Buy PainKillers online. Opioid addicts are turning to online forums for advice about quitting. Their conversations have a lot to teach us about drug use and public health.Doug JohnsonUndark October 20, 2019
Ryan Le Blanc got his first dose of opioids at three months old, after surgery for a unilateral cleft palate. Now in his late 20s, the English-as-a-second-language teacher has gone through about 15 more surgeries of varying severity.
With each operation came new painkillers. At 14, while living in New England, Le Blanc started buying and using illegal opioids for fun. By 16, he was injecting heroin, a habit that he carried from high school through college graduation.
As a teenager, Le Blanc came across Bluelight.org, a drug forum now more than 20 years old. He read post after post—innumerable lines of text and images about the substances he was taking, how to take them safely, and how to quit.
Today these threads aren’t just of interest to the site’s users. As the opioid epidemic worsens, claiming about 130 lives a day in 2018 in the United States alone, a cadre of researchers is looking for solutions to addiction and overdoses in the sprawl of drug forums. The researchers say that drug forums on the dark web—a catchall term for internet hubs that are often encrypted or unavailable through regular search engines—along with more mainstream counterparts such as Bluelight and drug-related threads on the website Reddit, might be medical or research tools in their own right.
For instance, in research published this spring, Stevie Chancellor, a postdoctoral fellow in computer science at Northwestern University, used computational linguistics and machine learning—a subset of artificial intelligence—to find out how forum-goers on Reddit attempt to get sober. “We wanted to unearth the things the doctors didn’t even know about,” Chancellor says.
Chancellor and other academics, as well as advocates of harm reduction (a philosophy that seeks to minimize the negative effects of drug use), believe that drug forums can also provide insight into a secretive subset of society. The forums could also provide a route to reach users with potentially life-saving information about drugs.
Therefore, Working with these communities has presented challenges. Some researchers in this relatively new field have trouble collecting data, particularly when law enforcement busts an illicit marketplace. But both researchers and people who use the forums to quit drugs believe that there’s value in the chatter.
In addition, the Chancellor’s machine-learning study, she and her colleagues also built a computer program to recognize distinct words and phrases in nearly 1.5 million posts on 63 subreddits where people discussed opioid-addiction recovery. The program found that many Redditors who were trying to quit heroin and fentanyl, a potent synthetic opioid, were using other drugs to do it.
More so, Chancellor was surprised, but the approach is common on the forums, though sometimes discouraged by moderators and other users: People may use alcohol, cannabis, or however heavier drugs to quell withdrawal symptoms. Le Blanc was no exception. At 22, he tried to quit opioids using other drugs, although three years later, after a family intervention, he entered a formal methadone program, which uses a lower-grade narcotic to wean users off harder drugs. As of a few months ago, he quit using maintenance drugs, working toward true sobriety to be free of opioids altogether.
Furthermore, Chancellor’s team found other examples of drugs that Redditors leaned on to quit opioids: benzodiazepines such as Valium or Xanax; the anti-diarrheal drug Imodium; ibogaine, a psychoactive plant substance with alleged anti-addiction properties; and kratom, a powdered preparation of a plant that, taken in large enough doses, can cause opioidlike sensations. Others used relatively weak opioids such as codeine to step back from heroin or fentanyl. And the forum-goers also developed elaborate dosing regimens to get through a workday relatively unscathed by withdrawal.
Any benefit from self-administered treatments would need to be verified or tweaked by medical professionals, Chancellor says. Mixing some of these drugs can be deadly. Even Imodium, when taken at recreational doses—more than 15 times the therapeutic dose—can cause severe heart problems.
The fact that people are using such an array of drugs to quit opioids is a clinical and medical blind spot, Chancellor says: “I think there’s a lot of potential for communities to back-inform what could be productive investigations for medical researchers.”