Exploring Harm Reduction Advice for Prescription Stimulants on Reddit

doi:10.21203/rs.3.rs-5265160/v1

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Research Article

Exploring Harm Reduction Advice for Prescription Stimulants on Reddit

https://doi.org/10.21203/rs.3.rs-5265160/v1

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Background

Psychostimulants such as amphetamine salts and methylphenidate are commonly prescribed for the treatment of attention deficit hyperactivity disorder (ADHD). However, their non-medical use is also prevalent. Both medical and non-medical use of these substances can lead to a range of side effects. Despite this, there is limited research on harm reduction strategies employed by individuals who use prescription stimulants. This study, therefore aimed to explore the harm reduction strategies discussed by individuals using prescription stimulants on Reddit, to provide insights into how these strategies are shared and implemented.

Methods

A multi-site qualitative analysis was conducted on discussions from four subreddits: r/ADHD, r/drugs, r/stims, and r/nootropics. The data were collected and analysed to identify common themes and strategies related to harm reduction.

Results

Across all subreddits individuals emphasized the importance of maintaining a balanced diet, engaging in regular exercise, staying hydrated, and practicing good sleep hygiene as crucial components of their harm reduction practices. Redditors on r/drugs, r/nootropics and r/stims frequently recommend various substances, such as depressants, vitamins, and minerals, to mitigate the side effects of stimulants. In contrast, r/ADHD focused more on consulting healthcare professionals and adjusting medication regimens.

Conclusions

This study highlighted the significant role of online communities in sharing harm reduction strategies and supporting individuals in managing their stimulant use. This study provides important insights for healthcare professionals to inform support and guidance for both medical and non-medical use of prescription stimulants.

ADHD

Psychostimulants

Harm Reduction

ADHD Medication

This study investigates the harm reduction strategies that people who use prescription stimulants engage in to avoid or manage the side effects from their substance use. Psychostimulants, such as amphetamine salts and methylphenidate, are commonly produced as prescription medication primarily for the treatment of attention deficit hyperactivity disorder (ADHD), due to their ability to reduce core symptoms of hyperactivity, impulsivity and inattention (1). Being the primary pharmacological treatment for ADHD (2), the prevalence of medically used prescription stimulants is high, estimated at around 4.5% of the USA population (3). This rate has been estimated to have increased (4), especially during and following the COVID-19 pandemic (4, 5).

Additionally, approximately 0.6–2% of US adults report past-year non-medical use of prescription stimulants – that is, use without being prescribed or taken differently than as prescribed (3, 6, 7). Qualitative investigation has found psychostimulants have been used amongst college students as cognitive enhancers because of their effect on memory, concentration and learning performance (8). Additionally, individuals have reported increased energy and interest in learning after taking prescription stimulants, allowing them to work for long periods (9).

The beneficial effects of prescription stimulants, however, also come with side-effects. Side-effects of prescription stimulants are extensive and include symptoms such as elevated blood pressure, irregular heartbeat, nausea, anxiety, insomnia and decreased appetite (10). These side effects have been reported for both medical and non-medical use (11). However, we know little about how people who use prescription stimulants seek to reduce the harms they experience from their use.

Previous research has investigated how people who use drugs have engaged in strategies to reduce their drug-related harm amongst people who inject drugs (12, 13), people who use opioids (14), and people who use MDMA (15, 16) and methamphetamine (17). Harm reduction strategies reported by participants in these studies included drug checking (18), monitoring their use (19), needle exchange and engaging in counselling (20). However, despite their prevalent use, the evidence base about harm reduction is lacking among people who use prescription stimulants, with existing findings being isolated anecdotes, or found peripherally in the investigation of other aims (21–23). Additionally, there is a general lack of information online about harm-reduction measures individuals can use when taking these medications as prescribed. This is especially relevant as people who use stimulants as prescribed have been found to report side effects more frequently than people who use prescription stimulants non-medically (11).

Understanding the real-world harm reduction practices of people who use drugs can be beneficial across a spectrum of professional settings. In this study, we focus on bottom-up harm reduction strategies, which refer to the self-initiated practices that individuals engage in to prevent or mitigate the harmful consequences associated with drug use (24). Examples of these strategies include monitoring dosage, engagement in community services and maintaining a healthy lifestyle (12, 25). These practices reflect the agency and self-care practices of individuals who use drugs, emphasizing their active role in managing their health and well-being (12, 26). They are distinct from top-down interventions, which are typically delivered by institutions or professionals (16).

