Reddit discussions about buprenorphine associated precipitated withdrawal in the era of fentanyl

Spadaro, Anthony; Sarker, Abeed; Hogg-Bremer, Whitney; Love, Jennifer S.; O’Donnell, Nicole H.; Nelson, Lewis S.; Perrone, Jeanmarie

doi:10.1080/15563650.2022.2032730

Cited by 40 publications

(49 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“… 7 Overall, our findings suggest that it may be challenging for acute care clinicians to pinpoint where patients are on the arc of this withdrawal syndrome. 20 , 21 Better discrimination may allow for alternate buprenorphine induction strategies, which may include low‐dose titration with initial doses ranging between 100 and 500 μg or high‐dose treatment with doses >16 mg. 16 , 22 , 23 , 24 , 25 Of note, all patients in this study received an initial dose ranging from 2 to 8 mg.…”

Section: Discussionmentioning

confidence: 99%

Precipitated opioid withdrawal after buprenorphine administration in patients presenting to the emergency department: A case series

et al. 2023

Self Cite

View full text Add to dashboard Cite

Objectives Buprenorphine is a highly effective medication for the treatment of opioid use disorder, but it can cause precipitated withdrawal (PW) from opioids. Incidence, risk factors, and best approaches to management of PW are not well understood. Our objective was to describe adverse outcomes after buprenorphine administration among emergency department (ED) patients and assess whether they met the criteria for PW. Methods This study is a case series using retrospective chart review in a convenience sample of patients from 3 hospitals in an urban academic health system. This study included patients who were reported by clinicians as potential cases of PW. Relevant clinical data were abstracted from the electronic health record using a structured retrospective chart review instrument. Results A total of 13 cases were included and classified into the following 3 categories: (1) PW after buprenorphine administration consistent with guidelines (n = 5), (2) PW after deviating from guidelines (n = 4), and (3) protracted opioid withdrawal with no increase in Clinical Opiate Withdrawal Scale score (n = 4). A total of 11 patients had urine drug testing positive for fentanyl, and 11 patients received additional doses of buprenorphine for symptom management. Of the patients, 5 had self‐directed hospital discharges, and 6 were ultimately discharged with prescriptions for buprenorphine. Conclusions Cases of adverse outcomes after buprenorphine administration in the ED and hospital meet criteria for PW, although some cases may have represented protracted opioid withdrawal. Further investigation into the incidence, risk factors, management of PW as well as patient perspectives is needed to expand and sustain the use of buprenorphine in EDs and hospitals.

show abstract

Section: Discussionmentioning

confidence: 99%

Precipitated opioid withdrawal after buprenorphine administration in patients presenting to the emergency department: A case series

et al. 2023

Self Cite

View full text Add to dashboard Cite

show abstract

“…Non-medical literature such as blogs and online discussion threads contain anecdotal patient reports of the benefits of “buprenorphine microdosing” and its utility in preventing opioid withdrawal [ 36 , 37 ]. Patients who rely on these platforms may develop unrealistic expectations of non-traditional dosing strategies.…”

Section: Discussionmentioning

confidence: 99%

Factors that distinguish opioid withdrawal during induction with buprenorphine microdosing: a configurational analysis

Adams

Miech

Sobieraj

2022

Addict Sci Clin Pract

View full text Add to dashboard Cite

Background Novel buprenorphine dosing strategies have emerged with an aim to transition patients from opioid agonists to buprenorphine without prerequisite opioid withdrawal. We applied a configurational approach to a subset of data from our earlier systematic review to answer the following question: when patients received a buprenorphine initiation strategy aimed to eliminate prerequisite withdrawal, what factors consistently distinguished patients that experienced withdrawal during the initiation process from patients that did not? Methods From the 24 cases identified by our systematic review, we included cases that were treated using buprenorphine microdosing strategies (oral or transdermal), cases with opioid use disorder, and cases that fully transitioned to buprenorphine without continuing the full opioid agonist. Configurational analysis was used to identify combinations of patient and regimen level factors that uniquely distinguished cases experiencing withdrawal during induction. Result Fourteen cases were included in our analysis, of which 9 experienced opioid withdrawal symptoms. Three factors were involved in explaining both the presence and absence of withdrawal symptoms: history of heroin use, history of methadone use, and duration of overlap between buprenorphine and the full opioid agonist during induction. For the presence of withdrawal symptoms, the addition of a fourth factor “buprenorphine starting dose” resulted in a model with perfect consistency and coverage; for the absence of withdrawal symptoms, the addition of a fourth factor “induction duration” similarly resulted in a model with perfect consistency and 80% coverage. Conclusion Application of configurational methods allowed synthesis of case reports identified through a systematic review.

