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Reddit discussions about buprenorphine associated precipitated withdrawal in the era of fentanyl
Open accessPublished version of a preprint
Abstract
ABSTRACT Background Buprenorphine is an evidence-based treatment for Opioid Use Disorder (OUD). Standard buprenorphine induction requires a period of opioid abstinence to minimize risk of precipitated opioid withdrawal (POW). Our objective was to study the impact of the increasing presence of fentanyl and its analogs in the opioid supply of the United States, on buprenorphine induction and POW, using social media data from Reddit. Methods This is a data-driven, mixed methods study of opioid-related forums, called subreddits, on Reddit to analyze posts related to fentanyl, POW, and buprenorphine induction. The posts were collected from seven subreddits using an application programming interface for Reddit. We applied natural language processing to identify subsets of salient posts relevant to buprenorphine induction, and performed manual, qualitative, thematic analyses of them. Results 267,136 posts were retrieved from seven subreddits. Fentanyl mentions increased from 3 in 2013 to 3870 in 2020, and POW mentions increased from 2 (2012) to 332 (2020). Manual review of 384 POW-mentioning posts and 106 ‘ Bernese method ’ (a microdosing induction strategy) mentioning posts revealed common themes and peoples’ experiences. Specifically, presence of fentanyl caused POWs despite long abstinence durations, and alternative induction via microdosing were frequently recommended in peer-to-peer discussions. Conclusions This study found that increased social media chatter on Reddit about POW correlated with fentanyl mentions. A subset of posts described microdosing as a self-management strategy to avoid POW. Reddit posts suggest that people are utilizing these strategies to initiate buprenorphine due to challenges arising from fentanyl prevalence in the opioid supply. Highlights Increase in mentions of precipitated opioid withdrawal (POW) on Reddit from 2012 to 2021 was closely correlated with the increase in fentanyl mentions. Experiences of precipitated opioid withdrawal (POW) were described by individuals who reported sufficient periods of abstinence by standard buprenorphine induction protocols. People with Opioid Use Disorder (OUD) on Reddit are using and recommending microdosing strategies with buprenorphine to avoid POW. People who used fentanyl report experiencing POW following statistically longer periods of abstinence than people who use heroin.
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In patients with opioid use disorder accustomed to high doses of heroin or fentanyl or who have been maintained on high doses of methadone, buprenorphine can precipitate acute withdrawal, as it is a partial mu opioid receptor agonist.
“In patients with opioid use disorder accustomed to high doses of heroin or fentanyl or who have been maintained on high doses of methadone, buprenorphine can precipitate acute withdrawal, as it is a partial mu opioid receptor agonist 191 .”
From Substance use disorders: a comprehensive update of classification, epidemiology, neurobiology, clinical aspects, treatment and prevention (2023) · cites this paper as [191]
The Background identifies buprenorphine as a partial mu-opioid receptor agonist and explains how starting it before withdrawal can displace residual opioids and cause acute precipitated withdrawal. It discusses heroin and heavy fentanyl use, but does not specifically address patients maintained on high doses of methadone; it also does not establish a high-dose threshold for heroin. (LLM, conf=0.88)
Experimental — accuracy not yet measuredBuprenorphine requires daily dosing, and typical doses range between 8 and 24 mg, with a recommended target dose of 16 mg.
“It requires daily dosing, and typical doses range between 8 and 24 mg, with a recommended target dose of 16 mg 191 .”
From Substance use disorders: a comprehensive update of classification, epidemiology, neurobiology, clinical aspects, treatment and prevention (2023) · cites this paper as [191]
The Results section on Bernese-method microdosing reports initial doses of 0.125–1 mg that increased over several days, not a typical maintenance-dose range. Searches for daily dosing, 8–24 mg, and a recommended 16 mg target found no passage in our copy addressing those claims. (LLM, conf=0.75)
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Metadata
- Authors
- Spadaro, A., Sarker, A., Hogg-Bremer, W., Love, J. S., O’Donnell, N., Nelson, L. S., & Perrone, J.
- Affiliations
- University of Pennsylvania (US)
- Emory University (US)
- Icahn School of Medicine at Mount Sinai (US)
- Rutgers, The State University of New Jersey (US)
- Corresponding author
- Spadaro, Anthony
- ORCID
- Venue
- Clinical Toxicology
- Publisher
- Informa UK Limited
- Published
- 2022-02-04
- Volume
- 60
- Issue
- 6
- Pages
- 694-701
- ISSN
- 0009-9309 (ISSN-L)
- 1556-3650
- 1556-9519
- PMC
- PMC10457147
- OpenAlex
- W4225272835
- Cited by
- 64
- References
- 22
- Citations by year
- 2026: 8 · 2025: 13 · 2024: 16 · 2023: 16 · 2022: 11
- FWCI
- 12.36
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Clinical Toxicology (publishedVersion, cc-by-nc-nd)
- medRxiv (acceptedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion, cc-by-nc-nd)
- Funders
- National Institute on Drug Abuse of the National Institutes of Health
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Keywords
- buprenorphine induction, fentanyl, fentanyl analogs, opioid use disorder, microdosing, Reddit discussions, social media, opioid abstinence, patient experience
- MeSH terms
- Analgesics, Opioid, Buprenorphine, Fentanyl, Humans, Opioid-Related Disorders, Substance Withdrawal Syndrome
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