Abstract Monitoring opioid-related chatter on social media can predict the course of opioid addiction and the overdose epidemic. We assessed the utility of TikTok, a prominent short video-based social media platform, as a means of tracking the opioid addiction and overdose crisis. We collected 569,581 TikTok comments (posted between January 2021 and June 2025) from 48,306 opioid-related videos, making this study the first large-scale analysis of TikTok comments for opioid surveillance.