show abstract

“…Initial subreddits were selected based on study group consensus of subreddit relevance and prior experience using Reddit to evaluate patterns in drug use. 19 From the chosen subreddits, we collected all publicly available retrievable posts via the PRAW Python application programming interface (API) for Reddit. 21 We searched for mentions of 'xylazine' and 'Tranq', as well as lexical variants, from the subreddits using NLP to identify references to xylazine.…”

Section: Qualitative Analysis Of Existing Postsmentioning

confidence: 99%

“…17 It allows subscribers to remain completely anonymous if they choose, and, due to this anonymity, Reddit has become a hub for the open discussion of sensitive or stigmatized topics including drug use. 18,19 Given rising concerns about xylazine we sought to identify a cohort of people who self report exposure to xylazine in the drug supply by using public social media data from Reddit to conduct this study. 19,20 Our objectives were to better understand xylazine use by utilizing social media to survey PWUDs about their experience with xylazine.…”

Section: Introductionmentioning

confidence: 99%

“…18,19 Given rising concerns about xylazine we sought to identify a cohort of people who self report exposure to xylazine in the drug supply by using public social media data from Reddit to conduct this study. 19,20 Our objectives were to better understand xylazine use by utilizing social media to survey PWUDs about their experience with xylazine. Specifically, we sought to answer the following: 1) what are the demographics of Reddit subscribers self-reporting exposure to xylazine?…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Self-reported Xylazine Experiences: A Mixed Methods Study of Reddit Subscribers

Spadaro¹,

O’Connor

Lakamana

et al. 2023

Preprint

Self Cite

View full text Add to dashboard Cite

Objectives: Xylazine is an alpha-2 agonist increasingly prevalent in the illicit drug supply. Our objectives were to curate information about xylazine through social media from People Who Use Drugs (PWUDs). Specifically, we sought to answer the following: 1) what are the demographics of Reddit subscribers reporting exposure to xylazine? 2) is xylazine a desired additive? and 3) what adverse effects of xylazine are PWUDs experiencing? Methods: Natural Language Processing (NLP) was used to identify mentions of "xylazine" from posts by Reddit subscribers who also posted on drug-related subreddits. Posts were qualitatively evaluated for xylazine-related themes. A survey was developed to gather additional information about the Reddit subscribers. This survey was posted on subreddits that were identified by NLP to contain xylazine-related discussions from March 2022 to October 2022. Results: 76 posts mentioning xylazine were extracted via NLP from 765,616 posts by 16,131 Reddit subscribers (January 2018 to August 2021). People on Reddit described xylazine as an unwanted adulterant in their opioid supply. 61 participants completed the survey. Of those that disclosed their location, 25/50 (50%) participants reported locations in the Northeastern United States. The most common eoute of xylazine use was intranasal use (57%). 31/59 (53%) reported experiencing xylazine withdrawal. Frequent adverse events reported were prolonged sedation (81%) and increased skin wounds (43%). Conclusions: Among respondents on these Reddit forums, xylazine appears to be an unwanted adulterant. PWUDs may be experiencing adverse effects such as prolonged sedation and xylazine withdrawal. This appeared to be more common in the Northeast.

show abstract

Reddit discussions about buprenorphine associated precipitated withdrawal in the era of fentanyl

Cited by 40 publications

References 19 publications

Precipitated opioid withdrawal after buprenorphine administration in patients presenting to the emergency department: A case series

Precipitated opioid withdrawal after buprenorphine administration in patients presenting to the emergency department: A case series

Factors that distinguish opioid withdrawal during induction with buprenorphine microdosing: a configurational analysis

Self-reported Xylazine Experiences: A Mixed Methods Study of Reddit Subscribers

Contact Info

Product

Resources

About