Which social media platforms facilitate monitoring the opioid crisis?

Social media can provide real-time insight into trends in substance use, addiction, and recovery. Prior studies have used platforms such as Reddit and X (formerly Twitter), but evolving policies around data access have threatened these platforms' usability in research. We evaluate the potential of a broad set of platforms to detect emerging trends in the opioid use disorder and overdose epidemic. From these, we identified 11 high-potential platforms, for which we documented policies regulating drug-related discussion, data accessibility, geolocatability, and prior use in opioid-related studies. We quantified their volume of opioid discussion, including in informal language by including slang generated using a large language model. Beyond the most commonly used Reddit and X/Twitter, the platforms with high potential for use in opioid-related surveillance are TikTok, YouTube, and Facebook. Leveraging a variety of social platforms, instead of merely one, yields broader subpopulation representation and safeguards against reduced data access in any single platform.