Bottom-up harm reduction strategies can be insightful to clinicians in how patients manage side effects, potentially informing safer prescribing practices. Alcohol and Other Drug (AOD) counsellors can better support individuals who use stimulants non-medically, offering targeted advice on minimizing risks. Mental health clinicians, general practitioners, and other substance use professionals can apply these findings to improve patient care and support, acknowledging the diverse ways individuals use and manage their stimulant use.

The goal of the present study was to qualitatively explore the self-reported experiences and harm reduction strategies described by people who use prescription stimulants The research question guiding this study was how do individuals who use prescription stimulants describe and engage in bottom-up harm reduction strategies?

To investigate this, we collected and analysed social media data (Reddit), an avenue that has been increasingly used in substance use research to understand the behaviours of individuals (27). Social media offers a unique opportunity to access naturally occurring data, where individuals may openly discuss their non-medical prescription drug use in ways they are often unwilling to disclose to healthcare professionals (28, 29). Therefore, this study will analyse this discussion qualitatively to explore the nuanced, bottom-up harm reduction strategies employed by individuals who use prescription stimulants.

Site Selection

Reddit is the largest online English forum board, with over 52 million daily users (commonly referred to as redditors) (30). Reddit is comprised of thousands of content-specific digital communities known as subreddits. Many of these subreddits contain discussions related to the use of prescription stimulants, each varying in their purpose and content. For example, the subreddit r/ADHD focuses on the experiences of those with ADHD, while r/drugs focuses more on non-medical use. This diversity allows us to capture a broad spectrum of harm reduction strategies related to prescription stimulant use. To capture a diversity of experiences, we employed a multi-site framework, analysing discussions from a series of subreddits (r/ADHD, r/drugs, r/stims, and r/nootropics).

This study drew from discussion on the subreddits r/ADHD, r/Nootropics, r/Stims and r/Drugs. The largest subreddit, r/ADHD (1.5 million redditors), discusses the experiences of those who have ADHD. The subreddit provided a useful avenue for examining the experience of stimulant use among those prescribed the medication. Additionally, discussion of stimulants on the subreddit r/nootropics (340k redditors), which discusses cognitive enhancers, was also included. Posts from the subreddit r/drugs, which has 916k members and is dedicated to discussions on all substances, as well as from r/stims, which has 116k members and focuses specifically on stimulants, were also examined. This selection of subreddits was expected to show the diversity of experiences of individuals who take stimulants.

This research received an ethics exemption from the University of Queensland Human Research Ethics Committee (2022/HE001469) because it did not include human participants and used publicly available data. Prior to examining the posts, the authors contacted the moderators of each subreddit informing them of the aims of the research. However, no response was received. Our use was compliant with Reddit's conditions of access at the time which stated permission is not required from Reddit to use their Application Programming Interface (API) for non-commercial use. To protect individuals’ identities, comments were obscured so they would remain unsearchable. This was done by amending grammar, correcting spelling errors and removing irrelevant sections. Reverse search checks were employed to verify deidentification.

Data Collection

The subreddit-comments-dl (31) tool was used to extract submissions made to these subreddits. This script retrieves the submission IDs for posts using the Reddit API search optimizer, pushshift.io, before extracting its content using the Python Reddit API Wrapper (PRAW) package.

Extractions were done between 26th − 28th July 2022. To ensure a representative sample of discussions, we scraped a large number of posts from each subreddit: r/ADHD (n = 11,992), r/stims (n = 11,985), r/drugs (n = 11,997), r/nootropics (n = 11,984). These posts were collected chronologically and ranged between 15th May 2021 to 25th July 2022. Comments from these posts were also extracted.

To filter out irrelevant discussion, a list of keywords were developed to search for posts about prescription stimulant use. This list included both the generic and brand names of prescription stimulants. These terms were then manually searched on each subreddit to remove those that resulted in no relevant posts. The full list of keywords can be seen in supplementary materials A.

Each subreddit was searched independently using R. Posts were included if they contained relevant terms in either the title or body text. The number of posts included varied between subreddits. For r/ADHD, 9.15% (n = 1,097) contained keywords; for r/stims, 20.77% (n = 2,487), for drugs 6.26% (n = 751) and for r/nootropics 3.21% (n = 385).

