Types and Sources of Stigma on Opioid Use Treatment and Recovery Communities on Reddit

Association Between Adverse Childhood Experiences and Opioid Use-Related Behaviors: A Systematic Review

As opioid use-related behaviors continue at epidemic proportions, identifying the root causes of these behaviors is critical. Adverse childhood experiences (ACEs) are shown to be an important predictor of opioid initiation, opioid dependence, and lifetime opioid overdose. The purpose of this systematic review is to examine the association between ACEs and opioid use-related behaviors later in life and to discuss implications for policy, practice, and research regarding ACEs and opioids. Five databases (PubMed, PsycINFO, CINAHL, Medline, and Scopus) were used to identify studies investigating the association between ACEs and opioid use-related behaviors. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 20 studies out of the initial 428 met the inclusion criteria for this review. Among the included 20 studies, 15 focused on the relationship between ACEs and lifetime opioid use-related behaviors, and five focused on current opioid use-related behaviors. All studies found statistical associations between ACEs and lifetime or current opioid use-related behaviors. Five studies found a significant gradient effect; that is, as the number of ACEs increased, the risk of opioid use-related behaviors also increased. A significant dose-response relationship exists between ACEs and opioid use-related behaviors. Hence, it is essential for clinicians to screen for ACEs before prescribing opioid medications, for opioid treatment to incorporate trauma-informed methods, and for messaging around opioid use interventions to include information about ACEs. The current review points to a critical need to implement standardized ACE screening instruments in clinical and research settings.

A qualitative content analysis of cannabis-related discussions on Reddit during the COVID-19 pandemic

Social media has become an increasingly important way to seek and share experiences, support, knowledge, and advice during the COVID-19 pandemic. Reddit, a pseudonymous social media platform, was one way that young people interacted during the pandemic. Our study goals were two-fold: (1) to categorize information sought and provided by users of r/saplings, a subreddit devoted to cannabis use and is often used by young people, and (2) to examine if conversations changed during the COVID-19 pandemic. We extracted 213 randomly selected posts and 2,546 related comments across four time periods (before the pandemic, during the first wave, summer, and next fall). We assessed the volume of posts and comments throughout our study period and conducted a qualitative content analysis. Quantitatively, the findings demonstrated an increase in the number of posts and comments throughout the study period. Given the substantial growth in subreddit activity throughout our study period, Reddit may play an increasingly important role in youth socialization related to cannabis. From the content analysis, we identified three major themes: how to acquire cannabis, how to use cannabis, and associated consequences. Reddit-users prioritized certain content in their posts at different stages of the pandemic. 'Places to acquire' and 'future use' were most common at the beginning of the pandemic, while the theme of 'consequences' and the topic of 'tolerance' became more prominent during the summer months. The comments to these posts were generally thorough and responsive to the post. Nearly all the information came from opinions or personal experiences. Firstly, our findings suggest that young people viewed Reddit as a viable outlet for conversations about cannabis. Secondly, due to the nature of the peer comments and lack of verifiable information being exchanged, misinformation may still circulate and inadvertently worsen the efforts to reduce cannabis-related harm. Interventions that provide understandable and accurate cannabis-related information in accessible formats may increase young people's ability to access and practice harm reduction.

