Decoding the emoji drug code and the #OnePillCanKill initiative

By Naveed Saleh, MD, MS | Fact-checked by Barbara Bekiesz
Published May 4, 2023

Key Takeaways

  • Emojis—once mere pictographs—are now being used as communication tools for the drug trade.

  • The DEA’s @OnePillCanKill campaign aims to educate stakeholders on how emojis are being used to market illicit drugs.

  • On the flip side, the power of medical emojis can cross language barriers and facilitate communication between healthcare providers and patients, especially in public health.

Emojis have suffused daily communications, and anyone who texts is familiar with them. These petite pictographs were originally used only to represent a simple emotion, activity, or event. Of late, however, criminal organizations and drug traffickers have leveraged the power of emojis to perpetrate crimes, which has caught the attention of the Drug Enforcement Administration (DEA).

But the use of emojis is not all bad, and they even have earned a place in medicine. Circumventing language barriers, emojis can be effective in public health messaging and can enhance verbal communication between patients and physicians.

Emojis for the drug trade

When DEA investigations discovered that drug dealers were using emojis in code for their activities, the DEA issued a reference guide to the meaning of these symbols, to give parents, caregivers, and influencers a better understanding of emoji parlance in the context of the illegal drug trade. The reference guide was part of the DEA’s #OnePillCanKill initiative.[]

“Emojis, on their own,” the DEA explained, “should not be indicative of illegal activity, but coupled with a change in behavior; change in appearance; or significant loss/increase in income should be a reason to start an important conversation.” The reference guide provides a link to educational resources on how to start conversations in these situations. 

Examples of emojis in the guide include the following:

  • Brown heart or dragon: for heroin

  • Heart: for MDMA and Mollies 

  • Grapes or purple heart: for cough syrup

  • Snowman or key: for cocaine

  • Four-leaf clover, palm tree, or fire: for marijuana

  • Blue heart or diamond: for meth

Emojis can also be combined to present concepts, such as package emoji plus a parachute to signify “package arrived.”

History of emojis

The word emoji is Japanese for “picture character.” These icons were first introduced in the late 20th century, according to a review on the role of emojis in public health published in Antimicrobial Resistance and Infection Control.[]

Emojis are a universal language, conveying nonverbal communication cues.

They also serve as a substitute for face-to-face interaction and can directly appeal to the reader's moods.

Upwards of 90% of online users take advantage of emojis to communicate complex ideas in an efficient manner. Emojis allow users of different nationalities to eliminate language barriers and communicate via standard, compact characters. The number of emojis increases with each passing year, adding to the smileys, people, animals, food, and nature emojis already in use. In 2015, the Oxford English Dictionary selected the emoji “face with tears of joy” as its Word of the Year. 

Medical perspective

Experts suggest that emojis can be used by physicians and their patients to overcome language barriers and improve communications.

The potential of pictographs was quickly realized in medicine, note the authors of the review. In 2005, before the advent of emojis, a series of emoticons—defined as symbols created using only typed characters (eg, :-0 for surprise)—was developed as an alternative to medical acronyms and abbreviations. Emojis are more neutral in design than emoticons, and add emotion, attitude, or attention to text.

In medical research, emojis allow researchers to interview participants from across geographical boundaries, without language barriers. 

It has been proposed that emojis could augment editorial communications and be used in manuscript writing as a substitute for words. Lack of standardization, and variance in meaning over time and across cultures, however, could limit their use in the medical literature. 

On whether emojis can contribute significantly to the scientific literature, the review authors write that “it is imperative to evaluate the impact of these symbols in health-related fields in order to harness their potential advantages for appropriate research applications and stave off scientific miscommunication.” 

The emoji is the message

To date, there is only a limited amount of medical literature on emojis, although the topic has been explored in psychology and other fields. There are also only a limited number of medical or health-related emojis.

Investigators in Taiwan evaluated the effectiveness of emojis in conveying preventive health information.[] They found that the symbols could be persuasive.

“Emoji are highly capable of promoting more accurate, comprehensible, and persuasive health information communication as well as improving saving cognitive resources for the execution of subsequent behavioral tasks,” they wrote.

"Thus, if used strategically and appropriately, visual symbols such as emoji may reduce message recipients’ cognitive load and strengthen their behavioral intention."

Lin TS, et al., SSM Population Health

“The results of this study,” the authors concluded, “suggest that unofficial organizations can effectively enhance the fear that people perceive by using visual symbols (eg, emoji) in the context of risk communication and preventive behaviors. This should encourage people to adopt appropriate prevention behaviors, especially during public health crises,” they added. 

What this means for you

Physicians should be aware of the use of emojis by drug users and drug dealers when trafficking illegal substances. The use of these emojis, combined with certain signs and symptoms in the potential user, can serve as a red flag. At the same time, however, emojis can serve as powerful tools of communication between physicians and their patients, as well as a means of facilitating medical research. In whatever context, the use of emojis with text can elicit more emotion, action, and immediacy than words alone.

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