JMIR Publications

ABSTRACT

Background:

Between 2016 and 2017, the national mortality rate involving opioids continued to escalate, with opioid deaths rising from 42,249 to 47,600, bringing the public health crisis to a new height. Considering 69% of adults in the United States use online social media sites, an underutilized resource in combating the epidemic is the personal experiences and motivations of individual opioid users. The Food and Drug Administration has identified five key risks of opioid drugs: misuse, abuse, addiction, overdose, and death. Frank discussions of these key risks are typically not captured in traditional surveillance systems.

Objective:

The purpose of the current study is to characterize the trends of conversation involving abuse, misuse, addiction, overdose, and death in the United States using internet posts mentioning fentanyl, hydrocodone, oxycodone, or oxymorphone.

Methods:

This study utilizes data from the publicly available internet to conduct qualitative analysis of internet posts and code these unstructured data into the 5 key risks. Over 5 million posts from 2015 to 2018 were collected using standard web-scraping methods. Posts not referring to personal experiences were removed, after which 3.1 million remained. A stratified sample of 61,000 was selected and manually coded for key outcomes of misuse, abuse, addiction, overdose, and death. Sampling probabilities of coded posts were used to estimate the total post volume for each key risk.

Results:

Addiction and misuse were the two most commonly mentioned key risks for hydrocodone, oxycodone, and oxymorphone. For fentanyl, overdose and death were the most discussed outcomes. 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 (3,548 and 12,679, respectively). Estimated post volume for fentanyl increased by over 10-fold in late 2017 and 2018. Odds of discussing fentanyl overdose and death were higher for social media (odds ratios: 4.315 and 5.045, respectively), while odds of discussing fentanyl abuse and addiction were higher for blogs/forums (odds ratios: 0.096 and 0.235). Of social media posts, 62.8% of hydrocodone posts, 49.8% of oxycodone posts, 30.6% of fentanyl posts, and 19.9% of oxymorphone posts originated from Twitter.

Conclusions:

Mentions of fentanyl overdose and death dominated discussion involving FDA defined key risks in recent years, while discussion of oxycodone, hydrocodone, and oxymorphone were decreasing. With the continued rise in drug related deaths, understanding motivations, circumstances, and consequences of drug abuse would assist in developing policy responses. Further, content was notably different based on the media source, and studies that exclusively utilize either social media sites (e.g. Twitter) or blogs/forums could miss important content.