Keith Humphreys’s research while affiliated with Stanford University and other places

The opioid epidemic persists in the U.S., with over 80,000 deaths annually since 2021, primarily driven by synthetic opioids. Responding to this evolving epidemic requires reliable and timely information. One source of data is social media platforms. We assessed the utility of Reddit data for surveillance, covering heroin, prescription, and synthetic drugs. We built a natural language processing pipeline to identify opioid-related content and created a cohort of 1,689,039 Reddit users, each assigned to a state based on their previous Reddit activity. We measured their opioid-related posts over time and compared rates against CDC overdose and NFLIS report rates. To simulate the real-world prediction of synthetic opioid overdose rates, we added near real-time Reddit data to a model relying on CDC mortality data with a typical 6-month reporting lag. Reddit data significantly improved the prediction accuracy of overdose rates. This work suggests that social media can help monitor drug epidemics.

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.

Background: Over 60% of individuals with alcohol use disorder (AUD) resume hazardous drinking within 6 months post-treatment, necessitating the development of more efficacious interventions. Accumulating evidence suggests transcranial magnetic stimulation (TMS) is a promising intervention for AUD. This randomized, double-blind, placebo-controlled trial assessed the efficacy of intermittent theta burst (iTBS), a form of TMS, as an adjunct treatment for AUD. Methods: Forty-nine Veterans with AUD (48 males, 1 female) were recruited from residential AUD and substance use disorder treatment. Participants were randomized to 20 sessions of Active (n=25) or Sham (n=24) iTBS (1200 pulses/session), targeting the left dorsolateral prefrontal cortex (DLPFC) administered over 14 days or less. Five participants were withdrawn unrelated to iTBS procedure adverse events. Participant alcohol/substance use was monitored for 6-months following final iTBS session. Results: Relative to participants who received Sham iTBS, those who received Active iTBS showed a significantly greater reduction in percent heavy drinking days and a trend for higher rate of continuous abstinence over 6-months. Among participants who resumed alcohol consumption, those in the Active group demonstrated significantly lower quantity and duration of alcohol consumption than Sham. Pre-study alcohol consumption variables were not related to post-iTBS treatment outcomes. Conclusions: Findings indicated that Active left DLPFC iTBS, delivered over approximately 2-weeks, was a safe and efficient intervention for AUD that promoted significantly reduced heavy drinking and improved clinical outcomes compared to Sham over 6-months post-iTBS. This study provides novel data to inform and power future larger-scale, multi-site clinical trials employing iTBS for AUD.

This cross-sectional study compares annual state-level fatal drug overdose rates from 2020 through 2023 with the expected fatal drug overdose rates based on trajectories before the COVID-19 pandemic.

Deaths due to overdose and suicide together comprise an urgent public health challenge. Using VHA electronic health records, we identified patients with high-risk Emergency Department (ED) visits related to suicidality or overdose between January 2010–September 2019 using diagnostic codes from the International Classification of Diseases. We calculated standardized mortality ratios (SMR) for 90-day all-cause and cause-specific mortality associated with high-risk VHA ED visits compared with other VHA ED users, all VHA users, and the US general population. Among 20,382,060 ED visits from 3,705,984 unique Veterans, we identified 318,950 high-risk ED visits. The 90-day all-cause mortality rate among Veterans with high-risk ED visits was 2.81 times the expected rate (95%CI:2.72, 2.92) for other VHA ED users after adjusting for sex, race, and age. Rates remained elevated compared to all VHA users and the US general population. By race, mortality rates were markedly elevated among veterans identified as Asian or Pacific Islander (SMR=3.50, 95%CI:2.86,4.24) compared to other VHA ED users. The 90-day cause-specific SMRs were most pronounced for suicide, overdose, and accidents or unintentional self-harm. These results suggest that high-risk ED visits should trigger assertive, continued mental health care directed at reducing acute mortality through structured suicide prevention programs.

Background: Collegiate Recovery Programs (CRPs) play a vital and expanding role in supporting students in recovery from substance use disorders and behavioral addictions at higher education institutions. Despite their importance, there is a lack of comprehensive research characterizing CRPs, including their program directors and the nature and influence of their funding streams. Methods: A survey was administered to 70 CRP directors across the US and Canada. Directors reported on their CRPs across a variety of site physical features, policy and program offerings, and funding sources, with "sustainable" funding defined as two or more sources. Results: CRP directors were predominantly non-Hispanic, White, and female, with representation from gender and sexual minorities. The highest concentration of directors responding were in the US states of North Carolina, California, and Texas. CRPs with more than one funding source served twice as many students and had significantly more space, drop-in facilities, and relapse management policies. CRP directors had positive perceptions of harm reduction principles. Additionally, results highlighted the robust availability of All Recovery meetings and the wide diversity of mutual-help group meetings offered within CRPs and directors' positive perceptions of these meetings. Conclusion: This research lays a foundation for enhancing CRPs within higher education settings, emphasizing the significance of sustained funding and an inclusive support framework for the program directors that run CRPs. Future studies should further explore the effectiveness of CRPs and their impacts on the schools and students they serve.

Therapeutic claims about many psychedelic drugs have not been evaluated in any studies of even modest rigor. The science of psychedelic drugs is strengthening however, making it easier to differentiate some promising findings amid the hype that suffuses this research area. Ketamine has risks of adverse side effects (e.g., addiction and cystitis), but multiple studies suggest it can benefit individuals with treatment-resistant depression. Other therapeutic signals from psychedelic drug research that merit rigorous replication studies include 3,4-Methylenedioxymethamphetamine (MDMA) for post-traumatic stress disorder (PTSD) and psilocybin for depression, end of life dysphoria, and alcohol use disorder. The precise mechanisms through which psychedelic drugs can produce benefit and harm are not fully understood. Rigorous research is the best path forward for evaluating the therapeutic potential and mechanisms of psychedelic drugs. Policies governing the clinical use of these drugs should be informed by evidence and prioritize the protection of public health over the profit motive.