Effective buprenorphine use and tapering strategies: Endorsements and insights by people in recovery from opioid use disorder on a Reddit forum

Abstract

Opioid use disorder (OUD) is a national crisis in the United States and buprenorphine is one of the most effective evidence-based treatments. However, few studies have explored successful strategies for using and tapering buprenorphine to achieve stable recovery, particularly due to the difficulties of conducting long-term studies involving patients with OUD. In this study, we show that discussions on the anonymous social network Reddit may be leveraged, via automatic text mining methods, to discover successful buprenorphine use and tapering strategies. We discovered that longer tapering schedules, compared to those investigated in past clinical trials, may lead to (self-reported) sustained recovery. Furthermore, Reddit posts also provide key information regarding buprenorphine withdrawal, cravings, adjunct medications for withdrawal symptoms and relapse prevention strategies. AbstractOpioid use disorder (OUD) is a public health emergency in the United States. Over 47,000 overdose-related deaths in 2017 involved opioids. Medication-assisted treatment (MAT), in particular, buprenorphine and buprenorphine combination products such as Suboxone®, is the most effective, evidence-based treatment for OUD. However, there are a limited number of conclusive scientific studies that provide guidance to medical professionals about strategies for using buprenorphine to achieve stable recovery. In this study, we used data-driven natural language processing methods to mine a total of 16,146 posts about buprenorphine from 1933 unique users on the anonymous social network Reddit. Analysis of a sample of these posts showed that 74% of the posts described users' personal experiences and that the top three topics included advice on using Suboxone® (55.0%), Suboxone® dosage information (35.5%) and information about Suboxone® tapering (32.0%). Based on two models, one that incorporated 'upvoting' by other members and one that did not, we found that Reddit users reported more successful recovery with longer tapering schedules, particularly from 2.0 mg to 0.0 mg (median: 93 days; mean: 95 days), as compared to shorter tapering schedules investigated in past clinical trials. Diarrhea, insomnia, restlessness, and fatigue were commonly reported adverse events. Physical exercise, clonidine, and Imodium® were frequently reported to help during the recovery process. Due to the difficulties of conducting longer-term clinical trials involving patients with OUD, clinicians should consider other information sources including peer discussions from the abundant, real-time information available on Reddit.

Self-reported Xylazine Experiences: A Mixed Methods Study of Reddit Subscribers

“…Although there are a growing number of studies that use NLP to look at existing posts on Reddit to answer research questions, there are few studies that use Reddit for surveys or as a recruitment tool. [32][33][34][35][36] Given the anonymity of Reddit and its large subscriber base, it could be a valuable source to survey questions about sensitive topics, perform toxicosurveillance, and study use patterns and adverse effects of emerging drugs with a novel method. 36 As new psychoactive substances emerge in the drug market, Reddit could be a promising resource to study these substances with the goal of informing public health, harm reduction efforts, and clinical care.…”

Reddit discussions about buprenorphine associated precipitated withdrawal in the era of fentanyl

“…3,10 This study adds to the body of literature focusing at the intersection of social media and OUD by using NLP to uncover discussions about a medical phenomenon, precipitated opioid withdrawal, associated with buprenorphine initiation after chronic fentanyl use. Similar to Graves et al (2019), this study draws from the experiences and voices of patients with OUD, often shared anonymously, to address evolving buprenorphine initiation strategies. 16 Our finding of multiple dosing regimens of buprenorphine microdosing (Table 3) is comparable to the multiple different dosing regimens described in case reports with a few exceptions.…”

“…Similar to Graves et al (2019), this study draws from the experiences and voices of patients with OUD, often shared anonymously, to address evolving buprenorphine initiation strategies. 16 Our finding of multiple dosing regimens of buprenorphine microdosing (Table 3) is comparable to the multiple different dosing regimens described in case reports with a few exceptions. 2,3,8,9 For example, the lowest dose described in our data started at 0.125 mg of buprenorphine.…”

“…Consequently, there is a considerable amount of self reported information on this social network on substance use disorder (SUD) including OUD, and a number of recent studies on the topic have utilized Reddit data. [15][16][17] We designed this study to be primarily data-driven, and hypotheses were generated and refined iteratively based on exploration of the data. The specific research questions that we attempted to answer via the analyses described in this study are as follows:…”

Automatic Breast Cancer Survivor Detection from Social Media for Studying Latent Factors Affecting Treatment Success

“…Several studies, including our own, have utilized social media to identify large cohorts of users with common health-related conditions, and then mine relevant longitudinal information about the cohorts using NLP methods. For example, in our past research, we showed that carefully-designed NLP pipelines can be used to discover cohorts of pregnant women [11] or patients suffering from opioid use disorder [6] from social media, and then mine important information from their social media posts ( e.g ., medication usage and recovery strategies). For cancer, studies have investigated the role of social media platforms for tasks such as spreading breast cancer awareness, health promotion, and cancer prevention [1, 3].…”