Which Social Media Platforms Provide the Most Informative Data for Monitoring the Opioid Crisis?

Background and Aims Social media can provide real-time insight into trends in substance use, addiction, and recovery. Prior studies have leveraged data from platforms such as Reddit and X (formerly Twitter), but evolving policies around data access have threatened their usability in opioid overdose surveillance systems. Here, we evaluate the potential of a broad set of platforms to detect emerging trends in the opioid crisis. Design We identified 72 online platforms with a substantial global user base or prior citations in opioid-related research. We evaluated each platform's fit with our definition of social media, size of North American user base, and volume of opioid-related discourse. We created a shortlist of 11 platforms that met our criteria. We documented basic characteristics, volume and nature of opioid discussion, official policies regulating drug-related discussion, and data accessibility of shortlisted platforms. Setting USA and Canada. Measurements We quantified the volume of opioid discussion by number of platform-specific Google search hits for opioid terms. We captured informal language by including slang generated using a large language model. We report the number of opioid-related hits and proportion of opioid-related hits to hits for common nouns. Findings We found that TikTok, YouTube, and Facebook have the most potential for use in opioid-related surveillance. TikTok and Facebook have the highest relative amount of drug-related discussions. Language on TikTok was predominantly informal. Many platforms offer data access tools for research, but changing company policies and user norms create instability. The demographics of users varies substantially across platforms. Conclusions Social media data sources hold promise for detecting trends in opioid use, but researchers must consider the utility, accessibility, and stability of data on each platform. A strategy mixing several platforms may be required to cover all demographics suffering in the epidemic.