First-hand accounts of structural stigma toward people who use opioids on Reddit

People who use opioids face multilevel stigma that negatively affects their health and well-being and drives opioid-related overdose. Little research has focused on lived experience of the structural levels of stigma toward opioid use. This study identified and qualitatively analyzed Reddit content about structural stigma toward opioid use. Iterative, human-in-the-loop natural language processing methods were used to identify relevant posts and comments from an opioid-related subforum. Ultimately, 273 posts and comments were qualitatively analyzed via directed content analysis guided by a prominent conceptualization of stigma. Redditors described how structures-including governmental programs and policies, the pharmaceutical industry, and healthcare systems-stigmatize people who use opioids. Structures were reported to stigmatize through labeling (i.e., particularly in medical settings), perpetuating negative stereotypes, separating people who use opioids into those who use opioids "legitimately" versus "illegitimately," and engendering status loss and discrimination (e.g., denial of healthcare, loss of employment). Redditors also posted robust formulations of structural stigma, mostly describing how it manifests in the criminalization of substance use, is often driven by profit motive, and leads to the pervasiveness of fentanyl in the drug supply and the current state of the overdose crisis. Some posts and comments highlighted interpersonal and structural resources (e.g., other people who use opioids, harm reduction programs, telemedicine) leveraged to navigate structural stigma and its effects. These findings reveal key ways by which structural stigma can pervade the lives of people who use opioids and show the value of social media data for investigating complex social processes. Particularly, this study's findings related to structural separation may help encourage efforts to promote solidarity among people who use opioids. Attending to first-hand accounts of structural stigma can help interventions aiming to reduce opioid-related stigma be more responsive to these stigmatizing structural forces and their felt effects.

Barriers and Facilitators to Harm Reduction for Opioid Use Disorder: A Qualitative Study of People With Lived Experience

STUDY OBJECTIVE

Although an increasing number of emergency departments (ED) offer opioid agonist treatment, naloxone, and other harm reduction measures, little is known about patient perspectives on harm reduction practices delivered in the ED. The objective of this study was to identify patient-focused barriers and facilitators to harm reduction strategies in the ED.

METHODS

We conducted semistructured interviews with a convenience sample of individuals in Massachusetts diagnosed with opioid use disorder. We developed an interview guide, and interviews were recorded, transcribed, and analyzed in an iterative process using reflexive thematic analysis. After initial interviews and coding, we triangulated the results among a focus group of 4 individuals with lived experience.

RESULTS

We interviewed 25 participants with opioid use disorder, 6 recruited from 1 ED and 19 recruited from opioid agonist treatment clinics. Key themes included accessibility of harm reduction supplies, lack of self-care resulting from withdrawal and hopelessness, the impact of stigma on the likelihood of using harm reduction practices, habit and knowledge, as well as the need for user-centered harm reduction interventions.

CONCLUSION

In this study, people with lived experience discussed the characteristics and need for user-centered harm reduction strategies in the ED that centered on reducing stigma, treatment of withdrawal, and availability of harm reduction materials.

Media framings of the role of genomics in "addiction" in the United States from 2015 to 2019: Individualized risk, biomedical expertise, and the limits of destigmatization

News coverage of the opioid epidemic is a useful site for examining genomic framings of addiction. Qualitative analysis of 139 articles published in the United States from 2015 to 2019 discussing genomics, addiction, and the opioid epidemic found an emphasis on both a postgenomic framing in which genetics operates in relation to social and environmental factors, and a molecularized understanding of addiction which highlighted the role of neurobiology and individual-level genetic risk. Discussions of genetics were often intertwined with calls for a biomedicalized approach that frames addiction as a chronic disease in need of medication, and thus under the purview of medical experts. Finally, while genomic discourses were invoked to reduce stigma, genomics was at times used to describe addicts as biologically distinct from other people, reflecting the possibility that genetics-even in the postgenomic context-can be used to promote a biologically essentialized understanding of people with addiction.

'There is no justice in nursing school': A qualitative analysis of nursing students' experiences of discrimination shared on Reddit

AIM

To explore nursing students' experiences of stigma and discrimination within nursing programmes as shared on Reddit, and how other Reddit users offer support and guidance.

DESIGN

Qualitative interpretive description.

METHODS

Through a critical social theory lens, this study draws on students' posts from three nursing subreddits: r/studentnurse, r/nursingstudent and r/nursing. Data were collected from March 2013 to March 2023. Reflexive thematic analysis was conducted to generate broad themes of nursing students' experiences of stigma and discrimination, and how other Reddit users offered support and guidance.