The remaining posts were then manually screened. Posts were included if they were English text-based posts related to prescription stimulants. Posts about non-pharmaceutically produced stimulants were excluded. We also excluded posts that were deleted by the poster or removed by moderator. Additionally, joke and parody posts, posts with no text (photos/videos only), and posts with less than 25 characters were removed. Inclusion rates and characteristics of included posts can be seen in See Supplementary Table 1, Additional File 1.

Insert Supplementary Table 1, Additional File 1 here.

From these, a random sample of 50 posts (47 for r/nootropics) was selected from each subreddit for analysis. Posts were then merged with their associated comments. For highly replied threads, we collected the top 100 most upvoted comments to ensure the most representative viewpoints were captured. This was to prevent the discourse from being dominated by a few extensive threads while still ensuring a diverse representation of community perspectives and focusing on the most valued insights. These were converted into text files and imported into NVivo 12 for qualitative analysis.

Data Analysis

For analysis, we adapted guidelines from Jenkins and colleagues (32) on multisite qualitative analysis (MSQA). MSQA utilises a three-stage approach, where data are analysed within-site, between-sites and within-site again. This approach allows us to examine the similarities and differences between discussion on the subreddits.

The first stage was within-site analysis, where discussion on each subreddit was analysed separately. The thematic analysis approach outlined by Braun and Clarke (2006) was used to explore these discussions. Initial stages of analysis were conducted by a single coder (B.J). This began with the coder reading the dataset and noting initial impressions. After familiarization, the coder re-examined the data and the coding process began. The initial coding process was conducted by B.J. without any predefined codes or themes, to capture emerging and novel insights present in the dataset. This meant actively engaging with the content to highlight emerging patterns, unique insights, and novel observations regarding individuals harm reduction behaviours. Collaboratively with another researcher (N.T.), the coded data were then collated into preliminary themes based on their similarity. Topics that were recurrent and held significant meaning within the dataset were coded. These themes were then reviewed and labelled. This process was repeated for all subreddits.

Following this, results were compared between sites (i.e. across subreddits). In this stage, we contrasted the themes from each subreddit to identify how harm reduction discussion varied and converged across online communities. This allowed us to identify patterns present across the entire dataset which informed the development of the overarching themes (32).

This stage was followed by a final within-site analysis, where the subreddits were re-examined independently to assess the suitability of the overarching themes and identify site-specific elements. Threads were then recoded deductively based on the finalized themes. The process also involved counting how often these themes appeared in posts across each subreddit. Additionally, for the theme "Use of Additional Substances," the frequency of mentions for various substances was counted and categorized by subreddit.

Harm reduction posts across the subreddits were primarily centred on providing practical advice, sharing personal experiences, and offering support to others. Redditors often engaged in discussions to suggest strategies for mitigating the adverse effects of prescription stimulant use, emphasizing a community-driven approach to managing their health. These posts included a wide range of recommendations. Through detailed exchanges, redditors created a collaborative environment where harm reduction strategies could be explored and refined. This analysis uncovered four specific themes: the use of additional substances, achieving a healthy lifestyle, consulting with healthcare professionals, and strategies for reducing stimulant use. The final themes can be seen in Supplementary Table 2, Additional File 1 here.

Insert Supplementary Table 2, Additional File 1 here.

Use of Additional Substances

Redditors frequently discussed substances they used or recommended to help manage the side effects. Most frequently, discussions were in reply to other redditors asking about the suitability of certain substances. On r/Nootropics, which contained the majority of substance discussions (n = 18), the use of other substances, from pharmaceutical drugs to over-the-counter supplements, were regularly given as general harm reduction advice. Redditors posting in r/drugs (n = 9) and r/stims (n = 11) also discussed reducing harm through the use of drugs, although the variety of substances recommended and consumed were not as wide or prevalent as featured on r/Nootropics. Discussion of additional substances for harm reduction on r/ADHD was limited (n = 3). However, some redditors recommended talking with their doctor about a medication that may help.

Redditors would typically share their thoughts on the substance, often based on their previous experiences. Some posters also linked research to support their position. When providing recommendations, posts would often describe what the substance does, instructions on dosage and unsafe interactions.

Overall, 31 substances were mentioned at least three times in discussions in the context of harm reduction. Full frequencies can be seen in Table 1.

Insert Table 1 here.

