Oversight Board Overturns Meta's Decision in Promoting Ketamine for Non-FDA Approved Treatments Case

The Oversight Board has overturned Meta’s decision to leave up a user’s Instagram post discussing their experience using ketamine as a treatment for anxiety and depression. The Board finds that the content violated Meta’s Branded Content policies (which apply to content for which creators receive compensation from a third-party “business partner,” as opposed to advertising where Meta receives compensation to surface ads to users) and the company’s Restricted Goods and Services Community Standard. This case indicates that Meta’s strong restrictions on branded content promoting drugs and attempts to buy, sell, or trade drugs may be inconsistently enforced.

About the Case

On December 29, 2022, a verified Instagram user posted 10 related images as part of a single post with a caption. A well-known ketamine therapy provider is tagged as the co-author of the post, which was labeled as a “paid partnership.” Under Meta’s Branded Content policies, Meta’s business partners must add such labels to their content to transparently disclose a commercial relationship with a third party.

In the caption, the user stated that they were given ketamine as treatment for anxiety and depression at two of the ketamine therapy provider’s office locations in the United States. While the user described ketamine as medicine, the post contains no mention of a professional diagnosis; no clear evidence that treatment occurred at a licensed clinic; and nothing showing that the treatment took place under medical supervision. The post describes the user’s treatment as a “magical entry into another dimension.” The post also expressed a belief that “psychedelics” (a category that the post implied includes ketamine) are an important emerging mental health medicine. Ten drawings, some including psychedelic imagery, depict the user’s experience in a storyboard style, indicating the user received several “therapy sessions” for “treatment-resistant depression and anxiety.” The account of the user describing the experience has around 200,000 followers and the post was viewed around 85,000 times.

Three users reported one or more of the images included in the post, and the content was removed and then restored three times under Meta’s Restricted Goods and Services Community Standard. After the third time the post was removed, the content creator brought it to Meta’s attention. The content was then escalated to policy or subject matter experts for an additional review and restored around six months after it was originally posted. Meta then referred the case to the Board. The content creator’s status as a “managed partner” helped to escalate the post within Meta. “Managed partners” are entities across different industries, including individuals such as celebrities and organizations such as businesses or charities. They receive varying levels of enhanced support, including access to a dedicated partner manager.

Key Findings

As explained more fully below, this case indicates that Meta’s strong restrictions on branded content promoting drugs and attempts to buy, sell, or trade drugs on its platforms may be inconsistently enforced.

Because the content in this case was posted as part of a paid partnership, the Branded Content policies should apply. The Board is concerned that Meta did not describe this aspect of the case as part of its referral or initial submissions. Instead, the Board only learned about the paid nature of the post after submitting questions to the company. Meta’s Branded Content policies state that “certain goods, services, or brands may not be promoted with branded content” including “drugs and drug-related products, including illegal or recreational drugs.” As the content in this case was part of a “paid partnership,” clearly promoted the use of ketamine, and was not covered by an exception, it violated these policies. In response to the Board’s questions, Meta acknowledged that not all content with a “paid partnership” label is reviewed against its Branded Content policies, that moderators reviewing content at scale cannot see this label, and that they cannot reroute content to the specialized team in charge of enforcing the Branded Content policies. This greatly increases the risk of under-enforcement against this kind of content. As such, the Board urges Meta to ensure that it reviews content against all relevant policies, including its Branded Content policies.

The Board also finds that the content violated the Restricted Goods and Services Community Standard. This permits the promotion of “pharmaceutical drugs” (“drugs that require a prescription or medical professionals to administer”) but prohibits the promotion of “non-medical drugs” (“drugs or substances that are not being used for an intended medical purpose or are used to achieve a high”). As this case indicates, however, some drugs fall in both categories. This tension would be best resolved by emphasizing the essential role of medical professionals in prescribing or administering the drug. As noted in the preceding paragraph, paid content is subject to an even stricter standard. As the content in this case included statements that strongly indicated the use of a drug to achieve a “high” but made no direct reference to a medical diagnosis, nor references to medical staff (e.g., “doctor,” “nurse,” “psychiatrist”), the Board finds that the user in this case did not sufficiently demonstrate the use of ketamine occurred under medical supervision. Thus, the content violates this Community Standard and should be removed.

The Board is also concerned about the possibility of inconsistent enforcement of Meta’s policies related to drugs. A recent investigation by the Wall Street Journal based on a review of ads for a four-week period in late 2022 discovered “more than 2,100 ads on Facebook and Instagram that described benefits of prescription drugs without citing risks, promoted drugs for unapproved uses or featured testimonials without disclosing whether they came from actors or company employees.” A public comment received by the Board from the National Association of Boards of Pharmacy (NABP) also notes that unambiguous violations of Meta’s Restricted Goods and Services Community Standard on Meta’s platforms may be common. The NABP noted that “with only a cursory search, less than 1 minute,” they found multiple posts featuring ketamine, clearly marked for recreational use.

The Oversight Board’s Decision

The Oversight Board overturns Meta’s decision to leave up this content, requiring the post to be removed.

The Board recommends that Meta:

  • Clarify the meaning of the “paid partnership” label wherever these labels are mentioned, including in the process of reviewing branded content. This includes explaining the role of business partners in the approval of paid content and in the addition of “paid partnership” labels.
  • Clarify in the language of the Restricted Goods and Services Community Standard that content that “admits to using or promotes the use of pharmaceutical drugs” is allowed where that use may result in a “high” only in the context of a “supervised medical setting.”
  • Improve its review process to ensure that content created as part of a paid partnership is reviewed against all applicable policies (i.e., Community Standards and Branded Content policies). Meta should ensure that content is routed to reviewers or automated systems that are able and trained to apply Meta’s Branded Content policies when implicated.
  • Audit the enforcement of policy lines from its Branded Content policies and Restricted Goods and Services Community Standard that relate to the selling and/or paid promotion of drugs. Meta should then close any gaps in enforcement.

For Further Information

To read the full decision, click here.

To read a synopsis of public comments for this case, please click here.

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