We have made available the ROA taxonomy and the corresponding vocabulary to the research community. We provided a longitudinal perspective on online interest in the opioids discourse and a quantitative characterization of the adoption of different ROA, with a focus on the less-studied yet emerging and relevant practices. These terms are invaluable to performing exhaustive and at-scale analyses of user-generated content from social media, as they include colloquialisms, slang, and nonmedical terminology that is established on digital platforms and hardly used in the medical literature. Second, using word embeddings, we identified and cataloged a large set of terms describing practices of nonmedical opioids consumption.
First, leveraging and expanding a recent methodology proposed by Balsamo et al, we identified a large cohort of opioid firsthand users (ie, Reddit users showing explicit interest in firsthand opioid consumption) and characterized their habits of substance use, administration, and drug tampering over a period of 5 years. Reddit constitutes a nonintrusive and privileged data source to study a variety of issues, including sensitive topics such as mental health, weight loss, gender issues, and substance abuse. Due to fair guarantees of anonymity, no limits on the number of characters in a post, and a large variety of debated topics, this platform is often used to uninhibitedly discuss personal experiences. This platform is structured into subreddits, user-generated and user-moderated communities dedicated to the discussion of specific topics ( Multimedia Appendix 1). This paper seeks to complement current studies widening the understanding of opioid consumption patterns by using Reddit, a social content aggregation website, as the primary data source. However, to the best of our knowledge, no large-scale empirical evidence has been found to unveil the relationships between substance manipulation, unconventional ROA, and nonmedical substance administration. Research has also been focused on developing tamper-resistant and abuse-deterrent drug formulations.
The alteration of the pharmacokinetics of opioids through drug-tampering methods, together with unconventional administration, may potentially lead to very different addictive patterns and ultimately have unexpected health-associated risks. Many of these studies acknowledge that drug tampering, that is, the intentional chemical or physical alteration of medications, is an important constituent of drug abuse. Researchers have estimated the prevalence of routes of administration for nonmedical prescription opioids and opiates however, they rarely consider less common ROA, such as rectal, transdermal, or subcutaneous administration, leaving the mapping of nonmedical and nonconventional administration behaviors greatly unexplored.
Pharmacology research is interested in understanding the consequences of various routes of administration (ROA), that is, the paths by which a substance is taken into the body, due to the different effects and potential health-related risks tied to them. A few recent studies investigated the temporal unfolding of the opioid epidemic in the United States by leveraging complementary data sources different from the official US Centers for Disease Control and Prevention data and using social media like Reddit.
Researchers have used digital and social media data to perform various tasks, including detecting drug abuse, forecasting opioid overdose, studying transition into drug addiction, predicting opioid relapse, and discovering previously unknown treatments for opioid addiction. Alongside traditional medical, pharmacological, and public health studies on the nonmedical adoption of prescription opioids, several phenomena related to the opioid epidemic have recently been successfully tackled through a digital epidemiology approach. In the last decade, the United States witnessed an unprecedented growth of deaths due to opioid drugs, which sparked from overprescriptions of semisynthetic opioid pain medication such as oxycodone and hydromorphone and evolved in a surge of abuse of illicit opioids like heroin and powerful synthetic opioids like fentanyl.
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