Comparing Opioid Treatment Barriers: Social Media vs. Literature

Introduction: Medications such as buprenorphine and methadone are effective for treating opioid use disorder (OUD), but many patients face barriers related to treatment and access. We analyzed two sources of data—social media and published literature—to categorize and quantify such barriers. Methods: In this mixed methods study, we analyzed social media (Reddit) posts from three OUD-related forums (subreddits): r/suboxone, r/Methadone, and r/naltrexone. We applied natural language processing to identify posts relevant to treatment barriers, categorized them into insurance- and non-insurance-related, and manually subcategorized them into fine-grained topics. For comparison, we used substance use-, OUD- and barrier-related keywords to identify relevant articles from PubMed published between 2006 and 2022. We searched publications for language expressing fear of barriers, and hesitation or disinterest in medication treatment because of barriers, paying particular attention to the affected population groups described.

presents the breakdown of non-insurance barriers described by Reddit subscribers. 26.2% (22/84) of the posts are related to financial difficulties without any reference to insurance coverage (e.g., “Sad that access is so expensive.”), 47.6% (40/84) were related to stigma (e.g., “I hate that we get the label as bad people or stupid for choosing to be an addict.”), 4.8% (4/84) were attributed to issues with a healthcare provider such as difficulty finding care or regulations (e.g., “What I’d really like to see is less requirements for getting take home medications to start with.”), 3.6% (3/84) were related to poor treatment by either a clinician or pharmacist (e.g., “I am shocked that I got snubbed like this.”), and 1.2% (1/84) were related to the fear of beginning treatment (e.g., “I was interested in a solution but I was too afraid to try it.”). 16.7% (14/84) of the posts fit multiple categories (e.g., “I have felt frustrated with many aspects of being on it such as urinalysis, snarky pharmacists, the cost, and often stigma associated with taking this.”). The ‘financial difficulties’ category was only assigned to posts that specifically mentioned difficulties associated with finances without referring to insurance coverage. It is possible, and even likely, that the financial difficulties described by the subscribers were related to their insurance coverage in some way. Also, in our interpretation, descriptions of poor treatment by a clinician or pharmacist were considered to be external stigma.

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• ¹Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, GA, United States
• ²Department of Biomedical Informatics, School of Medicine, College of Engineering and Applied Sciences, Stony Brook University, Stony Brook, NY, United States
• ³Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
• ⁴Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States
• ⁵Canadian Association of People Who Use Drugs, Dartmouth, NS, Canada
• ⁶Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
• ⁷Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States

Citation: Bremer W, Plaisance K, Walker D, Bonn M, Love JS, Perrone J and Sarker A (2023) Barriers to opioid use disorder treatment: A comparison of self-reported information from social media with barriers found in literature. Front. Public Health. 11:1141093. doi: 10.3389/fpubh.2023.1141093 Received: 10 January 2023; Accepted: 21 March 2023; Published: 20 April 2023.