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The complex unfolding of the US opioid epidemic in the last 20 years has beenthe subject of a large body of medical and pharmacological research, and it hassparked a multidisciplinary discussion on how to implement interventions andpolicies to effectively control its impact on public health. This studyleverages Reddit as the primary data source to investigate the opioid crisis.We aimed to find a large cohort of Reddit users interested in discussing theuse of opioids, trace the temporal evolution of their interest, and extensivelycharacterize patterns of the nonmedical consumption of opioids, with a focus onroutes of administration and drug tampering. We used a semiautomaticinformation retrieval algorithm to identify subreddits discussing nonmedicalopioid consumption, finding over 86,000 Reddit users potentially involved infirsthand opioid usage. We developed a methodology based on word embedding toselect alternative colloquial and nonmedical terms referring to opioidsubstances, routes of administration, and drug-tampering methods. We modeledthe preferences of adoption of substances and routes of administration,estimating their prevalence and temporal unfolding, observing relevant trendssuch as the surge in synthetic opioids like fentanyl and an increasing interestin rectal administration. Ultimately, through the evaluation of odds ratiosbased on co-mentions, we measured the strength of association between opioidsubstances, routes of administration, and drug tampering, finding evidence ofunderstudied abusive behaviors like chewing fentanyl patches and dissolvingbuprenorphine sublingually. We believe that our approach may provide a novelperspective for a more comprehensive understanding of nonmedical abuse ofopioids substances and inform the prevention, treatment, and control of thepublic health effects.

Patterns of Routes of Administration and Drug Tampering for Nonmedical Opioid Consumption: Data Mining and Content Analysis of Reddit Discussions