Abstract
Background
Fentanyl is a pressing concern in the current drug supply. Social media data can provide access to near real-time understanding of drug trends that may complement official mortality data.
Design
The total number of fentanyl-related posts and the total number of posts for eight drug subreddit categories (alcohol, cannabis, hallucinogens, multi-drug, opioids, over the counter, sedatives, stimulants) were collected from 2013 to 2021 using the Pushshift Reddit dataset. The proportion of fentanyl-related posts as a fragment of total subreddit posts was examined. Linear regressions described the rate of change in post volume over time.
Results
Overall, fentanyl-related content increased across drug-related subreddits from 2013 to 2021 (1292% increase, linear trend p ≤ 0.001). Opioid subreddits (30.62 per 1000 posts, linear trend p ≤ 0.001) had the most fentanyl-related content during the examined time period. Multi-drug (5.95 per 1000; p ≤ 0.01), sedative (3.23 per 1000, p ≤ 0.01), and stimulant (1.60 per 1000, p ≤ 0.01) subreddits also had substantial increases in fentanyl-related content. The greatest increases occurred in the multi-drug (1067% 2013:2021) and stimulant (1862% 2014:2021) subreddits.
Conclusion
Fentanyl-related posts on Reddit trended upward, with the fastest rate of change for multi-substance and stimulant subreddits. Beyond opioids, harm reduction and public health messaging should ensure inclusion of individuals who use other drugs.
Supplementary Information
The online version contains supplementary material available at 10.1007/s11606-023-08256-7.
KEY WORDS: Fentanyl, Reddit, Stimulants, Social media, Drug supply, Overdose
INTRODUCTION
Recent trends in overdoses and drug seizures demonstrate the alarming rise in fentanyl contamination of the drug supply.1–3 Estimates from 2020 to 2021 suggest that 64% of overdose deaths involved synthetic opioids, most notably fentanyl and fentanyl analogs.2 While the risk of fentanyl contamination was once greatest for persons who use opioids due to contamination of white powder heroin and pressed prescription opioid pills,1,3 the contamination of stimulants, benzodiazepines, and other illicitly manufactured pills is a rising concern. Most notably, stimulant overdose deaths co-involving fentanyl have increased, 2,4 and have been particularly detrimental among minoritized groups such as Black, Hispanic/Latinx, American Indian, and Asian Americans.5,6 The increasing fentanyl contamination of non-opioid substances such as stimulants and benzodiazepines can be particularly risky, as segments of these populations may be opioid-naïve, having little to no opioid tolerance and potentially without regular access to the opioid overdose reversal agent naloxone.
The urgency of this topic is established, yet we lack data on how these epidemiologic trends relate to the perceptions and concerns of persons who use drugs. In particular, little is known about how individuals who use non-opioid drugs have reacted and responded to the fentanyl crisis, and how this has changed over time. The current manuscript analyzes data from a popular social media site, Reddit.com, to explore fentanyl contamination discussions across different drug type forums over time. Reddit is a social media forum site containing a multitude of subforums (subreddits) where participants, often referred to as “Redditors,” can post comments and related discussions on topics of interest. There are subreddits for nearly any topic or theme one can imagine: including a plethora of drug-specific subreddits. Reddit is a particularly attractive social media platform to discuss stigmatizing topics such as drug use, as Redditors use anonymous pseudonyms (“usernames”) that allow them to be protect their real-life identity. Indeed, prior research has used Reddit to explore a multitude of topics as related to emerging trends in drug use, including mutual support in opioid subreddits during the early stages of the COVID-19 pandemic 7,8 and emerging forms of cannabis use. 9 Reddit as a whole is used primarily in the USA, more often by males ages 18 to 2910 — a subpopulation with higher rates of substance use.11 However, 12% of women and 35% of persons 30 years and older have also indicated they use Reddit.10 Therefore, while not necessarily representative of the general population of persons who use drugs, the use of Reddit and drug-specific subreddits can provide near real-time data to understand emerging drug use–related discussions among an otherwise hard-to-reach population.
