Social media platforms have become valuable tools for understanding public health challenges by offering insights into patient behaviors, medication use, and mental health issues. However, analyzing such data remains difficult due to the prevalence of informal language, slang, and coded communication, which can obscure the detection of opioid misuse. This study addresses the issue of opioid-related user behavior on social media, including informal expressions, slang terms, and misspelled or coded language. We analyzed the existing Bidirectional Encoder Representations from Transformers (BERT) technique and developed a BERT-BiLSTM-3CNN hybrid deep learning model, named SABIA, to create a single-task classifier that effectively captures the features of the target dataset. The SABIA model demonstrated strong capabilities in capturing semantics and contextual information. The proposed approach includes: (1) data preprocessing, (2) data representation using the SABIA model, (3) a fine-tuning phase, and (4) classification of user behavior into five categories. A new dataset was constructed from Reddit posts, identifying opioid user behaviors across five classes: Dealers, Active Opioid Users, Recovered Users, Prescription Users, and Non-Users, supported by detailed annotation guidelines. Experiments were conducted using supervised learning. Results show that SABIA achieved benchmark performance, outperforming the baseline (Logistic Regression, LR = 0.86) and improving accuracy by 9.30%. Comparisons with seven previous studies confirmed its effectiveness and robustness. This study demonstrates the potential of hybrid deep learning models for detecting complex opioid-related behaviors on social media, supporting public health monitoring and intervention efforts.

Background: Electronic health records (EHRs) are a data source for opioid research. Opioid use disorder is known to be under-coded as a diagnosis, yet problematic opioid use can be documented in clinical notes. Objectives: Our goals were 1) to identify problematic opioid use from a full range of clinical notes; and 2) to compare the characteristics of patients identified as having problematic opioid use, exclusively documented in clinical notes, to those having documented ICD opioid use disorder diagnostic codes. Materials and Methods: We developed and applied a natural language processing (NLP) tool to the clinical notes of a patient cohort (n=222,371) from two Veteran Affairs service regions to identify patients with problematic opioid use. We also used a set of ICD diagnostic codes to identify patients with opioid use disorder from the same cohort. We compared the demographic and clinical characteristics of patients identified only through NLP, to those of patients identified through ICD codes. Results: NLP exclusively identified 57,331 patients; 6,997 patients had positive ICD code identifications. Patients exclusively identified through NLP were more likely to be women. Those identified through ICD codes were more likely to be male, younger, have concurrent benzodiazepine prescriptions, more comorbidities, more care encounters, and less likely to be married. Patients in the NLP and ICD groups had substantially elevated comorbidity levels compared to patients not documented as experiencing problematic opioid use. Conclusions: NLP is a feasible approach for identifying problematic opioid use not otherwise recorded by ICD codes. Clinicians may be reluctant to code for opioid use disorder. It is therefore incumbent on the healthcare team to search for documentation of opioid concerns within clinical notes.

In the last decade, the United States has lost more than 500,000 people from an overdose involving prescription and illicit opioids (https://www.cdc.gov/drugoverdose/epidemic/index.html) making it a national public health emergency (USDHHS, 2017). To more effectively prevent unintentional opioid overdoses, medical practitioners require robust and timely tools that can effectively identify at-risk patients. Community-based social media platforms such as Reddit allow self-disclosure for users to discuss otherwise sensitive drug-related behaviors, often acting as indicators for opioid use disorder. Towards this, we present a moderate size corpus of 2500 opioid-related posts from various subreddits spanning 6 different phases of opioid use: Medical Use, Misuse, Addiction, Recovery, Relapse, Not Using. For every post, we annotate span-level extractive explanations and crucially study their role both in annotation quality and model development. We evaluate several state-of-the-art models in a supervised, few-shot, or zero-shot setting. Experimental results and error analysis show that identifying the phases of opioid use disorder is highly contextual and challenging. However, we find that using explanations during modeling leads to a significant boost in classification accuracy demonstrating their beneficial role in a high-stakes domain such as studying the opioid use disorder continuum. The dataset will be made available for research on Github in the formal version.

