Online Forums Like Reddit Could Work as Drug Use Early Warning System

Novel Psychoactive Substances, Synthetic Drugs, Designer Drugs, Opioids, Reddit, Online Forums, Drug Use, Adverse Events, Intoxication, Overdose, Death, Early Warning System, Intervention, Social Media, Toxicology, Poisoning

Carfentanil is a synthetic opioid and one of eight novel psychoactive substances selected for the study.

By gisele galoustian | 1/26/2022

“Synthetic” or “designer” drugs known as novel psychoactive substances (NPS), an offshoot of drugs created to mimic the effects of controlled substances, account for an increasing proportion of adverse events such as hospitalizations and death. Due to their increasing potency and unexpected biological effects compared to their predecessors, they continue to present growing challenges for the scientific, medical and interventional communities.

A study by researchers at Florida Atlantic University and the Center for Forensic Science Research & Education, Fredric Rieders Family Foundation, and others, is the first to evaluate the utility of drug use forums as an early indicator of impending NPS intoxications with potentially harmful or lethal outcomes before they happen.

Researchers examined the relationship between online mentions of NPS on Reddit, a social media platform with more than 430 million active users worldwide, and their involvement in toxic exposures or overdoses. They selected eight NPS, all of which have received some level of notoriety due to the prevalence of adverse outcomes and/or death.

The drugs were carfentanil (a synthetic opioid), U-47700 (a synthetic opioid), eutylone (a synthetic stimulant/cathinone), flualprazolam (a new benzodiazepine) N-ethylpentylone (a synthetic stimulant/ cathinone), 5F-MDMB-PICA (a synthetic cannabinoid), isotonitazene (a synthetic opioid), and brorphine (a synthetic opioid). These NPS covered several subclasses and a predetermined time range (2013–2020).

Researchers tallied mentions on Reddit drug forum discussions and assessed toxicology testing results from forensic investigations in the United States. Results of the study, published in print last month in the International Journal of Drug Policy , showed that seven NPS (excluding 5F-MDMB-PICA) appeared in discussions on Reddit prior to their implication in poisonings or intoxications.

Distinct increases and decreases in number of mentions and number of exposures were observed. For most substances (n = 5, 63 percent), a rise in Reddit mentions was soon followed by a corresponding rise in toxicology positivity. Peak positivity for carfentanil and flualprazolam, however, preceded peak Reddit mentions.

“Results from our study confirm that activity on drug use forums in the virtual world can help predict changes in exposures associated with new or re-emerging novel psychoactive substances in the real world, which has the potential to be used as a strategy for inclusion in early warning systems,” said Elan Barenholtz, Ph.D., senior author, an associate professor of psychology and member of the Center for Complex Systems and Brain Sciences within the Charles E. Schmidt College of Science, and a member of the FAU Stiles-Nicholson Brain Institute. “An advanced early warning system should include capabilities to capture a signal that is concurrent with, or even predates, the observed exposures themselves.”

Researchers generated data from comprehensive toxicological analyses performed on biological specimens. Retrospective data-mining efforts were conducted, when possible, to determine true date of drug emergence and positivity prior to addition to toxicology testing scope. The number of Reddit mentions and number of related exposures were aggregated by month and quarter within each year.

“Factors influencing the emergence and detection of novel psychoactive substances are complex, as this broad category of drugs is continually evolving,” said Alex J. Krotulski, Ph.D., corresponding author and associate director at the Center for Forensic Science Research & Education, Fredric Rieders Family Foundation. “We saw striking similarities for most novel psychoactive substances; peaks in online mentions were typically followed, in fairly close succession, by peaks in exposures. With the exception of 5F-MDMB-PICA, online discussion appeared to predict later exposures to a surprisingly high degree.” 

5F-MDMB-PICA, a synthetic cannabinoid, is vastly different from other NPS subclasses. The researchers think that one reason that it behaved differently from the other NPS and was not a predictor for future exposures on Reddit discussions is due to naming complexities. 5F-MDMB-PICA is more commonly known by its street names, “K2” or “Spice.”

Study co-authors are Paul Morris, a Ph.D. student in FAU’s Center for Complex Systems and Brain Sciences; Nicole D. Fitzgerald, a Ph.D., student at the University of Florida; Austin Le, D.D.S., an assistant research scientist at NYU Langone Health and an orthodontic resident at NYU College of Dentistry; Donna M. Papsun, toxicologist, NMS Labs; Barry K. Logan, Ph.D., executive director, Center for Forensic Science Research & Education, and senior vice president, chief scientist, NMS Labs; William E. Hahn, Ph.D., an assistant professor of psychology, FAU Center for Complex Systems and Brain Sciences; Bruce A. Goldberger, Ph.D., University of Florida Health; Linda B. Cottler, Ph.D., M.P.H., University of Florida Health; and Joseph J. Palamar, Ph.D., M.P.H., NYU Langone Health.

The study is part of the National Drug Early Warning System (NDEWS), which is funded by the National Institute of Drug Abuse (NIDA), National Institutes of Health. 

This research was supported by NIDA under award numbers U01DA051126 (PI: Cottler), T32DA035167 (PI: Cottler), and R01DA044207 (PI: Palamar). This work also was supported by the Fredric Rieders Family Foundation.