The present study builds on previous work 12 that examined the general trend in fentanyl mentions across 103 drug subreddits from 2010 to 2017. Bowen et al. found an overall increase in any fentanyl-related posts and notably considered that increases occurred approximately 1–2 years earlier than reported rises in synthetic opioid overdose death rates. The current research expands on this preliminary study to both expand the timeframe of the Bowen et al.12 study and explore trends by substance-specific categories of subreddit. Understanding how trends may vary by substance used is particularly relevant to the worsening polysubstance use crisis and fentanyl contamination of the non-opioid drug supply. Given the expansion of fentanyl contamination across multiple drug categories, the current research sought to explore the extent to which different groups of people who use drugs may be concerned or reacting to fentanyl contamination. The current research was exploratory in nature, but given the current drug market landscape the authors hypothesized there would be an increase in the proportion of discussions on drug subreddits involving fentanyl over time.
METHODS
Data were collected from 71 drug-related subreddits. A list of subreddits was gathered by consulting with Bowen and colleagues (to be consistent with prior research), and the study team completed a thorough review of these and related subreddits in the summer of 2021. Exclusion criteria were applied to a compiled list of 238 subreddits. Subreddits were excluded if they were (1) determined to be irrelevant to recreational drug use, defined as no longer operating, no longer public, not drug related, not in English, or specific to one country; (2) had no posts within 2 weeks of the review; (3) and were a subreddit containing only photos or videos but not textual content. Given the nature of Reddit—to create subreddits at any given time based on user interests—some of the subreddits may not have yet been created during earlier years of data collection. That is, not all subreddits were active or in existence across the entire study period. The 71 drug-related subreddits were then coded as belonging to one of eight substance-specific subreddit categories: alcohol, cannabis, hallucinogens, multi-drug, opioids, over-the-counter (OTC), sedatives, or stimulants. This categorization was based on the subreddit description and the content of posts. The multi-drug category includes subreddits where persons could share drug comments and experiences regarding several or any drugs. The study team reviewed the categorization of subreddits and came to agreement on classifications (see Figure S1).
Historical post data was collected for each subreddit from 2013 to 2021. Two values were computed for each combination of subreddit and year: (1) the total number of posts during the time interval (each year) and (2) the number of posts related to fentanyl. The number of fentanyl-related posts was identified using 34 fentanyl terms, analogs, variations, and misspellings (Table S1). This list of 34 terms was provided by Bowen et al.’s12 previous research on this topic. To account for natural fluctuations in posts to subreddits over time, we report the proportion of total posts for the given year/subreddit that were related to fentanyl. Only original post data was collected; the number of comments was not counted or collected for data collection as they may or may not have related to the original post containing the fentanyl mention. The “post” refers to the main content that was created to be shared on the subreddit, whereas comments are in reply to the main post. A full mirror of the Pushshift Reddit archive was scanned with a regular expression matching the case-independent terms. As is common with directly specified lexicons, this approach is likelier to favor precision over recall, i.e., to err on the side of minimizing false positives and therefore somewhat under-count.
The proportion of fentanyl-related posts as a fragment of total subreddit posts was calculated as a standard proportion (p̂ = fentanyl-related posts/total subreddit posts). Proportions were created for total volume (all subreddits) and for each of the eight substance categories. Percent change in relative post volume for each substance category per year was calculated, relative to the year prior as well as for 2021 relative to 2014. Linear regressions with relative post volume as a function of time in years, as both linear and quadratic functions, described the rate of change in post volume over time. Analyses were completed with Stata v.15.1 and Excel v.16.62.
RESULTS
Data are presented for each substance category in Table 1. There were 7.5 million total posts across the 71 drug-related subreddits from 2013 to 2021. Of these posts, 0.47% (N = 35,278) mentioned any fentanyl keywords (i.e., proportion or “relative post volume” = 4.71 per 1000 posts). The majority of these fentanyl-related posts were in opioid (N = 23,479) and multi-drug subreddits (N = 9433).
