Frequently asked questions about dabbing concentrates in online cannabis community discussion forums

A qualitative content analysis of cannabis-related discussions on Reddit during the COVID-19 pandemic

Social media has become an increasingly important way to seek and share experiences, support, knowledge, and advice during the COVID-19 pandemic. Reddit, a pseudonymous social media platform, was one way that young people interacted during the pandemic. Our study goals were two-fold: (1) to categorize information sought and provided by users of r/saplings, a subreddit devoted to cannabis use and is often used by young people, and (2) to examine if conversations changed during the COVID-19 pandemic. We extracted 213 randomly selected posts and 2,546 related comments across four time periods (before the pandemic, during the first wave, summer, and next fall). We assessed the volume of posts and comments throughout our study period and conducted a qualitative content analysis. Quantitatively, the findings demonstrated an increase in the number of posts and comments throughout the study period. Given the substantial growth in subreddit activity throughout our study period, Reddit may play an increasingly important role in youth socialization related to cannabis. From the content analysis, we identified three major themes: how to acquire cannabis, how to use cannabis, and associated consequences. Reddit-users prioritized certain content in their posts at different stages of the pandemic. 'Places to acquire' and 'future use' were most common at the beginning of the pandemic, while the theme of 'consequences' and the topic of 'tolerance' became more prominent during the summer months. The comments to these posts were generally thorough and responsive to the post. Nearly all the information came from opinions or personal experiences. Firstly, our findings suggest that young people viewed Reddit as a viable outlet for conversations about cannabis. Secondly, due to the nature of the peer comments and lack of verifiable information being exchanged, misinformation may still circulate and inadvertently worsen the efforts to reduce cannabis-related harm. Interventions that provide understandable and accurate cannabis-related information in accessible formats may increase young people's ability to access and practice harm reduction.

The U.S. hemp-derived cannabinoid industry and the potential of self-regulation: Using social media to assess an evolving health risk

BACKGROUND

Facing statewide bans and increasing oversight in the U.S., representatives from the hemp-derived cannabinoid industry, product advocates, and consumers have been discussing self-policing and self-regulation. Prominent examples of these discussions are found online in Reddit groups.

METHODS

We conducted a qualitative thematic analysis of Reddit posts between September 2020 to August 2022, focusing on the conversations surrounding regulation and consumer safety. Approximately 3800 posts were collected and subject to initial analysis. Thematic analysis was guided by literature on self-regulation and consumer health, from the anthropology of pharmaceuticals and the commercial determinants of health.

RESULTS

The hemp-derived cannabinoid community is discussing self-regulation, shared standards, and transparency. Self-regulation is desired by many, in hopes to stave off prohibition or restrictive government regulation and simultaneously protect consumer health. However, there is little agreement as to what these standards should be, who should oversee them, or how basic concepts should be defined. Subreddit moderators note the ease at which unlicensed or untested products can enter retail store shelves or the informal market, thereby putting health at risk. Given the lack of collective agreement, the absence of state and federal oversight, and the possibilities for consumer deception, consumer frustration and confusion are rampant. With limited access to trustworthy and verifiable information about product safety, purchasers ultimately resort to experimenting on their own bodies to assess risks and benefits.

CONCLUSIONS

Reddit posts reflect the multiple existing tensions in the evolving industry between a genuine appeal among some for workable and consistent industry standards that could protect consumer health, a distrust of regulatory scrutiny from state or federal government, and a desire by others to maintain current profits within the existing unrestrictive free market. Our findings emphasize the urgency of developing coherent, collective, agreed upon policies structured by objective, transparent, scientifically informed regulation in order to develop a safe supply of cannabinoid products and protect consumer health.

COVID-19-Related Changes to Drug-Selling Networks and Their Effects on People Who Use Illicit Opioids

OBJECTIVE

The COVID-19 pandemic has significantly affected people's ability to buy, sell, and obtain items that they use in their daily lives. It may have had a particularly negative effect on the ability of people who use illicit opioids to obtain them because the networks they relied on are illicit and not part of the formal economy. Our objective in this research was to examine if, and how, disruptions related to COVID-19 of illicit opioid markets have affected people who use illicit opioids.

METHOD

We collected 300 posts--including replies to posts--related to the intersection of COVID-19 and opioid use from Reddit.com, a forum that has several discussion threads (i.e., subreddits) dedicated to opioids. We then coded posts from the two most popular opioid subreddits during the early pandemic period (March 5, 2020-May 13, 2020) using an inductive/deductive approach.

RESULTS

We found two themes related to active opioid use during the early pandemic: (a) changes in drug supply and difficulty obtaining opioids, and (b) buying less-trustworthy drugs from lesser-known sources.

