Methadone and suboxone^® mentions on twitter: thematic and sentiment analysis

Figures & data

Table 1. Description of themes associated with tweets mentioning suboxone^® and methadone.

Theme	Description	Example Methadone Tweet	Example Suboxone^® Tweet
Access	patients’ ability to obtain medication legally	“Why do junkies get to queue at the chemist everyday for methadone?”	“@username how are you getting suboxone to those who can. ot afford it?”
Stigma	the negative view of the medication, its users, its clinics, or objects related to medication	“just seen an addict swig her methadone down in the chemist, what an awful life she is living. so thin and gaunt.”	“@username worry about your suboxone popping daughter and not drama”
Pain management	medication being used for to treat pain rather than opioid dependence	“@username It was methadone BID, Norco q6-8 h. Just seemed like a lot of opiates for something chronic”	“@username I confess I don’t understand. Suboxone doesn’t strike me as 1st, 2nd or 3rd choice for post-op pain.”
OUD Treatment	treatment for OUD, including MOUD or other ways of treating OUD	“@username the accurate statement is: bupe and methadone are more effective than Vivitrol -- show me otherwise.”	“instead of free needles, how about free suboxone & vivitrol? #needle exchange”
Tapering/ withdrawal	tapering oneself off, or the withdrawal associated with, the medication	“@username Just got off methadone could use all the help and prayers I can get ”	“#suboxone withdrawal sucks. Don’t be a junkie, kids.”
Safety/ side effects	the safety of medication or the side effects of medication	“drugs like vicodin, oxycontin and methadone must be carefully monitored as there is a risk of fatal overdose. however, experts say it is…”	“@username highest death rates from overdose in the u.s include traces of suboxone, fentenal or methadone in their toxicology reports!”
Greed/ corruption	an entity acting as drug dealers or promoting medication out of hope for profits or kickbacks	“opioid dependants were created by greedy pharmaceutical co’s & obamacare .check out the number of methadone clinics and who owns them”	“@username 2 to 1 its pharmaceutical lobbyists pushing this. Suboxone makes gazillions”
Continued drug use	continuing to use or abuse opiates or opioids while being prescribed or using medication	“@username My friend has been on methadone for 8 months and is still shooting heroin. I just don’t understand why long-term residential tx isn’t an option. Surely if the drug use hasn’t stopped she needs something more?”	“@username I’ve only encountered 2-3 people who have been sober through suboxone/methadone treatments successfully. Most of the time people just use them as a way to keep doing drugs”
Misuse/ diversion	using medication in ways other than prescribed, using illegally obtained medication, or selling prescribed medication	“made a sell to a dude that stays fucked up and he gave me weed and a methadone pill lol”	“#Busted a visitor at Southern New Mexico Correctional Facility was caught trying to introduce suboxone into the facility! #NMCD #SNMCF #notonourwatch”
Uncategorized	medication and/or its use but does not fall into one of the above categories	“@username Obama was giving out smokes at the methadone clinic again.”	“In PA everyone was on suboxone ”
Unrelated	not related to medication or its use	“Methadone Mary n black eye Bill”	“tales of symphonia and suboxone”

Table 2. Analysis of themes associated with tweets mentioning suboxone^® and methadone.

	Methadone Tweets (N = 450)	Suboxone^® Tweets (N = 450)
Theme	n (%)	n (%)	p Value
Access	69 (15.3)	64 (14.3)	.64
Stigma	77 (17.0)	70 (15.5)	.53
Pain management	25 (5.5)	32 (7.0)	.33
OUD Treatment	57 (12.8)	70 (15.6)	.21
Tapering/ withdrawal	14 (3.0)	25 (5.6)	.07
Safety/ side effects	26 (5.8)	18 (4.0)	.21
Greed/ corruption	24 (5.3)	61 (13.5)	<.001^a
Continued drug use	8 (1.8)	8 (1.8)	1
Misuse/ diversion	9 (2.0)	38 (8.5)	<.001^a
Uncategorized	63 (14.0)	80 (17.3)	.14
Unrelated	129 (28.8)	16 (3.5)	<.001^a

^astatistically significant difference.

Table 3. Subthemes of tweets mentioning methadone.

