Confessions of contemporary English opium-eaters: a netnographic study of consumer negotiation of over-the-counter morphine for misuse

A Mapping Review of Netnography in Nursing

People use the Web to seek health-related information and to discuss health issues with peers. Netnography, a qualitative research methodology, has gained the attention of researchers interested in people's health and health issues. However, no previous reviews have accounted for how netnography is used in nursing research. The purpose of this mapping review was to generate a map of netnographic research in nursing. The search was conducted in PubMed, Academic Search Elite, the Cumulative Index to Nursing and Allied Health Literature, Medline, PsycINFO, Scopus, and Web of Science. Data were extracted from 53 original articles. The results show an increasing trend in published netnographies over time; 34% of the total sample was published in 2021. Of the total, 28% originated from Sweden, and 81% had used a covert approach. In studies in which the researchers used more participatory designs, the time spent on online forums ranged between 4 weeks and 20 months. Informed consent is found to be an issue in netnographic studies. We discuss the fact that nursing researchers have used netnography to address a wide range of research topics of concern and interest, from self-care support in an online forum for older adults to nursing students' perspectives on effective pedagogy. In line with the digital transformation in society in general, we discuss the fact that netnography as a research methodology offers great opportunities for nurse researchers to monitor new spaces and places that presuppose online methodological knowledge.

2,4 dinitrophenol: It's not just for men

BACKGROUND

2,4 dinitrophenol (DNP) is an organic compound which causes thermogenesis resulting in fat burning and weight loss. Although not licensed for human consumption, the globalised access to and information about this compound on the internet has prompted a renewed interest in DNP making it readily available to purchase online.  Studies into user experiences remain scarce and much of the previous literature has focused on DNP use in male dominated bodybuilding communities. While online accounts of female DNP use are plentiful, this group are under researched.

METHOD

Ten online forums containing female discussion of DNP were identified and 440 threads subjected to a thematic analysis. Semi structured interviews were conducted with four forum moderators (all men) and one woman who reported use of DNP.

RESULTS

The findings highlighted diverse motivations for why women use DNP as well as differences in experiences, dosing regimens, willingness to take risks and adverse effects. Many women reported using online forums to seek advice and trusted the information they received. However, much of the discussion and protocols for use online is perpetuated by and geared towards men, with DNP seen as a 'hard core' drug that is not suitable for women. Female DNP use was frequently stigmatised because the potential risks were seen to be at odds with women's roles as mothers and caregivers. Women who used DNP were often ignored, ridiculed or seen as novice users, while men were viewed as the DNP experts.

CONCLUSION

This study provides an overview of female experiences of DNP use. There is a growing body of evidence as to the harms associated with this compound and there are no guaranteed 'safe' regimens that can be advocated for any potential user. Users equate deaths or ill harms from DNP with incorrect dosing or insufficient knowledge of the impact of the drug on the body. This leads women to incorrectly assume that if they are not suffering ill effects they are using DNP safely. Of key concern from this study is that within a vacuum of harm reduction advice, women are reported to be accepting DNP advice circulating in male-dominated forums and adopting the protocols of male bodybuilders with potentially fatal consequences. Furthermore, women using DNP are doing so without any 'real world' support, gender sensitive treatment pathways or interventions in place.

Designing Effective Warnings about Addiction on the Patient Information Leaflet of Over-the-Counter Codeine Sold in England to University Students

(1) Background: The harm of misusing over-the-counter (OTC) codeine-containing medicines among university students in England is being increasingly recognized. Based on English university students, this paper aims to study the importance of information design on information communication, explore methods for effective warning design, and investigate university students’ perception of OTC codeine. (2) Methods: The effective warning design is addressed through case studies, answering correctness by the heat map generated from the eye-tracking experiment (ETE), and the total time spent on the tasks. User perceptions are made though online surveys. (3) Results: Information design significantly affects the way user processes information. Therefore, two emphasized warnings displayed in the headline, and the “possible side effect (PSE)” sections and warning signs of addiction presented under the PSE are suggested as effective ways to display warnings. For students’ perception of OTC codeine, 80% of university students are unfamiliar with the substance. After reading the patient information leaflets (PILs), 47% recommended tight regulation on codeine. (4) Conclusions: The misuse of OTC codeine could be a potential problem among English university students. The design of the PIL significantly influences the chance of unintentional medicine misuse. The display of warnings on the PILs of OTC codeine should be redesigned for better understanding.

Home Manufacture of Drugs: An Online Investigation and a Toxicological Reality Check of Online Discussions on Drug Chemistry

Emerging trends in market dynamics and the use of new psychoactive substances are both a public health concern and a complex regulatory issue. One novel area of investigation is the availability of homemade opioids, amphetamines and dissociatives, and the potential fueling of interest in clandestine home manufacture of drugs via the Internet. We illustrate here how online communal folk pharmacology of homemade drugs on drug website forums may actually inform home manufacture practices or contribute to the reduction of harms associated with this practice. Discrepancies between online information around purification and making homemade drugs safer, and the synthesis of the same substances in a proper laboratory environment, exist. Moderation and shutdown of synthesis queries and discussions online are grounded in drug websites adhering to harm-reduction principles by facilitating discussions around purification of homemade drugs only. Drug discussion forums should consider reevaluating their policies on chemistry discussions in aiming to reach people who cannot or will not refrain from cooking their own drugs with credible information that may contribute to reductions in the harms associated with this practice.