Mining Social Media for Barriers to Opioid Recovery with LLMs.

Opioid abuse and addiction remain a major public health challenge in the US. At a broad level, barriers to recovery often take the form of individual, social, and structural issues. However, it is crucial to know the specific barriers patients face to help design better treatment interventions and healthcare policies. Researchers typically discover barriers through focus groups and surveys. While scientists can exercise better control over these strategies, such methods are both expensive and time consuming, needing repeated studies across time as new barriers emerge. We believe, this traditional approach can be complemented by automatically mining social media to determine high-level trends in both well-known and emerging barriers. In this paper, we report on such an effort by mining messages from the r/OpiatesRecovery subreddit to extract, classify, and examine barriers to opioid recovery, with special attention to the COVID-19 pandemic's impact. Our methods involve multi-stage prompting to arrive at barriers from each post and map them to existing barriers or identify new ones. The new barriers are refined into coherent categories using embedding-based similarity measures and hierarchical clustering. Temporal analysis shows that some stigma-related barriers declined (relative to pre-pandemic), whereas systemic obstacles-such as treatment discontinuity and exclusionary practices-rose significantly during the pandemic. Our method is general enough to be applied to barrier extraction for other substance abuse scenarios (e.g., alcohol or stimulants).