Trends in Co-mention of Stimulants and Opioids: A Natural Language Processing Driven Analysis of Reddit Forums

BackgroundDespite recent increasing focus on fatal overdoses involving multiple substances, there is a paucity of knowledge about stimulant co-use patterns among people who use opioids (PWUO) or people being treated with medication for opioid use disorder (PTMOUD). This study examines stimulant co-mention trends among PWUO/PTMOUD on social media.MethodsWe collected publicly-available data from 14 prescription and illicit opioid and MOUD-related forums on Reddit (subreddits) between 2011-2020 and timelines comprising past posts from a sample of Reddit users (Redditors) on these forums. We applied natural language processing to detect mentions of opioids, opioid-related medications, and stimulants and described trends and patterns in co-mentions. ResultsPosts collected for 13,812 Redditors indicated 12,306 (89.1%) mentioned ≥1 opioid, opioid-related medication or stimulant. Analyses showed the number and proportion of Redditors mentioning both opioids and/or opioid-related medications and stimulants steadily increased over time. Relative rates of co-mentions of heroin and methamphetamine, substances most commonly co-mentioned, decreased in recent years while those of fentanyl and MOUD with methamphetamine increased. ConclusionData from Reddit reflect increasing mentions of stimulants, particularly methamphetamine, among PWUO/PTMOUD and closely resemble the growth in overdose deaths involving both opioids and stimulants. These findings are consistent with recent reports suggesting increasing stimulant use among people receiving treatment for opioid use disorder. These data offer insights on emerging trends in the overdose epidemic and underscore the importance of scaling efforts to address co-occurring opioid and stimulant use including harm reduction and comprehensive healthcare access spanning mental-health services and substance use disorder treatment.