Reddit discussions about buprenorphine associated precipitated withdrawal in the era of fentanyl

BackgroundBuprenorphine is an evidence-based treatment for Opioid Use Disorder (OUD). Standard buprenorphine induction requires a period of opioid abstinence to minimize risk of precipitated opioid withdrawal (POW). Our objective was to study the impact of the increasing presence of fentanyl and its analogs in the opioid supply of the United States, on buprenorphine induction and POW, using social media data from Reddit. MethodsThis is a data-driven, mixed methods study of opioid-related forums, called subreddits, on Reddit to analyze posts related to fentanyl, POW, and buprenorphine induction. The posts were collected from seven subreddits using an application programming interface for Reddit. We applied natural language processing to identify subsets of salient posts relevant to buprenorphine induction, and performed manual, qualitative, thematic analyses of them. Results267,136 posts were retrieved from seven subreddits. Fentanyl mentions increased from 3 in 2013 to 3870 in 2020, and POW mentions increased from 2 (2012) to 332 (2020). Manual review of 384 POW-mentioning posts and 106 Bernese method (a microdosing induction strategy) mentioning posts revealed common themes and peoples experiences. Specifically, presence of fentanyl caused POWs despite long abstinence durations, and alternative induction via microdosing were frequently recommended in peer-to-peer discussions. ConclusionsThis study found that increased social media chatter on Reddit about POW correlated with fentanyl mentions. A subset of posts described microdosing as a self-management strategy to avoid POW. Reddit posts suggest that people are utilizing these strategies to initiate buprenorphine due to challenges arising from fentanyl prevalence in the opioid supply. HighlightsO_LIIncrease in mentions of precipitated opioid withdrawal (POW) on Reddit from 2012 to 2021 was closely correlated with the increase in fentanyl mentions. C_LIO_LIExperiences of precipitated opioid withdrawal (POW) were described by individuals who reported sufficient periods of abstinence by standard buprenorphine induction protocols. C_LIO_LIPeople with Opioid Use Disorder (OUD) on Reddit are using and recommending microdosing strategies with buprenorphine to avoid POW. C_LIO_LIPeople who used fentanyl report experiencing POW following statistically longer periods of abstinence than people who use heroin. C_LI