Effects of Substance Use, Recovery, and Non-Drug-Related Online Community Participation on the Risk of a Use Episode During Remission From Opioid Use Disorder: Longitudinal Observational Study.

BACKGROUND: Opioid addiction is currently one of the most pressing public health issues. Despite several treatment options for opioid addiction, the recurrence of use episodes during remission remains high. Research indicates that meaningful membership in various social groups underpins the successful transition from addiction to long-term remission. However, much of the current literature focuses on online peer-support groups for individuals in remission from substance use, sometimes also called recovery groups, a term we will use in line with the terminology used by the online community we studied. In contrast, online group memberships that promote substance use and groups that are unrelated to substance use and remission (non-drug-related groups) are rarely studied. OBJECTIVE: This study aims to understand whether engagement with a variety of Reddit subforums (subreddits) provides those in remission from opioid use disorder (OUD) with social capital, thereby reducing their risk of a use episode over several years. More specifically, it aims to examine the different effects of engagement with substance use, recovery, and non-drug-related subreddits. METHODS: A data set of 457 individuals in remission from OUD who posted their remission start date on Reddit was collected, of whom 219 (47.9%) indicated at least one use episode during the remission period. Using a Cox proportional hazards model, the effects of the number of non-drug-related, recovery, and substance use subreddits an individual had engaged with on the risk of a use episode were tested. Group engagement was assessed both in terms of the absolute number of subreddits and as a proportion of the total number of subreddits in which an individual had posted. RESULTS: Engagement with a larger number of non-drug-related online communities reduced the likelihood of a use episode irrespective of the number of posts and comments made in these forums. This was true for both the absolute number of non-drug-related communities (P<.001) and the proportion of communities with which a person engaged (P<.001). The findings were less conclusive for recovery support and substance use groups; although participating in more recovery support subreddits reduced the risk of a use episode (P<.001), being part of a higher proportion of recovery support groups relative to other subreddits increased the risk (P=.01). A higher proportion of substance use subreddits marginally increased the risk of a use episode (P=.06); however, the absolute number of substance use subreddits significantly reduced the risk of a use episode (P=.002). CONCLUSIONS: Our work indicates that even minimal regular engagement with several non-drug-related online forums may provide those in remission from OUD with an opportunity to grow their social capital and reduce the risk of a use episode over several years.

Navigating intersecting public health crises: a qualitative study of people with opioid use disorders' experiences during the COVID-19 pandemic.

BACKGROUND: The decades-long opioid epidemic and the more recent COVID-19 pandemic are two interacting events with significant public health impacts for people with opioid use disorder (OUD). Most published studies regarding the intersection of these two public health crises have focused on community, state, or national trends using pre-existing data. There is a need for complementary qualitative research aimed at identifying how people with opioid use disorder (OUD) are understanding, experiencing, and navigating this unprecedented time. The current study examines understandings and experiences of people with OUD while they have navigated these crises. METHODS: The study was guided by a pragmatic lens. We conducted brief semi-structured qualitative interviews with 25 individuals in Chicago, the majority of which had received methadone treatment during the pandemic. Thematic inductive analysis was guided by primary interview questions. RESULTS: The sample represents a high-risk group, being composed mostly of older non-Hispanic African American males and having considerable socioeconomic barriers. Themes demonstrate how individuals are keeping safe despite limited knowledge of COVID-19, how the pandemic has increased treatment motivation for some, how adaptations impacted treatment and recovery supports, how the availability social support had been reduced, and difficulties individuals had keeping or obtaining financial support. CONCLUSIONS: The findings can be useful for informing future public health response to ensure appropriate treatment access and supports are available. In particular are the need for treatment providers to ensure people with OUD receive appropriate and understandable health crisis-related information and ensuring funds are appropriately allocated to address mental health impacts of social isolation. Finally, there is a need for appropriate financial and infrastructure supports to ensure health and treatment access disparities are not exacerbated for those in greatest need.

Recovering from substance use disorders during the early months of the COVID-19 pandemic: A mixed-methods longitudinal study of women in Kansas City.

AIMS: During the early months of the U.S. COVID-19 outbreak, women suffered disproportionate burdens of pandemic-related psychological and economic distress. We aimed to describe the experiences of women in substance use disorder (SUD) recovery programs by (1) exploring the pandemic's impact on their lives, sobriety, and recovery capital and (2) tracking COVID-19 perceptions and preventative behaviors. METHODS: We conducted monthly semistructured interviews with women in residential and outpatient SUD recovery programs in Kansas City in April, May, and June 2020. Participants described the pandemic's impact on their life and sobriety and completed survey items on factors related to COVID-19 preventative behaviors. We interpreted qualitative themes longitudinally alongside quantitative data. RESULTS: In 64 interviews, participants (n = 24) described reduced access to recovery capital, or resources that support sobriety, such as social relationships, housing, employment, and health care. Most experienced negative impacts on their lives and feelings of stability in March and April but maintained sobriety. Four women described relapse, all attributed to pandemic stressors. Participants described relief related to societal re-opening in May and June, and increased engagement with their communities, despite rising infection rates. CONCLUSIONS: For women recovering from SUDs during COVID-19, securing recovery capital often meant assuming greater COVID-19 risk. As substance use appeared to have increased during the pandemic and COVID-19 transmission continues, public health planning must prioritize adequate and safe access to recovery capital and timely distribution of vaccines to people struggling with SUDs.