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. 2021 Dec:98:103393.
doi: 10.1016/j.drugpo.2021.103393. Epub 2021 Aug 5.

Online surveillance of novel psychoactive substances (NPS): Monitoring Reddit discussions as a predictor of increased NPS-related exposures

Elan Barenholtz  1 , Alex J Krotulski  2 , Paul Morris  1 , Nicole D Fitzgerald  3 , Austin Le  4 , Donna M Papsun  5 , Barry K Logan  6 , William E Hahn  1 , Bruce A Goldberger  7 , Linda B Cottler  3 , Joseph J Palamar  4
Affiliations

Online surveillance of novel psychoactive substances (NPS): Monitoring Reddit discussions as a predictor of increased NPS-related exposures

Elan Barenholtz et al. Int J Drug Policy. 2021 Dec.

Abstract

Background: Novel psychoactive substances (NPS) present continuous and growing challenges for the scientific, medical, and interventional communities as emerging substances on recreational drug markets change national and international drug landscapes. NPS account for an increasing proportion of adverse events, hospitalizations, and deaths due to increasing potency and unanticipated biological effects compared to predecessors. This study evaluated the utility of drug use forums as an early indicator or predictor of impending intoxications with potentially harmful or lethal outcomes prior to their occurrences.

Methods: Eight NPS were selected for evaluation to assess the relationship between online mentions of drugs and their involvement in toxic exposures or overdoses. Mentions on Reddit drug forum discussions were tallied and toxicology testing results from forensic investigations in the US were assessed. The selected NPS covered several subclasses and a predetermined time range (2013-2020). They included carfentanil, U-47700, eutylone, flualprazolam, N-ethylpentylone, 5F-MDMB-PICA, isotonitazene, and brorphine.

Results: 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%), 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.

Conclusions: This study demonstrated the utility of social media sites, such as Reddit, as a predictor for future trends in NPS-related exposures. These results provide confirmation that activity on drug use forums in the virtual world can help predict changes in exposures associated with new or re-emerging NPS in the real world. The results warrant further evaluation as a strategy for inclusion in early warning systems.

Keywords: Drug exposures; Monitoring; Novel psychoactive substances; Reddit; Surveillance; Toxicology.

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Conflict of interest statement

Declarations of Interest Dr. Palamar has consulted for Alkermes. The authors have no other potential conflicts to declare. The National Drug Early Warning System (NDEWS) is funded by the National Institute on Drug Abuse (NIDA) through the University of Florida (U01DA051126, PI: Cottler).

Figures

Figure 1:
Figure 1:
Reddit post mentioning isotonitazene and soliciting feedback (from January 2019).
Figure 2:
Figure 2:
Reddit traffic by country based on available statistics (as of December 2020). The “other” category includes the combined traffic from many countries (not reported individually).
Figure 3:
Figure 3:
Geographical distribution of toxicology sample origins for cases involving a) carfentanil, b) U-47700, c) eutylone, d) flualprazolam, e) N-ethylpentylone, f) 5F-MDMB-PICA, g) isotonitazene, and h) brorphine, as well as i) a combined map for all cases included in this study demonstrating national landscape.
Figure 4:
Figure 4:
Plot of Reddit mentions and exposure cases (x-axis) over time (y-axis), including statistical modeling, for a) carfentanil, b) U-47700, c) eutylone, d) flualprazolam, e) N-ethylpentylone, f) 5F-MDMB-PICA, g) isotonitazene, and h) brorphine.
See this image and copyright information in PMC

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