Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, GA, USA.
Clin Toxicol (Phila). 2022 Jun;60(6):694-701. doi: 10.1080/15563650.2022.2032730. Epub 2022 Feb 4.
Induction of buprenorphine, an evidence-based treatment for opioid use disorder (OUD), has been reported to be difficult for people with heavy use of fentanyl, the most prevalent opioid in many areas of the country. In this population, precipitated opioid withdrawal (POW) may occur even after individuals have completed a period of opioid abstinence prior to induction. Our objective was to study potential associations between fentanyl, buprenorphine induction, and POW, using social media data.
This is a mixed methods study of data from seven opioid-related forums (subreddits) on Reddit. We retrieved publicly available data from the subreddits an application programming interface, and applied natural language processing to identify subsets of posts relevant to buprenorphine induction, POW, and fentanyl and analogs (F&A). We computed mention frequencies for keywords/phrases of interest specified by our medical toxicology experts. We further conducted manual, qualitative, and thematic analyses of automatically identified posts to characterize the information presented. In 267,136 retrieved posts, substantial increases in mentions of F&A (3 in 2013 to 3870 in 2020) and POW (2 in 2012 to 332 in 2020) were observed. F&A mentions from 2013 to 2021 were strongly correlated with mentions of POW (Spearman's : 0.882; = .0016), and mentions of the (BM), a microdosing induction strategy (Spearman's : 0.917; = .0005). Manual review of 384 POW- and 106 BM-mentioning posts revealed that common discussion themes included "" (55.1%), " (38.2%) and "" (36.1%). Many reported experiencing POW despite prolonged opioid abstinence periods, and recommended induction microdosing, including specifically the BM.
Reddit subscribers often associate POW with F&A use and describe self-managed buprenorphine induction strategies involving microdosing to avoid POW. Further objective studies in patients with fentanyl use and OUD initiating buprenorphine are needed to corroborate these findings.HIGHLIGHTSIncrease in mentions of precipitated opioid withdrawal (POW) on Reddit from 2012 to 2021 was associated with the increase in fentanyl and analog mentions.Experiences of precipitated opioid withdrawal (POW) were described by individuals despite reporting prolonged periods of abstinence compared to standard buprenorphine induction protocols.People with Opioid Use Disorder (OUD) on Reddit are using and recommending microdosing strategies with buprenorphine to avoid POW.People who used fentanyl report experiencing POW following statistically longer periods of abstinence than people who use heroin.
阿片类药物使用障碍（OUD）的一种循证治疗方法是丁丙诺啡诱导，但在许多地区，使用芬太尼的人很难进行诱导，芬太尼是最常见的阿片类药物。在这些人群中，即使在诱导前完成了一段时间的阿片类药物戒断，也可能发生诱发的阿片类药物戒断（POW）。我们的目的是使用社交媒体数据研究芬太尼、丁丙诺啡诱导和 POW 之间的潜在关联。
这是一项对 Reddit 上七个与阿片类药物相关的论坛（子版块）的数据进行的混合方法研究。我们从子版块中检索了公开可用的数据，使用应用程序编程接口，并应用自然语言处理来识别与丁丙诺啡诱导、POW 和芬太尼及类似物（F&A）相关的帖子子集。我们计算了医学毒理学专家指定的关键词/短语的提及频率。我们进一步对自动识别的帖子进行了手动、定性和主题分析，以描述所呈现的信息。在 267136 条检索到的帖子中，F&A（2013 年的 3 次到 2020 年的 3870 次）和 POW（2012 年的 2 次到 2020 年的 332 次）的提及量显著增加。2013 年至 2021 年 F&A 的提及量与 POW 的提及量呈强烈相关（Spearman's：0.882；=0.0016），与微剂量诱导策略的 （BM）的提及量也呈强烈相关（Spearman's：0.917；=0.0005）。对 384 条 POW 提及和 106 条 BM 提及帖子的手动审查显示，常见的讨论主题包括“”（55.1%）、“”（38.2%）和“”（36.1%）。许多人报告说尽管有较长的阿片类药物戒断期，但仍经历了 POW，并建议采用诱导微剂量的方法来避免 POW，包括具体的 BM。
Reddit 用户经常将 POW 与 F&A 使用联系起来，并描述了涉及微剂量的自我管理丁丙诺啡诱导策略，以避免 POW。需要对使用芬太尼和 OUD 的患者进行进一步的客观研究，以证实这些发现。
从 2012 年到 2021 年，Reddit 上提及的诱发阿片类药物戒断（POW）与芬太尼和类似物的提及量增加有关。
个人在报告与标准丁丙诺啡诱导方案相比更长的戒断期后，经历了诱发的阿片类药物戒断（POW）。
Reddit 上的阿片类药物使用障碍（OUD）患者正在使用和推荐丁丙诺啡的微剂量策略来避免 POW。
与使用海洛因的人相比，使用芬太尼的人在统计上经历 POW 的时间更长。