Depressants such as alcohol, marijuana and benzodiazepines were frequently discussed for their ability to reduce anxiety and physical discomfort following stimulant use. Redditors also found these drugs helpful to aid eating and sleeping. This was usually following recreational use involving high dosages. Benzodiazepines, especially Valium and Xanax, were the most frequently mentioned, especially on r/drugs and r/stims. Many reported taking benzodiazepines during the stimulant’s active effect or on the comedown to reduce physical effects of anxiety and jitteriness:

I would save the benzos for when you really need them with the addy. Like to relax so you can sleep or to sleep. Or only when you feel you are experiencing uncomfortable physical anxiety. (r/Drugs)

Another commonly discussed option was caffeine. The effects of this substance varied between individuals. The effects of this substance varied between individuals, with some redditors finding it generally useful for mitigating the negative side effects associated with the "crash" experienced after stimulant medication wears off. Some users reported that caffeine helped reduce symptoms like irritability and fatigue, which often accompany the crash. For example, one redditor stated:

I’m on 30mg Vyvanse now and the crashes can be subdued with coffee… My crashes on adderal are a lot more subtle (irritability only, no dark thoughts, no hopelessness) (r/ADHD)

Also commonly recommended were vitamin and mineral supplements, most commonly Vitamin B, D and fish oils. These were recommended to improve general health whilst taking stimulants and reduce side-effects. Magnesium supplementation was also recommended and used widely as a harm reduction strategy for many purposes, primarily as a muscle relaxant to help with physical side-effects such as muscle cramping and jaw clenching. It was also recommended as helpful for insomnia:

I took magnesium glycinate at night when I took Adderall and it helped me get an awesome night’s sleep. (r/Drugs)

Redditors on r/Nootropics also frequently discussed alternative substances for harm reduction purposes. These substances rarely featured in discussion in other subreddits. Individuals on r/Nootropics would often report experimenting with a variety of substances and share detailed information about their effects, including their capabilities to reduce side-effects and increasing overall wellbeing:

L-Theanine helps reduce anxiety brought on by stimulants. Sabroxy can potentiate them and Skullcap can help smooth out the crash in the afternoon. Lemon Balm, GABA, Magnolia Bark, and Mulungu help sleep at night. (r/Nootropics)

Redditors also discussed substances that would help them alleviate the long-term effects of stimulant use. The most commonly discussed substance was N-acetylcysteine (NAC), which featured nearly exclusively on r/Nootropics. Individuals heavily promoted NACs ability to reduce stimulant tolerance, allowing redditors to get intended effects on lower dosages. NAC was also heavily promoted as an aid for recovery from adverse effects of long-term stimulant use, mainly anhedonia and emotional blunting:

I was getting bad side effects from methylphenidate and took NAC. I was surprised by how quickly and how much the side effects went away. (r/Nootropics)

Achieving a Healthy Lifestyle

Individuals across all subreddits discussed the importance of healthy living on their overall health and reducing long-term damage from stimulants. This discussion was especially common in r/ADHD (n = 10), but also featured in r/drugs (n = 5), r/stims (n = 7), and r/Nootropics (n = 2). Many redditors felt that stimulants impaired their ability to live healthily. The wakefulness and appetite-suppressing effects of stimulants reportedly impeded redditors’ ability to achieve adequate sleep and nutrition. Additionally, redditors often forgot to hydrate, which they felt was harmful to their health and led to worse side effects. To mitigate these side effects, redditors discussed and recommended various healthy living strategies. To combat the wakefulness effects, redditors recommended taking medication early in the day to avoid sleep disruption. Good sleep hygiene strategies, especially sunlight exposure upon waking, were also suggested. Exercise was recommended to help tire the body, aiding with sleep and reducing the comedown effects, for example:

Exercise is just as important as water or diet to make sure you’re letting [your]you’re body metabolize your meds (r/ADHD):

To navigate appetite suppression, redditors suggested eating large, high-protein meals before taking stimulants to reduce blood sugar fluctuations. Regular snacking throughout the stimulants’ active dose was also recommended. In r/ADHD, redditors frequently set alarms to remind themselves to eat and hydrate. One redditor shared:

Big protein-focused breakfast and set an alarm to remind myself to eat lunch!… Dinner a meat and a veggie. I avoid sugar and limit carbs! (r/ADHD).