Table 1.
Percent change of fentanyl-related post content across substance-specific subreddit categories, 2013–2021
| Year | 2013 | 2014 | 2015 | 2016 | 2017 | 2018 | 2019 | 2020 | 2021 | 2013:2021 | |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Total (N) | |||||||||||
| 71 subreddits | 296 | 616 | 1217 | 2632 | 3824 | 4072 | 5731 | 7586 | 9304 | 35,278 | |
| Change (count) | - | + 320 | + 601 | + 1415 | + 1192 | + 248 | + 1659 | + 1855 | + 1718 | + 9008 | |
| Relative post volume (RPV) per 1000 posts | 0.56 | 1.18 | 2.23 | 4.27 | 5.13 | 4.79 | 5.10 | 5.56 | 7.78 | 4.71 | |
| % yearly change in RPV | - | 110.5 | 89.8 | 91.0 | 20.1 | − 6.5 | 6.4 | 9.0 | 40.1 | 1291.8 | |
| Alcohol (N) | |||||||||||
| 4 subreddits | 1 | 2 | 3 | 7 | 8 | 9 | 14 | 15 | 23 | 82 | |
| Change (count) | - | + 1 | + 1 | + 4 | + 1 | + 1 | + 5 | + 1 | + 8 | + 22 | |
| RPV per 1000 posts | 0.05 | 0.06 | 0.08 | 0.14 | 0.12 | 0.10 | 0.13 | 0.14 | 0.21 | 0.13 | |
| % yearly change in RPV | - | 33.4 | 25.7 | 68.8 | − 13.3 | − 15.6 | 32.9 | 4.0 | 49.0 | 327.1 | |
| Cannabis (N) | |||||||||||
| 5 subreddits | 24 | 16 | 16 | 34 | 56 | 41 | 57 | 21 | 31 | 296 | |
| Change (count) | - | − 8 | 0 | + 18 | + 22 | − 15 | + 16 | − 36 | + 10 | + 7 | |
| RPV per 1000 posts | 0.06 | 0.05 | 0.06 | 0.15 | 0.23 | 0.17 | 0.23 | 0.09 | 0.18 | 0.12 | |
| % yearly change in RPV | - | − 17.4 | 22.1 | 154.5 | 55.7 | − 25.6 | 36.4 | − 62.4 | 100.2 | 205.4 | |
| Hallucinogens (N) | |||||||||||
| 8 subreddits | 1 | 0 | 1 | 21 | 13 | 75 | 71 | 50 | 83 | 315 | |
| Change (count) | - | − 1 | + 1 | + 20 | − 8 | + 62 | − 4 | − 21 | + 33 | + 82 | |
| RPV per 1000 posts | 0.05 | 0.00 | 0.02 | 0.34 | 0.16 | 0.58 | 0.29 | 0.15 | 0.32 | 0.26 | |
| % yearly change in RPV | - | − 100.0 | - | 1331.8 | − 52.7 | 263.9 | − 50.1 | − 49.7 | 116.8 | 500.8 | |
| Multi (N) | |||||||||||
| 28 subreddits | 32 | 137 | 513 | 1074 | 1498 | 1344 | 1521 | 1505 | 1809 | 9433 | |
| Change (count) | - | + 105 | + 376 | + 561 | + 424 | − 154 | + 177 | − 16 | + 304 | + 1777 | |
| RPV per 1000 posts | 0.63 | 1.53 | 3.81 | 6.28 | 7.44 | 6.98 | 6.36 | 5.80 | 7.35 | 5.95 | |
| % yearly change in RPV | - | 143.6 | 148.2 | 64.8 | 18.5 | − 6.2 | − 8.9 | − 8.8 | 26.8 | 1066.7 | |
| Opioids (N) | |||||||||||
| 14 subreddits | 238 | 459 | 676 | 1446 | 2155 | 2389 | 3734 | 5552 | 6830 | 23,479 | |
| Change (count) | - | + 221 | + 217 | + 770 | + 709 | + 234 | + 1345 | + 1818 | + 1278 | 6592 | |