CONCLUSIONS

Our findings suggest that COVID-19 has created market conditions that place people who use opioids at risk of adverse outcomes, such as fatal overdose.

Using Social Media Data to Investigate Public Perceptions of Cannabis as a Medicine: Narrative Review

BACKGROUND

The use and acceptance of medicinal cannabis is on the rise across the globe. To support the interests of public health, evidence relating to its use, effects, and safety is required to match this community demand. Web-based user-generated data are often used by researchers and public health organizations for the investigation of consumer perceptions, market forces, population behaviors, and for pharmacoepidemiology.

OBJECTIVE

In this review, we aimed to summarize the findings of studies that have used user-generated text as a data source to study medicinal cannabis or the use of cannabis as medicine. Our objectives were to categorize the insights provided by social media research on cannabis as medicine and describe the role of social media for consumers using medicinal cannabis.

METHODS

The inclusion criteria for this review were primary research studies and reviews that reported on the analysis of web-based user-generated content on cannabis as medicine. The MEDLINE, Scopus, Web of Science, and Embase databases were searched from January 1974 to April 2022.

RESULTS

We examined 42 studies published in English and found that consumers value their ability to exchange experiences on the web and tend to rely on web-based information sources. Cannabis discussions have portrayed the substance as a safe and natural medicine to help with many health conditions including cancer, sleep disorders, chronic pain, opioid use disorders, headaches, asthma, bowel disease, anxiety, depression, and posttraumatic stress disorder. These discussions provide a rich resource for researchers to investigate medicinal cannabis-related consumer sentiment and experiences, including the opportunity to monitor cannabis effects and adverse events, given the anecdotal and often biased nature of the information is properly accounted for.

CONCLUSIONS

The extensive web-based presence of the cannabis industry coupled with the conversational nature of social media discourse results in rich but potentially biased information that is often not well-supported by scientific evidence. This review summarizes what social media is saying about the medicinal use of cannabis and discusses the challenges faced by health governance agencies and professionals to make use of web-based resources to both learn from medicinal cannabis users and provide factual, timely, and reliable evidence-based health information to consumers.

Social media discourse and internet search queries on cannabis as a medicine: A systematic scoping review

The use of cannabis for medicinal purposes has increased globally over the past decade since patient access to medicinal cannabis has been legislated across jurisdictions in Europe, the United Kingdom, the United States, Canada, and Australia. Yet, evidence relating to the effect of medical cannabis on the management of symptoms for a suite of conditions is only just emerging. Although there is considerable engagement from many stakeholders to add to the evidence base through randomized controlled trials, many gaps in the literature remain. Data from real-world and patient reported sources can provide opportunities to address this evidence deficit. This real-world data can be captured from a variety of sources such as found in routinely collected health care and health services records that include but are not limited to patient generated data from medical, administrative and claims data, patient reported data from surveys, wearable trackers, patient registries, and social media. In this systematic scoping review, we seek to understand the utility of online user generated text into the use of cannabis as a medicine. In this scoping review, we aimed to systematically search published literature to examine the extent, range, and nature of research that utilises user-generated content to examine to cannabis as a medicine. The objective of this methodological review is to synthesise primary research that uses social media discourse and internet search engine queries to answer the following questions: (i) In what way, is online user-generated text used as a data source in the investigation of cannabis as a medicine? (ii) What are the aims, data sources, methods, and research themes of studies using online user-generated text to discuss the medicinal use of cannabis. We conducted a manual search of primary research studies which used online user-generated text as a data source using the MEDLINE, Embase, Web of Science, and Scopus databases in October 2022. Editorials, letters, commentaries, surveys, protocols, and book chapters were excluded from the review. Forty-two studies were included in this review, twenty-two studies used manually labelled data, four studies used existing meta-data (Google trends/geo-location data), two studies used data that was manually coded using crowdsourcing services, and two used automated coding supplied by a social media analytics company, fifteen used computational methods for annotating data. Our review reflects a growing interest in the use of user-generated content for public health surveillance. It also demonstrates the need for the development of a systematic approach for evaluating the quality of social media studies and highlights the utility of automatic processing and computational methods (machine learning technologies) for large social media datasets. This systematic scoping review has shown that user-generated content as a data source for studying cannabis as a medicine provides another means to understand how cannabis is perceived and used in the community. As such, it provides another potential 'tool' with which to engage in pharmacovigilance of, not only cannabis as a medicine, but also other novel therapeutics as they enter the market.