Some redditors recommended drinking water at a higher rate than usual due to the dehydrating effects of stimulants. Along with water, electrolyte drinks were also suggested. One redditor advised:

Keep electrolyte drinks on hand and drink them regularly. Amphetamines deplete them incredibly fast (r/Stims).

Consulting a Doctor

Individuals who were prescribed stimulants and experiencing adverse effects were often encouraged to consult their doctor about these side effects. This was most common on r/ADHD (n = 10), where individuals were taking medication as per their doctor's instruction. There were also discussions in r/Nootropics (n = 2), r/drugs (n = 1), and r/stims (n = 1). Many suggested checking with their doctor to determine if the side effects were normal and what steps to take to address them:

But, you should always consult your doctor if you have concerns about your meds. They know what they are doing and together you can find a treatment plan that works for you. (r/ADHD)

Several redditors suggested keeping a journal the record the effects of the medication. This was so individuals could provide their doctors with valuable information to make informed decisions about their treatment:

Keep up with the doctor, keep notes of how you feel, how they’re working and not working. It’s normal to need med and dose changes. (r/ADHD)

Some redditors suggested that a change in dosage or medication type may be helpful for alleviating their symptoms:

I didn't tolerate Adderall at first but was switched to Vyvanse and now handle it much better. (r/ADHD)

Reducing Use

The frequency and dosage of stimulant use, especially among those unprescribed, were regularly discussed and scrutinized by other individuals in the community. Under posts describing side effects from stimulant use, other individuals would commonly recommend reducing use or stopping altogether. These recommendations were typically found in r/drugs (n = 5) and r/stims (n = 9), where self-described periods of bingeing were more frequent. There were also some discussions in r/Nootropics (n = 2), but none in r/ADHD.

To encourage others to reduce their use, some individuals shared their struggles with dependence. One individual shared:

I just lost everything to amphetamine addiction.… Your health, your sleep, your relationships with anyone and everyone, your job, your financial independence (that one is tough) and if you really go overboard potential lifelong consequences to your physical and mental health (psychosis, movement disorders, cognitive deficits etc...). I don't know how to convey this next part but I will try. I was right where you are, right now, about a year ago. (r/Stims)

Individuals typically referenced the potential damage of excessive stimulant use to physical and mental health. They highlighted the risk of changes to brain function, which could lead to long-term consequences such as anhedonia and emotional instability. One individual cautioned:

You are burning dopamine receptors already at these doses. I would try to lower it to once a week but I can see you are hooked. Lack of dopamine will punish you later. Have that in mind. You are entering a slippery slope. (r/Stims)

Some individuals encouraged others to seek support, emphasizing the importance of getting professional support to manage their dependence. One noted:

All you can do is stay strong, get the right help and support, and definitely get rid of all the medications or you will be spending hours turning the house upside down looking for that one pill. Good luck; like any addiction, it's a lifetime of staying in control. (r/Drugs)

These individuals often emphasized taking time off to allow the body to recover. One individual advised:

‘Get off the stims, sleep for a month and a half if you have to. It will help with the anhedonia and to repair the dopaminergic system.’ (r/Stims).

The purpose of this study was to capture the diverse use of prescription stimulants described on Reddit and identify the broad spectrum of harm reduction strategies discussed. These findings provide novel insights into how individuals who use prescription stimulants seek to reduce their experience of harm from taking prescription stimulants. The desire for people who use drugs to actively consider and care for their health and well-being has been found broadly in qualitative research (12, 26). This study adds previously unreported details about individuals who, while planning to continue using prescription stimulants, actively discuss and implement harm reduction strategies.

This study adopted a unique approach, adapting methods from multi-site studies examining substance use behaviours (33, 34), by treating subreddits as analogous to physical locations. This framework allowed us to assess a wide range of redditors’ experiences with prescription stimulants. It was found that harm reduction recommendations differ between online locations, similar to differences in physical locations found in multi-site studies (33). These online communities all had separate purposes and contained distinct norms and rules that served as the context in which discussion took place (35, 36). This influenced the type of content on each subreddit, with some harm reduction practices absent altogether in some subreddits. These differences highlight the importance of incorporating findings from multiple contexts when seeking to comprehensively understand a phenomenon (37).