| RPV per 1000 posts | 13.20 | 16.47 | 18.62 | 21.58 | 22.70 | 24.74 | 33.55 | 34.93 | 43.83 | 30.62 | |
| % yearly change in RPV | - | 24.8 | 13.0 | 15.9 | 5.2 | 8.9 | 35.6 | 4.1 | 25.5 | 231.9 | |
| Over the counter (N) | |||||||||||
| 2 subreddits | 0 | 1 | 0 | 0 | 0 | 0 | 5 | 17 | 10 | 33 | |
| Change (count) | - | + 1 | - | - | - | - | + 5 | + 12 | − 7 | + 10 | |
| RPV per 1000 posts | - | 0.94 | - | - | - | - | 0.20 | 0.47 | 0.30 | 0.28 | |
| % yearly change in RPV | - | - | − 100.0 | - | - | - | - | 133.1 | − 35.6 | - | |
| Sedatives (N) | |||||||||||
| 5 subreddits | 0 | 0 | 3 | 25 | 30 | 89 | 132 | 235 | 188 | 702 | |
| Change (count) | - | 0 | + 3 | + 22 | + 5 | + 59 | + 43 | + 103 | − 47 | + 188 | |
| RPV per 1000 posts | 0.00 | 0.00 | 1.11 | 3.38 | 2.30 | 3.68 | 3.08 | 3.33 | 3.41 | 3.23 | |
| % yearly change in RPV | - | - | - | 204.9 | − 32.0 | 60.2 | − 16.3 | 8.1 | 2.3 | - | |
| Stimulants (N) | |||||||||||
| 5 subreddits | 0 | 1 | 5 | 25 | 64 | 125 | 197 | 191 | 330 | 938 | |
| Change (count) | - | + 1 | + 4 | + 20 | + 39 | + 61 | + 72 | − 6 | + 139 | + 330 | |
| RPV per 1000 posts | 0.00 | 0.11 | 0.32 | 0.99 | 1.57 | 1.82 | 1.73 | 1.25 | 2.10 | 1.60 | |
| % yearly change in RPV | - | - | 198.0 | 209.4 | 59.3 | 15.4 | − 4.6 | − 27.7 | 67.7 | - | |
A dashed line indicates a value was not calculated for years that were the reference year (2013) or where there were 0 fentanyl-related posts. Percent change was based on the proportion of fentanyl posts per total subreddit content (not raw counts) over the year prior (with exception to the 2013–2021 column, which compares change from 2013 to 2021)
As may have been expected, opioid-related subreddits had the greatest relative volume of fentanyl-related content in all years (ranging from 13.20 per 1000 posts in 2013 to 43.83 per 1000 posts in 2021), followed by multi-drug subreddits and then sedative subreddits. Subreddits specific to alcohol, cannabis, and OTC substance had relatively very few fentanyl-related posts (i.e., < 0.30 per 1000 posts).
Furthermore, Table 1 displays the percent change of fentanyl content from 2013 to 2021: across all subreddit categories, there was a 1292% increase in fentanyl-related content. The greatest increases from 2013 to 2021 occurred in the multi-drug (1067%) subreddits. Stimulant subreddits saw a large increase in content (1862%) from 2014:2019 (0 posts in 2013).