Theme	Subtheme	Description	Tweets	Example
			n (% of theme)
Access
	Cost/coverage^a	how methadone is covered or paid for, how much it costs patients	18 (25.7)	“@username methadone is not covered for the working poor either. only those on some type of social assistance.”
	Queuing/ distribution	the process of receiving methadone, including the need to stand in line at clinics	13 (18.8)	“i figure that’s either a bus stop right there or a methadone clinic.”
Stigma
	Opioid “substituting”^a	using methadone as “trading” one opioid for another, less desirable opioid	13 (17.1)	“Mad they got commercials for methadone and suboxone… like get off the street dope! Try ours instead! FOH”
	Stigma from healthcare providers	prejudice or negative sentiment towards people on methadone or with OUD from healthcare providers	9 (11.4)	“Hours spent in EDs watching derision & annoyance they had with him, the ‘#addict’. Help Us! Why no methadone there & then? #overdose #heroin”
OUD treatment
	Methadone vs suboxone^a	directly compares methadone to suboxone	11 (19.3)	“@username I know at least a dozen people who’ve tried to switch from methadone to buprenorphine, only one was successful long term!”
	MOUD success^a	successes of any of the MOUD options, including methadone specifically	9 (15.8)	“methadone + suboxone are effective heroin addiction treatments for many people + should remain the first line response. #phcsalome”
	Medical education^a	designed to educate readers, typically contain to facts and data about the opioid crisis or MOUD options	19 (33.3)	“amitiza nnt = 13 for constipation. does not reverse methadone related constipation!!! #hpm17”
Unrelated
	Analogies to methadone	compares unrelated things to methadone, often inferring that the thing compared to methadone is less desirable	24 (18.5)	“@username I’m a full blown crumpet junkie. I’ll have to go on crumpet methadone (English muffins in the states) when I get back just to survive.”
	“Try methadone”	have consistent pattern comprised of “question? You probably have []. This causes []. Try methadone.”	44 (34.1)	“Have freckles? Yes? You suffer from Skitzo. This causes numbness. Try Methadone”

^asubtheme was also seen in suboxone^®-containing tweets.

Table 4. Subthemes of tweets mentioning suboxone^®.

Theme	Subtheme	Description	Tweets n (% of theme)	Example
Access
	Cost/ Coverage^a	how suboxone is covered or paid for, how much it costs patients	25 (39.1)	“@username suboxone is very expensive, came to the u.s. from europe, initial training was data 2000 for an outpatient detox.”
	MD awareness/ licensing	difficulties in obtaining suboxone due to physician awareness, prescribing, or licensing issues	18 (28.1)	“@username but there are only a few docs who can give suboxone to people and they are restricted to 30”
Stigma
	Opioid “substituting”^a	using suboxone as “trading” one opioid for another, less desirable opioid	19 (27.1)	“Mad they got commercials for methadone and suboxone… like get off the street dope! Try ours instead! FOH”
	Myths	fallacies related to suboxone and the opioid epidemic	18 (25.7)	“It would kill me too! I already have breathing problems. They think #opioids are a big, bad problem (they’re not) but making suboxone will prove to be deadlier. Sorry to say that but I believe it’s already started.“
	Suboxone “addiction”	suboxone treatment as “suboxone addiction” or refers to the addictive properties of suboxone	10 (14.3)	“@username suboxone is one of the to drugs we detox patients from nowadays. #suboxoneaddiction”
OUD treatment
	Methadone vs suboxone^a	directly compares methadone to suboxone	9 (13.2)	“@username Yes suboxone is a miracle drug to treat the crisis / methadone clinics should be shut down : have big lobby group”
	MOUD success^a	successes using any of the MOUD options, including specific successes from suboxone	20 (28.9)	“@username i have 4 years 5 months and 13 days sober… suboxone saved my life for the better. amen to that! #beingthankful”
	Medical education^a	designed to educate readers, typically contain to facts and data about the opioid crisis or MOUD options	17 (23.7)	“@username its already available some places. nalaxone blocks opiate receptors in brain. just like suboxone”
Tapering/ Withdrawal
	Alternatives	alternatives to treat the opioid withdrawal (including kratom and cannabis)	8 (32.0)	“will #kratom help ween of suboxone???”

^asubtheme was also seen in methadone-containing tweets.

Figure 1. Distribution of user attitude among Tweets mentioning both “methadone” and “suboxone”.

Figure 2. Topic terms discovered via latent Dirichlet allocation from unlabeled data and their possible mappings to manually discovered themes (left: methadone; right: suboxone). Misuse/diversion and Greed/corruption only had possible mappings for suboxone, and they are shown in the bottom left of the figure. Text size indicates strength of association with topic.

Figure 3. Distributions of automatically detected sentiment polarities for tweets mentioning methadone and Suboxone^® (top), and sentiment polarities scaled by subjectivity scores (bottom).