Signals of increasing co-use of stimulants and opioids from online drug forum data

Abstract

Background Despite recent rises in fatal overdoses involving multiple substances, there is a paucity of knowledge about stimulant co-use patterns among people who use opioids (PWUO) or people being treated with medications for opioid use disorder (PTMOUD). A better understanding of the timing and patterns in stimulant co-use among PWUO based on mentions of these substances on social media can help inform prevention programs, policy, and future research directions. This study examines stimulant co-mention trends among PWUO/PTMOUD on social media over multiple years. Methods We collected publicly available data from 14 forums on Reddit (subreddits) that focused on prescription and illicit opioids, and medications for opioid use disorder (MOUD). Collected data ranged from 2011 to 2020, and we also collected timelines comprising past posts from a sample of Reddit users (Redditors) on these forums. We applied natural language processing to generate lexical variants of all included prescription and illicit opioids and stimulants and detect mentions of them on the chosen subreddits. Finally, we analyzed and described trends and patterns in co-mentions. Results Posts collected for 13,812 Redditors showed that 12,306 (89.1%) mentioned at least 1 opioid, opioid-related medication, or stimulant. Analyses revealed that the number and proportion of Redditors mentioning both opioids and/or opioid-related medications and stimulants steadily increased over time. Relative rates of co-mentions by the same Redditor of heroin and methamphetamine, the substances most commonly co-mentioned, decreased in recent years, while co-mentions of both fentanyl and MOUD with methamphetamine increased. Conclusion Our analyses reflect increasing mentions of stimulants, particularly methamphetamine, among PWUO/PTMOUD, which closely resembles the growth in overdose deaths involving both opioids and stimulants. These findings are consistent with recent reports suggesting increasing stimulant use among people receiving treatment for opioid use disorder. These data offer insights on emerging trends in the overdose epidemic and underscore the importance of scaling efforts to address co-occurring opioid and stimulant use including harm reduction and comprehensive healthcare access spanning mental-health services and substance use disorder treatment.

Which social media platforms facilitate monitoring the opioid crisis?

“…Many research groups have also created models to automatically identify posts on X and Reddit with discussion related to opioids. (42,43,109,(124)(125)(126)(127) Others have used these platforms to characterize factors that influence opioid use, recovery, and the opioid epidemic generally (6,8,(128)(129)(130)(131)(132), with particular interest shown to the impact of the COVID-19 pandemic (103,120,(133)(134)(135)(136)(137)(138)(139) and co-use between opioids and other drugs (140,141).…”

Year 2022 in Medical Natural Language Processing: Availability of Language Models as a Step in the Democratization of NLP in the Biomedical Area

“…• when other sources of information are not freely available, such as in languages other than English [7,9,19,20,22,38,43,47]; • when researchers investigate questions related to patients and population, while these questions are not discussed with medical doctors or require large population samples. We can mention for instance sentiment analysis on medication and vaccines [7,20,33,38,43,47], and adverse drug effects [76,77]; • when mental health of patients is concerned in cases like depression [9, 4, 78], eating disorders [79], suicide detection and prevention [19,80], quality of life of patients [31,81], and drug misuse [82][83][84].…”

An examination of harm reduction strategies in Oxycodone and Adderall buyer feedback on AlphaBay

“…Research shows that people often rely on virtual spaces to form anonymous support groups around stigmatized behaviors like suicidal thoughts, eating disorders, and drug use. Harm reduction strategies are also present in virtual environments (Davey et al., 2012; Davitadze et al., 2020; Masson & Bancroft, 2018; Móró & Rácz, 2013; Vale Pires et al., 2016; Rolando & Beccaria, 2019; Sarker et al., 2022). Some studies have explored specific spaces where harm reduction can be implemented for PWUD within darknet forums (Davitadze et al., 2020; Vale Pires et al., 2016).…”

“…Researchers have highlighted the benefits of harm reduction‐related interventions for DNM users. Most of these studies have explored how harm reduction strategies can be implemented by external parties like nonprofit organizations or trained medical specialists who are able to access darknet forums to offer advice to potential users (Davey et al., 2012; Davitadze et al., 2020; Masson & Bancroft, 2018; Móró & Rácz, 2013; Vale Pires et al., 2016; Rolando & Beccaria, 2019; Sarker et al., 2022). Although these findings have generated promising results on the use of harm reduction programs in forums, little research has explored the harm reduction knowledge and communication that is already present within the DNM itself.…”