Rocky Mountain Poison and Drug Safety, Denver, CO, United States.
JMIR Public Health Surveill. 2020 Jun 29;6(2):e17073. doi: 10.2196/17073.
Between 2016 and 2017, the national mortality rate involving opioids continued its escalation; opioid deaths rose from 42,249 to 47,600, bringing the public health crisis to a new height. Considering that 69% of adults in the United States use online social media sites, a resource that builds a more complete understanding of prescription drug misuse and abuse could supplement traditional surveillance instruments. The Food and Drug Administration has identified 5 key risks and consequences of opioid drugs-misuse, abuse, addiction, overdose, and death. Identifying posts that discuss these key risks could lead to novel information that is not typically captured by traditional surveillance systems.
The goal of this study was to describe the trends of online posts (frequency over time) involving abuse, misuse, addiction, overdose, and death in the United States and to describe the types of websites that host these discussions. Internet posts that mentioned fentanyl, hydrocodone, oxycodone, or oxymorphone were examined.
Posts that did not refer to personal experiences were removed, after which 3.1 million posts remained. A stratified sample of 61,000 was selected. Unstructured data were classified into 5 key risks by manually coding for key outcomes of misuse, abuse, addiction, overdose, and death. Sampling probabilities of the coded posts were used to estimate the total post volume for each key risk.
Addiction and misuse were the two most commonly discussed key risks for hydrocodone, oxycodone, and oxymorphone. For fentanyl, overdose and death were the most discussed key risks. Fentanyl had the highest estimated number of misuse-, overdose-, and death-related mentions (41,808, 42,659, and 94,169, respectively). Oxycodone had the highest estimated number of abuse- and addiction-related mentions (3548 and 12,679, respectively). The estimated volume of online posts for fentanyl increased by more than 10-fold in late 2017 and 2018. The odds of discussing fentanyl overdose (odds ratios [OR] 4.32, 95% CI 2.43-7.66) and death (OR 5.05, 95% CI 3.10-8.21) were higher for social media, while the odds of discussing fentanyl abuse (OR 0.10, 95% CI 0.04-0.22) and addiction (OR 0.24, 95% CI 0.15-0.38) were higher for blogs and forums.
Of the 5 FDA-defined key risks, fentanyl overdose and death has dominated discussion in recent years, while discussion of oxycodone, hydrocodone, and oxymorphone has decreased. As drug-related deaths continue to increase, an understanding of the motivations, circumstances, and consequences of drug abuse would assist in developing policy responses. Furthermore, content was notably different based on media origin, and studies that exclusively use either social media sites (such as Twitter) or blogs and forums could miss important content. This study sets out sustainable, ongoing methodology for surveilling internet postings regarding these drugs.
2016 年至 2017 年期间，涉及阿片类药物的全国死亡率继续上升；阿片类药物死亡人数从 42249 人上升至 47600 人，使公共卫生危机达到新的高度。考虑到美国 69%的成年人使用在线社交媒体网站，一种可以更全面地了解处方药物滥用的资源可以补充传统的监测工具。美国食品和药物管理局已经确定了阿片类药物的 5 个关键风险和后果——误用、滥用、成瘾、过量用药和死亡。确定讨论这些关键风险的帖子可以提供通常不会被传统监测系统捕捉到的新信息。
本研究的目的是描述美国涉及滥用、误用、成瘾、过量用药和死亡的在线帖子（随时间的频率）的趋势，并描述承载这些讨论的网站类型。研究人员检查了提到芬太尼、氢可酮、羟考酮或羟吗啡酮的帖子。
删除未提及个人经历的帖子后，剩余 310 万条帖子。选择了 61000 个分层样本。通过人工编码关键结果（误用、滥用、成瘾、过量用药和死亡），将非结构化数据分类为 5 个关键风险。编码帖子的抽样概率用于估计每个关键风险的总帖子量。
在氢可酮、羟考酮和羟吗啡酮方面，成瘾和误用是讨论最多的两个关键风险。对于芬太尼，过量用药和死亡是讨论最多的关键风险。芬太尼的误用、过量用药和死亡相关提及量估计最高（分别为 41808、42659 和 94169）。羟考酮的滥用和成瘾相关提及量估计最高（分别为 3548 和 12679）。2017 年末和 2018 年，芬太尼的在线帖子数量增加了 10 多倍。社交媒体上讨论芬太尼过量用药（比值比[OR]4.32，95%CI 2.43-7.66）和死亡（OR 5.05，95%CI 3.10-8.21）的可能性更高，而社交媒体上讨论芬太尼滥用（OR 0.10，95%CI 0.04-0.22）和成瘾（OR 0.24，95%CI 0.15-0.38）的可能性更高。
在 FDA 定义的 5 个关键风险中，芬太尼的过量用药和死亡在近年来占据了主导地位，而对羟考酮、氢可酮和羟吗啡酮的讨论则有所减少。随着与药物相关的死亡人数继续增加，了解药物滥用的动机、情况和后果将有助于制定政策应对措施。此外，内容根据媒体来源明显不同，仅使用社交媒体网站（如 Twitter）或博客和论坛的研究可能会错过重要内容。本研究提出了一种可持续的、持续的方法来监测与这些药物有关的互联网帖子。
