JMIR Publications

ABSTRACT

Background:

Opioid use disorder and its consequences are a persistent public health concern for Australians. Online activity has been utilized to understand perception of drug safety and diversion of drugs in contexts outside of Australia. The anonymity of the internet offers several advantages to surveilling and inquiring about specific covert behaviors, such as diversion or discussing sensitive subjects, where traditional surveillance approaches might be limited.

Objective:

The goal was to characterize content of online posts and compare reports of illicit sales of tapentadol and oxycodone from sources originating from Australia. First, post content was evaluated to determine if internet discussion encourages or discourages proper therapeutic use of the drugs. Second, we hypothesized that tapentadol would have lower street price and lower number of illicit sales than oxycodone.

Methods:

Web posts originating from Australia between 2017 and 2019 were collected using the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS®) System Web Monitoring Program. Post content was categorized into topics of discussion related to harms and behaviors that could lead to harm. Illicit sales data were collected through a crowdsourcing website between 2016 and 2019 using the RADARS® System StreetRx Program. Two multivariable regression models assessed differences in illicit price and number of sales.

Results:

A total of 4.67% of tapentadol posts (N = 600) discussed an adverse event while 10.27% (95% CI: 9.32, 11.21) of oxycodone posts (N = 8,598) discussed this topic. A total of 10.0% of tapentadol posts discussed unsafe use or side effects, while 20.17% (95% CI: 18.92, 21.41) of oxycodone posts discussed unsafe use or side effects. There were 31 illicit sale reports for tapentadol (geometric mean price per milligram: $0.12 Australian dollar (AUD)) and 756 for oxycodone ($1.28 AUD). Models detected no differences in the street price or number of sales between drugs when covariates were included, though potency of the pill significantly predicted the street price (P<0.001) and availability predicted number of sales (P=0.0295).

Conclusions:

Australians searching online for opinions could judge tapentadol as safer than oxycodone due to online post content. The illicit sales market for tapentadol was smaller than oxycodone, and drug potency and licit availability are likely important factors influencing the illicit market.