RESULTS

A total of 43 posts with 1412 associated comments were included in this analysis, which generated three predominant themes of nursing students' experiences. Nursing students faced stigma and discrimination across contexts, including from peers, nurses and other healthcare providers working in clinical practicum sites, and patients. Nursing students' posts described navigating the impacts and consequences of such experiences, including on well-being, and programme and career success. In contexts where students were often alone in their experiences of stigma and discrimination within their programmes and with few identified supports, Reddit users sought support and community through Reddit. While many comments offered validation and support, challenges of this social media platform included conflicting advice and unhelpful, judgmental messages.

CONCLUSIONS

Despite widely articulated social justice commitments in the profession, nursing students continue to experience stigma and discrimination across contexts within their nursing programmes.

IMPLICATIONS FOR PROFESSION

Nurses and nurse educators have a responsibility to acknowledge and make visible such experiences, and take direct action to prevent and remediate stigma and discrimination within nursing education.

IMPACT

This research contributes to the growing empirical evidence that nursing students' experience stigma and discrimination within nursing programmes and the healthcare system.

REPORTING METHOD

Adherence to COREQ guidelines was maintained.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Characteristics of Intimate Partner Violence and Survivor's Needs During the COVID-19 Pandemic: Insights From Subreddits Related to Intimate Partner Violence

Intimate partner violence (IPV) increased during the COVID-19 pandemic. Collecting actionable IPV-related data from conventional sources (e.g., medical records) was challenging during the pandemic, generating a need to obtain relevant data from non-conventional sources, such as social media. Social media, like Reddit, is a preferred medium of communication for IPV survivors to share their experiences and seek support with protected anonymity. Nevertheless, the scope of available IPV-related data on social media is rarely documented. Thus, we examined the availability of IPV-related information on Reddit and the characteristics of the reported IPV during the pandemic. Using natural language processing, we collected publicly available Reddit data from four IPV-related subreddits between January 1, 2020 and March 31, 2021. Of 4,000 collected posts, we randomly sampled 300 posts for analysis. Three individuals on the research team independently coded the data and resolved the coding discrepancies through discussions. We adopted quantitative content analysis and calculated the frequency of the identified codes. 36% of the posts (n = 108) constituted self-reported IPV by survivors, of which 40% regarded current/ongoing IPV, and 14% contained help-seeking messages. A majority of the survivors' posts reflected psychological aggression, followed by physical violence. Notably, 61.4% of the psychological aggression involved expressive aggression, followed by gaslighting (54.3%) and coercive control (44.3%). Survivors' top three needs during the pandemic were hearing similar experiences, legal advice, and validating their feelings/reactions/thoughts/actions. Albeit limited, data from bystanders (survivors' friends, family, or neighbors) were also available. Rich data reflecting IPV survivors' lived experiences were available on Reddit. Such information will be useful for IPV surveillance, prevention, and intervention.

Examining Symptoms of Stimulant Misuse and Community Support Among Members of a Recovery-Oriented Online Community

Misuse of prescription and non-prescription stimulants and related overdose deaths represent a growing public health crisis that warrants immediate intervention. We examined 100 posts and their respective comments from a public, recovery-oriented Reddit community in January 2021 to explore content related to DSM-V stimulant use disorder symptoms, access and barriers to recovery, and peer support. Using inductive and deductive methods, a codebook was developed with the following primary themes: 1) DSM-V Symptoms and Risk Factors, 2) Stigma/Shame, 3) Seeking Advice or Information, 4) Supportive or Unsupportive Comments. In 37% of posts community members reported taking high doses and engaging in prolonged misuse of stimulants. Nearly half of posts in the sample (46%) were seeking advice for recovery, but 42% noted fear of withdrawal symptoms or a loss of productivity (18%) as barriers to abstinence or a reduction in use. Concerns related to stigma, shame, hiding use from others (30%), and comorbid mental health conditions (34%) were also noted. Social media content analysis allows for insight into information about lived experiences of individuals struggling with substance use disorders. Future online interventions should address recovery barriers related to stigma and shame as well as fears associated with the physical and psychological impact of quitting stimulant misuse.