The quality of health information provided on web sites selling cannabis to consumers in Canada is poor

BACKGROUND

Cannabis is used by millions of people for both medical and recreational purposes, and this use is even greater in jurisdictions where it is legalized, such as Canada. Online cannabis vendors have gained popularity for purchasing cannabis due to easy access and convenience to consumers. The objective of this study was to evaluate the quality of health information provided by web sites of cannabis vendors selling products to Canadian consumers and to further identify trends in the information provided.

METHODS

Six different searches were conducted on Google.ca, and the first 40 webpages of each search were screened for eligibility. A total of 33 unique web sites of cannabis vendors selling products to Canadian consumers were identified and included. The DISCERN instrument, which consists of 16 questions divided into three sections, was used to evaluate the quality of cannabis-related health information on these web sites.

RESULTS

Across the 33 web sites, the average of the summed DISCERN scores was 36.83 (SD = 9.73) out of 75, and the mean score for the overall quality of the publication (DISCERN question 16) was 2.41 (SD = 0.71) out of 5. Many of these web sites failed to discuss uncertainties in research evidence on cannabis, the impact of cannabis use on quality of life, alternatives to cannabis use, risks associated with cannabis use, and lacked references to support claims on effects and benefits of use.

CONCLUSION

Our findings indicate that the quality of cannabis-related health information provided by online vendors is poor. Healthcare providers should be aware that patients may use these web sites as primary sources of information and appropriately caution patients while directing them to high-quality sources. Future research should serve to replicate this study in other jurisdictions and assess the accuracy of information provided by online cannabis vendors, as this was outside the scope of the DISCERN instrument.

Becoming a nitrous oxide user on social media: Learning to maximise pleasures and minimise harms

BACKGROUND

In his classic work 'Becoming a marihuana user', Howard Becker (1953) showed how drug use learning occurred in social interactions and settings, which in turn shape drug use. Today, social media offers people opportunities to learn about drugs without physical proximity. In this paper, we identify nitrous oxide (N₂O) users' key concerns about how to maximise pleasures and minimise harms, as expressed on the social media platform Reddit. In doing so, we consider what learning about N₂O online might mean for the provision of drug education in an era of internet technology.

METHOD

Data are drawn from a Reddit page (subreddit) dedicated to N₂O use. We undertook thematic analysis of 655 threads contributed in late-2020. The subreddit is conceptualised as an internet-mediated social world that constitutes drug user knowledges, practices and identities, rather than simply reflecting them.

RESULTS

Our analysis uncovers practices not previously been reported in academic literature or health information on N₂O, such as breathing techniques to maximise the effects and use of filters to reduce exposure to oil residue. While education resources often describe effects as 'mild', users recounted intense pleasures including euphoria, anaesthesia, sensory distortion, hallucination and epiphanies, especially when N₂O was used with other drugs. Subreddit members were deeply concerned to minimise the risk of harms. Yet official health advice regarding N₂O was not referenced, some misinterpretation of scientific literature was apparent and drug treatment was almost never suggested when people recounted harms.

CONCLUSION

In contrast to official health resources, the subreddit offers members practical advice on harm reduction. It provides opportunities for users of N₂O to position themselves as playful, informed and caring curators of drug use pleasures. We highlight the need for those formulating drug education to engage with the knowledge, practices and identities that emerge within internet-mediated social worlds.

COVID-19 Pandemic Impact on Substance Misuse: A Social Media Listening, Mixed Method Analysis

The restrictive measures adopted during the COVID-19 pandemic modified some previously consolidated drug use patterns. A focus on social networks allowed drug users to discuss, share opinions and provide advice during a worldwide emergency context. In order to explore COVID-19-related implications on drug trends/behaviour and on most popular psychotropic substances debated, the focus here was on the constantly updated, very popular, Reddit social platform’s posts and comments. A quantitative and qualitative analysis of r/Drugs and related subreddits, using a social media listening netnographic approach, was carried out. The post/comments analysed covered the time-frame December 2019–May 2020. Between December 2019 and May 2020, the number of whole r/Drugs subreddit members increased from 619,563 to 676,581 members, respectively, thus increasing by 9.2% by the end of the data collection. Both the top-level r/Drugs subreddit and 92 related subreddits were quantitatively analysed, with posts/comments related to 12 drug categories. The drugs most frequently commented on included cannabinoids, psychedelics, opiates/opioids, alcohol, stimulants and prescribed medications. The qualitative analysis was carried out focussing on four subreddits, relating to some 1685 posts and 3263 comments. Four main themes of discussion (e.g., lockdown-associated immunity and drug intake issues; drug-related behaviour/after-quarantine plans’ issues; lockdown-related psychopathological issues; and peer-to-peer advice at the time of COVID-19) and four categories of Redditors (e.g., those continuing the use of drugs despite the pandemic; the “couch epidemiologists”; the conspirationists/pseudo-science influencers; and the recovery-focused users) were tentatively identified here. A mixed-methods, social network-based analysis provided a range of valuable information on Redditors’ drug use/behaviour during the first phase of the COVID-19 pandemic. Further studies should be carried out focusing on other social networks as well as later phases of the pandemic.

