okusuri Charm” from 2022 to June 2023 were analyzed (n = 321).

^b Out of the aforementioned 321, posts that also contained the hashtag “Okusuri Mogu Mogu” were analyzed (n = 138).

Next, the categorization of posts revealed that most of the posts could be categorized into either “transaction” or “fashion and crafting” (Table S1), occupying 37.2% and 50.4% of posts, respectively. This result indicates that the “Okusuri Charm” movement possessed two different perspectives; one was negative in terms of inappropriate use of prescription medication, and another was positive in that individuals just played with artistic accessories.

4. DISCUSSION

Given that posts or user accounts were possibly erased over time, so our analysis might have included multiple counts from identical individuals. Therefore, the quantitative validity of our findings is quite limited. Nonetheless, our preliminary investigation provides an indication that “Okusuri Charm” extends beyond a personal endeavor, hinting at its manifestation as a social movement.

It is plausible that “Okusuri Charm” may be related to adverse mental conditions because the hashtag “Okusuri Mogu Mogu” is included in 43% of posts (138 of 321 posts), of which those related to psychiatric drugs were prevalent. This indicates a strong relationship to the previous research, ⁵ which showcased the illegal medication trading with the particular term “Okusuri Mogu Mogu” (Table S1). Given that posts with the hashtag “Okusuri Mogu Mogu” often accompany words relative to the desire to connect with people who have poor mental conditions, ⁶ we may be able to hypothesize two proposals. First, the use of these hashtags may serve as a means to unite them. Second, these keywords may be relevant to the phenomena such as “menhera”, “fashion menhera”, or “Yamikawa”. These Japanese words have emerged as a social media trend in Japan, where individuals consider poor mental health conditions to be fashionable or even charming. ⁷ The emergence of “Okusuri Charm” and “Okusuri Mogu Mogu” could be one of these, although further studies are warranted, especially similar situations beyond Japan. However, those who post under “Okusuri Charm” do not necessarily trade prescription drugs illegally and might just be showing their own artistic work. In this context, their involvement in “Okusuri Charm” could be perceived as an expression of appreciation for the cute and fashionable accessories.

Our preliminary investigation had some limitations. First, posts were possibly erased over time, as mentioned. Second, we chose only an X (Twitter)® to perform our preliminary research on this emerging movement since the service allows for the diffusion of new information because of loosely linked connections between users in contrast with other social networking services such as Facebook and Instagram. ⁸ Third, we make a general note below on research involving X (Twitter)®: The number of posts retrieved differed a little among researchers in this study, and only the overlapping portions of these posts were included in the analysis; the number of posts retrieved could have differed among researchers because of API rate limits that newly came into effect from July 2023. ⁹ This also negatively affected the validity of the numerical analysis. It should be noted that API rate limits will have a significant impact on quantitative validity in X (Twitter)® surveys in the future. Overall, further comprehensive discussion from various viewpoints is expected to shed more light on this intriguing phenomenon.

5. CONCLUSIONS

The authors propose two distinct perspectives for understanding the “Okusuri Charm” movement. One is a negative perspective that deems this movement socially unacceptable because of its association with potential adverse mental health conditions and inappropriate use of parts of medical resources However, another perspective adopts a positive outlook, welcoming “Okusuri Charm” as an emerging fashion trend so long as blister packaging is obtained through legal means. From the former standpoint, a call for surveillance for “Okusuri Charm” will be required in terms of pharmacovigilance and public health. Additionally, under this scenario, medical practitioners may be able to pay more careful attention by understanding the risk of illicit drug use to prevent excessive prescription of psychiatric medications. For instance, pharmacists could play a substantial role in communicating with medical doctors, such as consideration of alternative medications or confirmation of patients' drug history, when they get questionable prescriptions. Conversely, the latter viewpoint encourages “Okusuri Charm” as a burgeoning art movement.

CONFLICT OF INTEREST STATEMENT

The authors declare no competing interests.

ETHICS STATEMENT

This cross‐sectional observational study was performed only with publicly available data and did not involve any interventions or individual patient records. Thus, institutional review board approval and patients' informed consent were not necessary.

Supporting information

Table S1

Ikejiri T, Hakariya H, Kai H, Yokoyama N, Hakariya A. The “Okusuri Charm” movement in Japan: Prescription drug accessories emerging on X (Twitter). J Gen Fam Med. 2024;25:77–80. 10.1002/jgf2.666