Social Listening for Patient Experiences With Stopping Extended-Release Buprenorphine: Content Analysis of Reddit Messages.

BACKGROUND

Discontinuation of buprenorphine as a medication for opioid use disorder (MOUD) necessitates careful tapering to reduce opioid withdrawal and relapse. With a half-life of 43-60 days, buprenorphine extended-release formulation (BUP-XR) may provide gradual taper, facilitating successful treatment discontinuation.

OBJECTIVE

This study sought to understand experiences with stopping BUP-XR as described on social media.

METHODS

Reddit records (March 2018 to August 2022) were evaluated for the presence of referents to BUP-XR using parallel criteria based on predefined keywords and subreddit context. The keyword-based search identified records mentioning "Sublocade" (or similar search strings) regardless of subreddit. The subreddit context-based criteria identified records that were created within the r/Sublocade subreddit. Records that included reference to BUP-XR were further evaluated for mentions of treatment cessation using predefined keywords. A 50% randomized sample was then selected for qualitative analysis by a single experienced subject matter expert. Records were manually coded to validate references to BUP-XR and MOUD cessation and were evaluated for additional predefined constructs related to opioid craving and withdrawal, BUP-XR and other MOUD treatment details, and other nonmedical opioid use. Emergent constructs related to cessation-related knowledge, attitudes, behaviors, and experiences were also identified as part of the data coding and annotation process.

RESULTS

Of 6082 total, 3041 records were coded and analyzed; most (n=2692, 97.4%) referenced BUP-XR, of which, 43.8% (n=1179) referenced cessation of BUP-XR as MOUD. Many individuals shared information about prior use of MOUD, primarily transmucosal buprenorphine (185 records/63 authors), including the use of BUP-XR to taper off buprenorphine. Individuals provided details of their BUP-XR treatment experiences before and following cessation. Only 102 (8.7%) records mentioned opioid withdrawal; 1 record mentioned craving. Withdrawal experiences with BUP-XR were generally described as less intense than other drugs, although at least mild withdrawal was seen as an inevitable part of cessation. Thematic analysis revealed discussions of polypharmacy with transmucosal buprenorphine and the importance of personalized treatment and patient agency.

CONCLUSIONS

There was nuanced discussion of treatment cessation using BUP-XR on Reddit, with individuals describing detailed courses of treatment and treatment experiences. Few records mentioned opioid withdrawal, and when discussed, withdrawal experiences during cessation of BUP-XR were generally described as less intense than withdrawal experiences with other drugs. These results suggest that social media, such as Reddit, can be leveraged to explore perspectives on treatment and recovery among individuals with opioid use disorder. Overall, this study provides insights into real-world patient experiences with cessation of BUP-XR and is consistent with prior case series; however, more research is needed to understand the course of opioid use disorder following cessation of BUP-XR as well as other MOUD.