Lee Eleanor, Cooper Richard J
School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom.
JMIR Ment Health. 2019 Apr 25;6(4):e12354. doi: 10.2196/12354.
The use of codeine as an analgesic is well-recognized, 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.
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.
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. A total of 95 relevant posts were identified; a purposive sample of 25 posts was selected to undertake subsequent six-stage thematic analysis and development of emerging themes. These 25 posts were posted between 2003 and 2016 and comprised 757 individual posts.
Individuals created posts to actively request help in relation to usually their own, but occasionally their 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, 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 users' posts and, while 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 toward doctors and their prescribing practices.
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 suggested 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. Improvements in prescribing codeine and in the over-the-counter supply of codeine are required to prevent problematic use from occurring.
可待因作为一种镇痛药的用途已得到广泛认可，但人们越来越担心，对某些人来说，持续使用可能会导致滥用、成瘾和死亡。研究表明，受影响的人群可能是难以接触到的群体，他们不接受正规治疗服务。
本研究旨在探讨自我报告对可待因成瘾者的经历，特别是探讨如何利用社交媒体论坛就这一问题与他人进行交流。
经许可使用定性网络民族志方法，对社交媒体论坛Mumsnet进行研究，并于2016年搜索了所有与可待因和成瘾相关的帖子。共识别出95条相关帖子；从中选取25条帖子作为有目的的样本，进行后续的六阶段主题分析和新出现主题的发展。这25条帖子发布于2003年至2016年之间，包含757条个人帖子。
个人发布帖子，主要是就自己（偶尔也涉及伴侣或亲属）与可待因使用及自我报告的“成瘾”相关的问题积极寻求帮助。在关于可待因使用问题的叙述中提供了不同程度的细节。出现了对副作用的正面和负面描述、戒断经历中的问题以及停止使用可待因的尝试失败。从那些自我报告有医疗行业经验的人或普通受访者那里，对帖子的回应主要是积极和支持性的，他们经常借鉴自己类似问题的经历。治疗建议主要以两种方式出现，一是指向正规医疗服务，二是指向非正式方法，且往往是关于如何逐渐减少用量或采用突然停药方法的轶事性建议。一些帖子对原发帖者更为批评，对建议的争论和质疑并不罕见。羞耻和污名往往与用户的帖子相关，虽然在这个论坛上希望得到支持和治疗建议，但用户通常希望在生活的其他方面隐瞒自己使用可待因的情况。对于责任在于开处方者还是患者，出现了截然不同的观点。一些用户对医生及其开处方的做法表示愤怒。
本研究提供了独特的见解，揭示了个人如何利用公共互联网论坛来确认有问题的可待因使用情况并寻求支持，以及其他人的回应方式。互联网论坛以匿名方式提供此类信息，且普通受访者提出的治疗选择各不相同，这表明需要增加对可待因成瘾的正规支持和认识。可能有机会直接在这类在线论坛上提供进一步的支持。需要改进可待因的处方开具以及非处方供应，以防止出现有问题的使用情况。
