Approximately 16 million Americans used a prescription drug for nonmedical reasons in 2010, according to the National Institute on Drug Abuse (NIDA). Many of those drugs were painkillers, or pharmaceutical opiates such as hydrocodone (Vicodin®) and oxycodone (Percocet®, OxyContin®).
The nonmedical use of prescription painkillers is one of the fastest growing forms of drug abuse in the United States. Since 2002, buprenorphine (Suboxone® and Subutex®) has been prescribed to treat opiate addiction in substance abuse treatment programs, as well as by qualified private physicians. However, buprenorphine is now emerging as an abused substance.
To understand attitudes and behaviors related to the nonmedical use of buprenorphine, researchers are studying the illicit use of the drug through a NIDA-funded study, which is a collaborative effort between the Center for Interventions, Treatment & Addictions Research (CITAR) at the Boonshoft School of Medicine and the Ohio Center of Excellence in Knowledge-enabled Computing (Kno.e.sis) at Wright State University.
Raminta Daniulaityte, Ph.D., a research associate professor in the Department of Community Health (CITAR), and Amit Sheth, Ph.D., professor of computer science and engineering, LexisNexis Ohio Eminent Scholar and Kno.e.sis Center director, are principle investigators of the study.
By gleaning information from web forums of drug users, who share their experiences and post unsolicited, unfiltered and anonymous questions, comments and opinions about various drugs, WSU researchers are learning about the trends in knowledge, attitudes and behaviors related to the nonmedical use of buprenorphine and other illicit opiates.
Daniulaityte explained that little information about the illicit use of buprenorphine exists. “While more buprenorphine is being prescribed to treat opiate addiction, more of it is being diverted,” she said. “We want to learn more about the population who is using it for nonmedical purposes and how they use it.”
CITAR is working with Kno.e.sis to extract information from various web forums. Kno.e.sis developed an application, PREDOSE (Prescription Drug abuse Online-Surveillance and Epidemiology), that helps researchers access, retrieve and analyze user-generated content about illicit drug use on various web forums. The application currently contains more than one million posts.
The purpose of this collaborative research is to eventually achieve a high level of automation in information extraction by applying Semantic Web, a technology that allow machines to understand the meaning of information, and other cutting-edge information processing techniques. “However, automatic information extraction is a very challenging task because the web forum posts do not always follow grammatical rules,” Sheth said. “The posts may contain many abbreviations and slang terms.”
Daniulaityte explained that people share their lay knowledge about drugs in these web forums. “A lot of people go there looking for information,” she said. “There is an increase in discussions about buprenorphine. It appears that a lot of people are using it to self-treat opiate withdrawal symptoms.”
Other indicators, such as the increase in buprenorphine-related emergency department visits, also confirm that nonmedical use of buprenorphine is increasing.
Her team also is trying to obtain geographic data to determine where buprenorphine use is prevalent. However, people using the web forums do not give their true location. They give fake locations or use slang terms to refer to a location. “Geographic indicators are very challenging,” she said. “That requires much more work than what we expected.”
An unexpected finding has been the extra-medical use of loperamide (Imodium®), a non-prescription medication used to treat diarrhea. Illicit drug users have been posting on various web forums that they use loperamide to self-treat a wide range of opioid withdrawal symptoms. “That was surprising,” Daniulaityte said. “Nobody really knew that was happening.”
Daniulaityte cautions against relying only on the web but sees its potential as a leading data source in identifying emerging drug-use practices.
“The web can be a very useful supplement,” she said. “It can help researchers identify trends much earlier.”