Drug abuse researchers are using the social media site Reddit as a window into the experiences of people living with opioid addiction.
Abeed Sarker in Emory’s Department of Biomedical Informatics has a paper in Clinical Toxicology focusing on the phenomenon of “precipitated withdrawal,” in collaboration with emergency medicine specialists from Penn, Rutgers and Mt Sinai.
Precipitated withdrawal is a more intense form of withdrawal that can occur when someone who was using opioids starts medication-assisted treatment with buprenorphine – and also when someone receives naloxone for an overdose.
When it occurs prior to medication-assisted treatment, precipitated withdrawal is reported to occur more often when someone has a history of fentanyl use, possibly because fentanyl remains in the body’s peripheral tissues, even during periods of abstinence. The buprenorphine washes out remaining fentanyl or its relatives quickly, leading to symptoms such as diarrhea and vomiting, and sometimes to dehydration and hospitalization.
“From Reddit, we have found that people who use opioids had been talking about it [precipitated withdrawal] for a couple of years now and they have, as a community, come up with their own self-management strategies,” Sarker says.
The strategies are based on microdosing; one approach is called the “Bernese method.”
“These findings are important because this cohort is very difficult to follow, and therefore studying causes and solutions to precipitated withdrawal after buprenorphine initiation is challenging,” Sarker says. “We are essentially trying to give people who use opioids a voice.”
Highlights from the paper include:
- An increase in mentions of precipitated withdrawal on Reddit from 2012 to 2021, associated with an increase in fentanyl and analog mentions
- Individuals report experiences of precipitated withdrawal despite prolonged periods of abstinence compared to standard buprenorphine induction protocols
- People who used fentanyl report experiencing precipitated withdrawal following statistically longer periods of abstinence than people who use heroin
- On Reddit, people with opioid use disorder are using and recommending microdosing strategies with buprenorphine to avoid precipitated withdrawal
The research was supported by the National Institute on Drug Abuse (R01DA046619).