Digital communities on platforms like Reddit not only provide a space for discussion but also serve as essential resources where individuals engage actively in exchanging detailed harm reduction advice. This is particularly significant given the accessibility and anonymity these platforms offer, allowing redditors to seek and share information that might be unavailable or stigmatized in more traditional health promotion settings. Studies suggest that the Internet is often the primary source for adolescents learning about harm reduction (38), emphasizing the need to ensure the reliability of the information shared. For instance, “learning how to use drugs more safely” is a commonly given reason for visiting online drug forums (39), highlighting these platforms' role in promoting safer drug use practices.

These findings align with existing literature on harm reduction practices in several ways. Redditors widely recommended maintaining a healthy lifestyle, including regular exercise, a balanced diet, and adequate hydration, to mitigate the side effects of stimulant use, which is consistent with harm reduction strategies identified in studies on other substance use contexts (16, 26, 40).

On platforms like r/drugs and r/stims, where higher dosages and prolonged usage of stimulants were often discussed, community members regularly advocated for reducing or ceasing use when discussing the negative side effects encountered. These types of recommendations were particularly prevalent in discussions involving significant use, reflecting a community-driven approach to managing potential risks associated with non-medical stimulant use.

Additionally, for non-medical use, redditors regularly described regulating use to reduce long-term adverse effects, which are also described in qualitative studies (12, 26). Reduction strategies such as setting definitive limits and using substances in moderation are standard practices identified in harm reduction research (38, 41). This selective reduction approach becomes even more pertinent among redditors who have either witnessed or personally experienced the detrimental effects of substantial stimulant use, motivating them to adjust their behaviour to minimize these risks (33).

The use and recommendation of various supplements by redditors to counteract adverse effects of prescription stimulants mirror similar recommendations found in other drug-use contexts (42) (43). These findings align with harm reduction strategies observed in studies in other stimulants, with combinations of stimulants such as cocaine and methamphetamine found to be frequently combined with a depressant to either calm down, induce sleep, alleviate anxiety or distress (44–46). This may explain the high rate of polysubstance use among people who use non-medical prescription stimulant (47), especially alcohol marijuana and pain relievers.

This study also found a variety of other substances that individuals used to reduce side effects, which are not commonly found in the harm reduction literature, such as NAC and L-Theanine. NAC has been explored for its use in reducing methamphetamine dependence with limited success (48). However, individuals mainly recommended it for reducing stimulant tolerance, allowing individuals to get the intended effects on lower dosages. NAC was also heavily promoted as an aid for recovering from adverse effects of long-term stimulant use, mainly anhedonia and emotional blunting. Additionally, the use of substances such as vitamins and magnesium for harm reduction purposes were frequently discussed, even though they have been previously unexplored in harm reduction research. Individuals praised the benefits of magnesium for reducing comedown problems such as sleep issues and cramps. Magnesium has been found to have benefits for neuromuscular relaxation (49), which may counteract muscle tension and cramps experienced as side effects of stimulant medications. It may also improve sleep quality by activating the parasympathetic nervous system, promoting relaxation and helping redditors fall asleep more easily and maintain deeper sleep (50).

These recommendations were mainly found on r/Nootropics, which is a subreddit containing lots of discussion of unconventional substances. This further shows the impact that the culture and purpose of an online community have on the type of harm reduction strategies employed, emphasizing the importance of exploring a diverse range of domains when investigating this issue.

This study provides important insights for healthcare professionals, including clinicians, Alcohol and Other Drug counsellors, mental health clinicians, general practitioners, and other substance use professionals. It highlights the harm reduction strategies employed by individuals taking prescription stimulants. Awareness of these strategies is crucial for effective and comprehensive care. Encouraging patients to discuss online strategies with healthcare providers can bridge the gap between informal advice and professional guidance.

It is important for healthcare professionals to manage side effects effectively for the successful treatment of ADHD with medication, as studies have shown that individuals often discontinue treatment due to adverse effects (51). Our study shows that individuals typically describe guidance from healthcare providers as their primary strategy to deal with harm from taking prescription stimulants, underscoring the importance of having informed healthcare providers. This demonstrates the critical role of clinicians in reducing harm and understanding the strategies that individuals may be engaging in to mitigate these effects.

Future research needs to consider the overall effectiveness of these harm reduction strategies for individuals using prescription stimulants. Specifically, it is important to assess the efficacy and interactions of various substances used for harm reduction, such as vitamins and magnesium, with other medications. Understanding these interactions and their long-term health impacts is crucial for developing comprehensive harm reduction guidelines.

