P2.A013: Exploring TikTok's Censorship and Dissemination of Opioid-Related Content

Background: TikTok is a global social media platform that has over a billion users, with >50% under 35 years old, who have access to view and share content. There are increasing concerns regarding opioid overdose in the adolescent and young adult populations. Given the opioid epidemic and recent political discussions on banning TikTok from the US, this cross-sectional study investigates the current level of TikTok’s management and dissemination of opioid-related content.

Methods: A cross-sectional study was performed on January 15, 2024. A new TikTok account was created using a new email account. Utilizing search function, we investigated 18 opioid-related terminology. For those that TikTok restricted from search, we documented the type of restriction notification and attempted to circumvent the restriction by adding “s” to the end of the restricted terminology. If restrictions were successfully circumvented, we utilized “Top” page of TikTok to examine the first 10 videos listed. If restrictions were not successfully circumvented, there were additional attempts with added letters/words/phrases. Videos were categorized and analyzed based on creator type, content, and number of views. TikTok was operated on a single computer to avoid any potential variations that may occur using other devices.

Results: When creating TikTok account, users are required to be ≥13 years, but no age verification tools were present.

170 videos were analyzed. 11 restricted terminology among the 18 opioid-related terminology inputted into TikTok’s search function. 10 of those restricted terminology were able to be circumvented with the addition of “s” and only “heroin” was unable to be circumvented, even with additional efforts.

We observed two main TikTok restriction notifications with links to TikTok’s Substance Support page and Community Guidelines page. These are not randomly generated, and are attached to the specific opioid-related terminology, but we are unable to determine any particular pattern. A 3rd notification associated only with “opioid overdose” was noted, which was “You are not alone” with the same link to TikTok’s Substance Support and phone numbers to be connected with the Crisis Text Line.

Healthcare providers/organizations created minority of videos (80/170; 47.0%), of which majority provided educational information (67/80; 83.7%). From the 170 videos, there were a total of 52,689,956 views with minority views from healthcare providers/organizations (18,534,720/52,689,956; 35.1%).

Conclusion: This study reveals that TikTok's restrictions on opioid-related content are not entirely foolproof, allowing users to easily circumvent restrictions by slightly modifying the terminology. Albeit there is evidence of basic restrictions and opioid education, there is a gap in the reach of critical health information by healthcare providers. These results suggest users, who are primarily adolescents and young adults, are being exposed to opioid-related content on TikTok without adequate restriction or education. Limitations of this study includes analyzing data from a single point in time.