The percent change in proportion of fentanyl-related content by subreddit grouping each year relative to the prior year reflects the trends shown in Fig. 1. In linear and quadratic regressions analyses, there were significant changes in the proportion of total subreddit posts mentioning fentanyl terms overall (linear trend: p = 0.0001, b = 0.0008 or 0.80; quadratic: p = 0.0006, b = − 0.00004 or − 0.04) indicating an overall increase in fentanyl-related content, but a subsequent decreasing trend, as shown in Fig. 1. There was a significant linear increase over time in proportion of posts mentioning fentanyl terms in the multi-drug (p = 0.007, b = 0.0007 or 0.76), opioids (p = 0.00001, b = 0.003 or 3.51), sedative (p = 0.004, b = 0.0005 or 0.46), and stimulant (p = 0.001, b = 0.0003 or 0.26) subreddits, and a significant quadratic (i.e., increasing then decreasing) relationship over time in proportion of posts mentioning fentanyl terms in the multi-drug (p = 0.001, b = − 0.0002 or − 0.19), sedative (p = 0.003, b = − 0.00009 or − 0.09), and stimulant (p = 0.003, b = − 0.00003 or − 0.03) subreddits. The opioid subreddits experienced a significant positive change of slope (p = 0.00001, b = 0.0003 or 0.32) and positive quadratic trend coefficient, indicating that the rate of increase has been more rapid in later years. Alcohol subreddits had significant linear and quadratic trends, but the relative post volume of these subreddits was overall very small (< 1/1000 relative post volume). There were no significant changes in linear or quadratic trends for groupings of subreddits specific to cannabis, hallucinogens, or OTC.
Figure 1.
Proportion of Reddit posts mentioning fentanyl, by substance category.
While not shown, analyses were run with data up until August 2022 (time of writing) and regression trends were similar. Relative post volume for the partial 2022 data shows continued increases in fentanyl-related discussions across subreddits.
DISCUSSION
The current research sought to understand current trends in fentanyl-related discussions among online content of persons who use a variety of drugs. Overall, the proportion of fentanyl-related posts in 71 drug-related subreddits increased over time from 2013 to 2021, most rapidly in non-opioid-specific forums, including sedative, stimulant, and multi-drug subreddits. While opioid subreddits had the greatest volume of fentanyl-related content, these data indicate that conversations on fentanyl have rapidly increased among Redditors posting in subreddits discussing multiple other non-opioid drugs. These observations of fentanyl mentions on Reddit trended similarly upward to US overdose rates involving stimulants and sedatives. Indeed, recent data from 2020 to 2021 indicate that four in ten fentanyl deaths now co-involve stimulants and approximately one in ten involve benzodiazepine sedatives,2 providing support to the idea that social media can provide an early warning to drug trends. Importantly, social media sources such as Reddit may provide earlier signal to drug trends as more formal sources (e.g., overdose data) are typically substantially lagged. For example, a study by the National Drug Early Warning System found Reddit mentions of novel psychoactive substances predated exposure toxicology data.13 As emerging substances continue to shift overdose trends in the USA (e.g., xylazine), the innovative monitoring of social media may be increasingly beneficial. Future research may also seek to understand the extent to which these trends may relate to major news coverage of fentanyl-related incidents or the “popular news cycle,” rather than epidemiologic prevalence of fentanyl contamination experiences.
Overall, the current research provided an opportunity to understand trends in fentanyl-related content among persons who use a variety of drugs and provides continued support in the use of social media data to understand emerging drug trends. There are limitations to this study based on the non-representative nature of Reddit users, an inability to distinguish between what drugs were being discussed in multi-drug subreddits and a lack of qualitative examination of the nature of the fentanyl content. Even with these limitations, the current research is an example of how social media and other complementary data sources can be quickly mobilized to gather insights to emerging drug trends. Given the data collected here and elsewhere, it is critical that harm reduction and public health agencies ensure that fentanyl messaging, access to fentanyl test strips, and naloxone distribution is inclusive of all persons who use drugs as the market continues to witness the expansion of fentanyl contamination to a multitude of drugs.
Supplementary Information
Below is the link to the electronic supplementary material.
Funding
This work was supported by the National Institutes of Health R25DA037190 (AB), K01DA053435 (AB), and K01 DA046697 (MM).
Declarations:
Disclaimer:
The opinions expressed are those of the authors.
Conflict of Interest
Author NK is involved in ongoing opioid litigation. The remaining authors have no conflicts of interest to declare.
Footnotes
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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