Additionally, research should identify which harm reduction strategies are effective for different types of prescription stimulant use, whether medical or non-medical. This distinction is essential for providing tailored harm reduction approaches that address the specific needs of each group.

Limitations

These findings should be interpreted within the context of the study limitations. The generalizability of results is limited by the characteristics of the sample and dataset. The demographics of the sample are unknown and were not analysed in this study. The userbase of Reddit tends to skew towards younger males who are left-leaning (52), which means this study may not capture experiences from individuals outside of these characteristics.

Additionally, redditors often choose to divulge only certain elements of their experiences. Information about individuals’ social and occupational environments and the circumstances surrounding their stimulant use were often not described, resulting in an incomplete picture of their overall experience and the full range of factors contributing to stimulant use and the harm reduction strategies individuals employ. The study was also unable to distinguish between medical and non-medical use of prescription stimulants due to the ambiguity in the data, making it difficult to ascertain if there were any differences in harm reduction strategies for medical and non-medical use.

Overall, the harm reduction strategies that individuals recommended to each other align with those observed with other substances. This study provides valuable insight into the role of social networks in sharing harm reduction strategies among individuals who take prescription stimulants. Through the comprehensive analysis of reported experiences and behaviours associated with the use of prescription stimulants, this study demonstrates the value that online forums, such as Reddit, offer for understanding substance use behaviours. These forums serve as dynamic platforms for individuals to share harm reduction practices related to prescription stimulant use and offer researchers a nuanced understanding of real-world substance use behaviours.

However, more research is needed to understand how these behaviours differ between individuals who take prescription stimulants medically and non-medically, as this study was unable to clearly differentiate between the two groups. This distinction is crucial for developing tailored harm reduction strategies that address the specific needs of each group.

Ethics approval and consent to participate

Consent for publication

Consent for publication was not required as per the ethics committee as the data used in this study were publicly available on Reddit. However, all identifiable user information has been anonymized to protect privacy, following ethical guidelines for using data from online platforms.

Availability of data and materials

The datasets used and/or analysed during the current study are not publicly available due to privacy concerns but are available from the corresponding author on reasonable request.

Competing interests

The authors declare that they have no competing interests.

Funding

Not applicable.

Authors' contributions

B.J. was responsible for all stages of the study, including conception, data analysis, data collection, writing, and editing the manuscript. C.R. was responsible for the conception and editing of the manuscript. N.L. contributed to the conception, data analysis, supervision, and editing of the final manuscript.

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Table 1

List of Substances Mentioned for Harm Reduction at Least Three Times
	Mentions
Substance	ADHD	Nootropics	Drugs	Stims	Total
Supplements
Magnesium	0	46	1	10	57
L-Theanine	0	30	1	6	37
L-Tyrosine	0	30	0	4	34
Vitamin B	4	11	6	6	27
Vitamin D	0	6	3	6	15
Omega-3	0	7	3	1	11
Vitamin C	0	8	0	2	10
GABA	0	1	1	7	9
Zinc Supplements	0	5	1	0	6
Ginkgo Biloba	0	6	0	0	6
Multivitamin	0	1	0	3	4
Stimulants
Caffeine/Coffee	11	21	16	24	72
Racetam	0	6	2	3	11
Clobenzorex	0	0	0	4	4
Nootropics
NAC (N-acetylcysteine)	0	63	0	2	65
Agmatine	0	24	0	5	29
Racetam	0	16	2	3	21
Phenibut	0	16	0	0	16
Memantine	0	10	0	0	10
NALT	0	6	0	0	6
L-Dopa	0	6	0	0	6
Ginseng Root	1	4	0	0	5
Magnolia Bark	0	3	0	0	3
Depressants
Xanax	0	20	31	11	62
Weed/Cannabis	0	18	26	9	53
Alcohol	0	6	20	10	36
Valium	0	11	9	7	27
Diazepam	1	8	10	2	21
Klonopin	0	12	3	1	16
Kratom	0	5	5	1	11
Opiates	0	3	2	3	7

No competing interests reported.

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Exploring Harm Reduction Advice for Prescription Stimulants on Reddit

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Abstract

Background

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Background

Methods

Site Selection

Data Collection

Data Analysis

Results

Use of Additional Substances

Achieving a Healthy Lifestyle

Consulting a Doctor

Reducing Use

Discussion

Limitations

Conclusion

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References

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Additional Declarations

Supplementary Files

Status:

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