Discovering Alternative Treatments for Opioid Recovery with Reddit
Takeaway/tl;dr- We studied 1.5 million Reddit posts with machine learning to see how people self-direct recovery from opioid addiction. In a CHI 2019 paper, we discovered that clinically unverified substances were being discussed and used as treatment for addiction. We also found conflicting support and risks for these treatments — some may be effective, whereas others are potentially dangerous. Read the paper here (PDF), or check out the long-form summary below.
Opioid addiction is a serious problem in the US. More people died from opioid overdoses than from car accidents in 2017, and new reports on this crisis indicate that people are working through how to hold pharmaceutical companies partially responsible for the crisis.
In response to this crisis, people are turning to online communities to support their own paths to recover from addiction. These communities support many different journeys, including in-patient programs and twelve-step programs like Narcotics Anonymous. However, some people come online to try recovery without the assistance of doctors or other professionals.
Using machine learning on 1.5 million posts on Reddit, we looked at how communities were supporting or hindering opioid addiction recovery for those trying to do it themselves. We discovered that communities are using unconventional and surprising substances to facilitate their recovery, ranging from over-the-counter medications to illicit drugs. We also found the creation of “kits” or “stacks” of drugs used together to combat addiction and reduce the impacts of withdrawal. Some of these substances could be medically useful, but others may be dangerous. Here’s a short list of substances we found being used (you can find more in the paper (PDF)):
- Kratom — a shrub from Southeast Asia traditionally used as a tea for improving their energy, but people have started using it to wean themselves off heroin or fentanyl
- Imodium — over-the-counter anti-diarrheal. At high enough doses, users report it having opioid like properties
- Xanax and other benzodiazepines (benzos) — commonly prescribed to treat depression and anxiety, these anti-psychotic medications seem to help relieve the worst symptoms of withdrawal (insomnia and restless leg syndrome)
How’d we do it?
Before we even started our project, we partnered with a substance abuse expert to understand how people talk about and engage in self-directed recovery efforts. This was a really important part of our process, because his insights helped us better understand the community as computer scientists without expertise.
Then, we analyzed 1.5 million Reddit posts with machine learning to understand the substances individuals use for recovering from opioid addiction. First, we created a machine learning algorithm that automatically labels if someone is talking about opioid addiction recovery or not. This is called transfer learning, which takes the model learned from one dataset and applies it to a similar but different dataset. This algorithm worked really well — its accuracy is about 91% on held out data from the communities, and 80% with the labels provided by our substance abuse expert.
Next, using language analysis and a technique called word embeddings, we created clusters of words used in circumstances related to recovery-based drug use, and identified new substances from these clusters. We then manually studied how people in communities talked about their effectiveness.
Here’s a paraphrased example of the reported effectiveness of these substances:
Treat loperamide like Suboxone — it’s an opioid replacement and has a bad withdrawal and a long half life. You’re fooling yourself if you think using Imodium to ‘take the edge off’ isn’t extending your withdrawals.
What Should We Do About These Behaviors?
One of the outcomes of this research is a preliminary list of new substances people are using in these communities. We hope that this will help guide medical research to understanding whether these are effective at helping with opioid addiction recovery. For many substances in this list, we couldn’t find experimental medical research on them, with maybe one or two case studies on people overdosing or mixing them with other substances. This research could help doctors begin understanding these substances and how people are using them.
However, research like this leads to interesting questions about platforms and moderation of these behaviors, and social network responsibility. Frequently, I am asked — “Well, should we let them do this? Shouldn’t platforms ban their behavior because it’s illegal and dangerous?”
I think a lot about these questions, because I study high-risk health behaviors, like suicide, pro-ana, and addiction. It’s obvious that some behaviors are physically dangerous. We shouldn’t minimize the risk of activities like mixing medication, testing experimental medications without real guidance on what may be risky.
However, these communities ALSO provide a lot of support for safety, giving tips and advice about reducing the risks of heroin and fentanyl, and some of these new substances — one post was a detailed description about how to not get addicted to Imodium. There are also hundreds of thousands of posts encouraging individuals to seek clinical recovery. What do we do in these circumstances?
I strongly believe that these communities provide valuable harm reduction advice to community members. Harm reduction is an approach to policymaking that encourages actions that reduce the negative consequence of drug use. These policies are why we have safe needle drop-offs and clean needles through community centers, free HIV testing for IV drug users, and no arrests for drug use in hospitals. But this also means being comfortable with those who will still engage in these behaviors. Rather than ridicule or condemn these behaviors or say that Reddit ought to ban these communities, we could support these healthier behaviors as people move towards wanting to recover.
How we hold communities responsible for “better” behaviors is a hot issue right now as we learn more about how social networks moderate online content. Opioid addiction recovery is one example of a behavior that challenges social media platforms. I hope that in the future, we have more research that explores the impacts of these communities so we can have healthier online interactions.
Chancellor, S., Nitzburg, G., Hu, A., Zampieri, F., & De Choudhury, M. (2019, April). Discovering alternative treatments for opioid use recovery using social media. In Proceedings of the 2019 CHI Conference on Human Factors in Computing Systems (p. 124). ACM.
Credit where credit’s due: Thanks to the GVU Comm team for helping me think through how to talk about this paper earlier this year.
