Fentanyl in Pressed Oxycodone Pills: A Qualitative Analysis of Online Community Experiences with an Emerging Drug Trend

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.

Enhancing drug checking services for supply monitoring: perspectives on implementation in syringe service programs in the USA

BACKGROUND

Shifts in the US drug supply, including the proliferation of synthetic opioids and emergence of xylazine, have contributed to the worsening toll of the overdose epidemic. Drug checking services offer a critical intervention to promote agency among people who use drugs (PWUD) to reduce overdose risk. Current drug checking methods can be enhanced to contribute to supply-level monitoring in the USA, overcoming the selection bias associated with existing supply monitoring efforts and informing public health interventions.

METHODS

As a group of analytical chemists, public health researchers, evaluators, and harm reductionists, we used a semi-structured guide to facilitate discussion of four different approaches for syringe service programs (SSPs) to offer drug checking services for supply-level monitoring. Using thematic analysis, we identified four key principles that SSPs should consider when implementing drug checking programs.

RESULTS

A number of analytical methods exist for drug checking to contribute to supply-level monitoring. While there is likely not a one-size-fits-all approach, SSPs should prioritize methods that can (1) provide immediate utility to PWUD, (2) integrate seamlessly into existing workflows, (3) balance individual- and population-level data needs, and (4) attend to legal concerns for implementation and dissemination.

CONCLUSIONS

Enhancing drug checking methods for supply-level monitoring has the potential to detect emerging threats in the drug supply and reduce the toll of the worsening overdose epidemic.

Are you thinking what I'm thinking? Defining what we mean by "polysubstance use."

The rise in drug overdoses and harms associated with the use of more than one substance has led to increased use of the term "polysubstance use" among researchers, clinicians, and public health officials. However, the term retains no consistent definition across contexts. The current authors convened from disciplines including sociology, epidemiology, neuroscience, and addiction psychiatry to propose a recommended definition of polysubstance use. An iterative process considered authors' formal and informal conversations, insights from relevant symposia, talks, and conferences, as well as their own research and clinical experiences to propose the current definition. Three key concepts were identified as necessary to define polysubstance use: (1) substances involved, (2) timing, and (3) intent. Substances involved include clarifying either (1) the number and type of substances used, (2) presence of more than one substance use disorder, or (3) primary and secondary substance use. The concept of timing is recommended to use clear terms such as simultaneous, sequential, and same-day polysubstance use to describe short-term behaviors (e.g., 30-day windows). Finally, the concept of intent refers to clarifying unintentional use or exposure when possible, and greater attention to motivations of polysubstance use. These three components should be clearly defined in research on polysubstance use to improve consistency across disciplines. Consistent definitions of polysubstance use can aid in the synthesis of evidence to better address an overdose crisis that increasingly involves multiple substances.