Comparison of Water Pipes vs Other Modes of Cannabis Consumption and Subsequent Illicit Drug Use in a Longitudinal Cohort of Young Swiss Men

IMPORTANCE

There are concerns that the use of water pipes to consume cannabis is associated with increased risks of engaging in more addictive behaviors.

OBJECTIVE

To examine whether consuming cannabis with a water pipe was associated with later consumption of other illicit drugs compared with not using a water pipe.

DESIGN, SETTING, AND PARTICIPANTS

The Cohort Study on Substance Use Risk Factors (C-SURF) was a population-based study, recruiting 5987 Swiss men aged 18 to 25 years from 3 of 6 Swiss Armed Forces recruitment centers (response rate: 79.2%). The baseline assessment (t0) was done from 2010 to 2012, first follow-up (t1) from 2012 to 2014, and second follow-up (t2) from 2016 to 2018. Our sample included men who participated in both t0 and t2 assessments and used cannabis but no other illicit drugs at t0. Data analysis was performed from July 2020 to January 2021.

EXPOSURES

Cannabis use frequency and route of administration from self-administered questionnaires completed at t0 and t2.

MAIN OUTCOMES AND MEASURES

Outcome measures were initiation of illicit drug use and cannabis use disorder, identified by the Cannabis Use Disorder Identification Test. To examine whether water pipe use at t0 was associated with illicit drug use at t2, multivariable logistic regression analysis was performed.

RESULTS

Among 1108 Swiss male cannabis users who did not use other illicit drugs at t0, the mean (SD) age was 20 (1.2) years, 617 (55.7%) were from Switzerland's French-speaking region, and 343 (30%) used water pipes to consume cannabis. Water pipe users at t0 were more likely to use other illicit drugs at t2 compared with water pipe nonusers (adjusted odds ratio [aOR], 1.54; 95% CI, 1.10-2.16). The odds of using middle-stage drugs (including stimulants, hallucinogens, and inhaled drugs) at t2 were increased for water pipe users (aOR, 1.61; 95% CI, 1.13-2.29). Water pipe use at t0 was not associated with cannabis use disorder at t2 after adjusting for cannabis use frequency.

CONCLUSIONS AND RELEVANCE

This cohort study's results suggest that, among Swiss young men, water pipe use is associated with other illicit drug use later in life, particularly middle-stage illicit drugs. Preventive programs must focus on the potential of later harm to cannabis users who use water pipes but have not yet started taking other illicit drugs.

"How will I get my next week's script?" Reactions of Reddit opioid forum users to changes in treatment access in the early months of the coronavirus pandemic

BACKGROUND

The COVID-19 pandemic poses significant challenges to people with opioid use disorder (OUD). As localities enforce lockdowns and pass emergency OUD treatment regulations, questions arise about how these changes will affect access and retention in care. In this study, we explore the influence of COVID-19 on access to, experiences with, and motivations for OUD treatment through a qualitative analysis of public discussion forums on Reddit.

METHODS

We collected data from Reddit, a free and international online platform dedicated to public discussions and user-generated content. We extracted 1000 of the most recent posts uploaded between March 5th and May 13th, 2020 from each of the two most popular opioid subreddits "r/Opiates" and "r/OpiatesRecovery" (total 2000). We reviewed posts for relevance to COVID-19 and opioid use and coded content using a hybrid inductive-deductive approach. Thematic analysis identified common themes related to study questions of interest.

RESULTS

Of 2000 posts reviewed, 300 (15%) discussed topics related to the intersection of opioid use and COVID-19. Five major themes related to OUD treatment were identified: Concern about closure of OUD treatment services; transition to telehealth and virtual care; methadone treatment requirements and increased exposure to COVID-19; reactions to changing regulations on medications for OUD; and influences of the pandemic on treatment motivation and progress.

CONCLUSION

In the face of unprecedented challenges due to COVID-19, reactions of Reddit opioid forum users ranged from increased distress in accessing and sustaining treatment, to encouragement surrounding new modes of treatment and opportunities to engage in care. New and less restrictive avenues for treatment were welcomed by many, but questions remain about how new norms and policy changes will be sustained beyond this pandemic and impact OUD treatment access and outcomes long-term.