Study Objectives: To characterize postings made on the reddit.com forum titled "opiates." In particular, we tested the hypothesis that the proportion of online posts glorifying opiate use is greater than the proportion advocating harm reduction. We further characterized posts across a variety of categories.Methods: This is an analysis of posting to the reddit.com forum "Opiates" (reddit.com/ r/opiates). On May 1, 2018, an extraction of the most recent 500 posts made to this forum was performed. Duplicate posts and posts with unanalyzable content such as unreadable text were excluded. The posts were then categorized by their main topic, including such categories as "glorifying use, including obtaining and consuming", "harm reduction", "avoiding law enforcement" and "interacting with physicians". We also identified specific characteristics of posts to quantify how often these characteristics appeared, such as those which endorse unsafe behavior (beyond opioid use), those which discuss obtaining and the safe use of naloxone, those which discuss medication assisted therapy, those which discuss pharmaceutical opioid use, and those which discuss polysubstance abuse. Posts endorsing unsafe opioid behavior were identified as those endorsing combinations of opioids and other respiratory depressants, using opioids while operating dangerous machinery and other dangerous behaviors while combined with opioids.Results: 500 posts were obtained, 34 were excluded as duplicates or unanalyzable, and 466 were analyzed. The proportion "glorifying use" was 205/466 (43.9%) and the proportion "advocating harm reduction" was 72/466 (15.4%). Difference in proportion was +28.5% (95% CI +22.7% to +34.3%). 10 posts (2.1%) discuss avoiding law enforcement and 13 posts (2.8%) discuss interacting with physicians, including how to obtain stronger or longer prescriptions. Within the above topics, 19.3% of posts endorse unsafe behavior, beyond use for simple analgesia. These include many posts endorsing polysubstance use, especially combining opioids with benzodiazepines or alcohol, as well as one unique post encouraging patients to follow reports of deadly fentanyl outbreaks to obtain more potent opioids. Only 15% of posts encouraged harm reduction, including ways to quit, encouragement for those quitting, and reducing side effects and risky behavior, and 1% discussed obtaining naloxone or the appropriate administration of naloxone. The consumption of pharmaceutical opioids appears very common, with 47.6% (123 of 258) of the posts discussing the use of opioids specifically identifying pharmaceutical opioids being consumed. 26 posts (5.6%) discuss medication assisted therapy including buprenorphine or methadone.Conclusions: Online forums such as the reddit.com forum "Opiates" advertise themselves as harm reduction forums, but our data show that these forums instead have a small amount of harm reduction information. Many posts glorify unsafe drug use. Sites like these may represent an impediment to educating patients with opiate use disorder on saf...

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