Monitoring the opioid epidemic via social media discussions

Opioid-involved overdose deaths have risen significantly since 1999 with over 80,000 deaths annually since 2021, primarily driven by synthetic opioids, like fentanyl. Responding to the rapidly changing opioid crisis requires reliable and timely information. One possible source of such data is the social media platforms with billions of user-generated posts, a fraction of which are about drug use. We therefore assessed the utility of Reddit data for surveillance of the opioid epidemic, covering prescription, heroin, and synthetic drugs (as of September 2024, up-to-date Reddit data was still accessible on the open web). Specifically, we built a natural language processing pipeline to identify opioid-related comments and created a cohort of 1,689,039 geo-located Reddit users, each assigned to a state. We followed these users from 2010 through 2022, measured their opioid-related posting activity over time, and compared this posting activity against CDC overdose and National Forensic Laboratory Information System (NFLIS) drug report rates. To simulate the real-world prediction of synthetic drug overdose rates, we added near real-time Reddit data to a model relying on CDC mortality data with a typical 6-month reporting lag and found that Reddit data significantly improved prediction accuracy. We observed drastic, largely unpredictable changes in both Reddit and overdose patterns during the COVID-19 pandemic. Reddit discussions covered a wide variety of drug types that are currently missed by official reporting. This work suggests that social media can help identify and monitor known and emerging drug epidemics and that this data is a public health “common good” to which researchers should continue to have access.