Opioid related aberrant behaviors (ORAB) present novel risk factors for opioid overdose. Previously, ORAB have been mainly assessed by survey results and by monitoring drug administrations. Such methods however, cannot scale up and do not cover the entire spectrum of aberrant behaviors. On the other hand, ORAB are widely documented in electronic health record notes. This paper introduces a novel biomedical natural language processing benchmark dataset named ODD, for ORAB Detection Dataset. ODD is an expert-annotated dataset comprising of more than 750 publicly available EHR notes. ODD has been designed to identify ORAB from patients' EHR notes and classify them into nine categories; 1) Confirmed Aberrant Behavior, 2) Suggested Aberrant Behavior, 3) Opioids, 4) Indication, 5) Diagnosed opioid dependency, 6) Benzodiapines, 7) Medication Changes, 8) Central Nervous System-related, and 9) Social Determinants of Health. We explored two state-of-the-art natural language processing (NLP) models (finetuning pretrained language models and prompt-tuning approaches) to identify ORAB. Experimental results show that the prompt-tuning models outperformed the finetuning models in most cateogories and the gains were especially higher among uncommon categories (Suggested aberrant behavior, Diagnosed opioid dependency and Medication change). Although the best model achieved the highest 83.92% on area under precision recall curve, uncommon classes (Suggested Aberrant Behavior, Diagnosed Opioid Dependence, and Medication Change) still have a large room for performance improvement.

A deadly new virus circling the globe makes many people more anxious. The pandemic's psychological toll can be particularly weighty for people with an existing mental health condition. One 25-year-old on the US East Coast seeing a therapist for help with anxiety found additional support from an unexpected source: a chatbot. "Therapy twice a month was fine before, it's just now sometimes I have days where I feel like I need something extra," says the person, who identifies as gender nonbinary, and asked to remain anonymous. Their budget didn't allow more frequent therapy sessions, making them receptive when a friend mentioned Woebot, a chatbot built on Stanford research that delivers a digital version of cognitive behavioral therapy.

Measurement error in observational datasets can lead to systematic bias in inferences based on these datasets. As studies based on observational data are increasingly used to inform decisions with real-world impact, it is critical that we develop a robust set of techniques for analyzing and adjusting for these biases. In this paper we present a method for estimating the distribution of an outcome given a binary exposure that is subject to underreporting. Our method is based on a missing data view of the measurement error problem, where the true exposure is treated as a latent variable that is marginalized out of a joint model. We prove three different conditions under which the outcome distribution can still be identified from data containing only error-prone observations of the exposure. We demonstrate this method on synthetic data and analyze its sensitivity to near violations of the identifiability conditions. Finally, we use this method to estimate the effects of maternal smoking and opioid use during pregnancy on childhood obesity, two import problems from public health. Using the proposed method, we estimate these effects using only subject-reported drug use data and substantially refine the range of estimates generated by a sensitivity analysis-based approach. Further, the estimates produced by our method are consistent with existing literature on both the effects of maternal smoking and the rate at which subjects underreport smoking.

The opioid epidemic in the United States claims over 40,000 lives per year, and it is estimated that well over two million Americans have an opioid use disorder. Over-prescription and misuse of prescription opioids play an important role in the epidemic. Individuals who are prescribed opioids, and who are diagnosed with opioid use disorder, have diverse underlying health states. Policy interventions targeting prescription opioid use, opioid use disorder, and overdose often fail to account for this variation. To identify latent health states, or phenotypes, pertinent to opioid use and opioid use disorders, we use probabilistic topic modeling with medical diagnosis histories from a statewide population of individuals who were prescribed opioids. We demonstrate that our learned phenotypes are predictive of future opioid use-related outcomes. In addition, we show how the learned phenotypes can provide important context for variability in opioid prescriptions. Understanding the heterogeneity in individual health states and in prescription opioid use can help identify policy interventions to address this public health crisis.

As the amount of information in the world nearly doubles each year, detecting relevant signals through the noise is becoming even more difficult. However, successfully separating the signal from the noise, especially in healthcare, can be a tremendous value creator. For decades, the industry has been chasing the goal of evidence-based medicine, where proven science and published literature guides therapies. The application of machine learning algorithms to diverse big data sets means we can deliver the evidence at the point of care. As we combine genomic data, published literature, and other clinical data to guide therapies, we can radically and dramatically transform the patient experience and clinical outcomes.