JMIR Publications

ABSTRACT

Background:

The use of codeine as an analgesic is well recognised but there are increasing concerns that for some individuals, continued use may lead to misuse, dependence and fatalities. Research suggests that those affected may represent a hard to reach group who do not engage with formal treatment services.

Objective:

This study sought to explore the experiences of people with self-reported addiction to codeine and specifically, how a social media forum is used to communicate with others about this issue.

Methods:

Using a qualitative netnographic methodology, the social media forum Mumsnet was used, with permission, and searches were undertaken in 2016 of any posts that related to codeine and addiction. 95 relevant posts were identified and a purposive sample of 25 (posted between 2003 and 2016 and comprising 757 individual posts) was selected to undertake subsequent 6-stage thematic analysis and development of emerging themes.

Results:

Individuals created posts to actively request help in relation to, usually their own, but occasionally partner’s or relative’s, problems relating to codeine use and self-reported ‘addiction’. Varying levels of detail were provided in narratives of problematic codeine use. There were both positive and negative descriptions of side effects emerging and problems experiencing withdrawal and failed attempts to discontinue codeine use. Mainly positive and supportive responses to posts were identified from those with either self-reported health profession experience or lay respondents, who often drew on their own experiences of similar problems. Treatment advice emerged in two main ways, either as signposting to formal health services, or to informal approaches and often anecdotal advice about how to ‘taper’ or use ‘cold turkey’ techniques. Some posts were more critical of the original poster and arguments and challenges to advice were not uncommon. Shame and stigma were often associated with user's posts and whilst there was a desire to receive support and treatment advice in this forum, users often wanted to keep their codeine use hidden in other aspects of their lives. Distinctly different views emerged as to whether responsibility lay with prescribers or patients. Some users expressed anger towards doctors and their prescribing.

Conclusions:

This study provides a unique insight into how a public internet forum is used by individuals to confirm and seek support about problematic codeine use, and of the ways others respond. The pseudonymous use of internet forums for such information and variation in treatment options provided by often lay respondents suggest that increased formal support and awareness about codeine addiction are needed. There may be opportunities for providing further support directly on such online forums also. Improvements in prescribing and over-the-counter supply of codeine are required to prevent problematic use from occurring.