Harm reduction and knowledge exchange on drug-related Internet discussion forums

[Chip (OP)]

source: https://harmreductionjournal.biomedcentral.com/articles/10.1186/1477-7517-11-25

Harm reduction and knowledge exchange—a qualitative analysis of drug-related Internet discussion forums

08 September 2014

Some excerpts only - see the source link for the full article

Abstract

Background

Novel psychoactive substances (NPS) are continuously and increasingly appearing on the international drug market. Global Internet forums are a publicly available reality where users anonymously discuss and share information about NPS. The aim of this study was to explore and characterize the discussions about NPS on international Internet forums.

Methods

The most post-frequent NPS discussions were collected from three “leading edge” international Internet forums. A total of 13,082 posts from 60 threads of discussion were systematically examined and interpreted to reveal recurring topics and patterns. Each thread was coded with emerging topics and supporting quotations from the data set. Eventually, codes with coherent meaning were arranged into 51 broader categories of abstraction, which were combined into four overarching themes.

Results

Four themes emerged during the analysis: (1) uncovering the substance facts, (2) dosage and administration, (3) subjectively experienced effects, and (4) support and safety. The first theme dealt primarily with substance identification, pharmacology, and assessed not only purity but also legal status and acquisition. The second theme focused on administration techniques, dose recommendations, technical talk about equipment, and preferred settings for drug use. The third theme involved a multitude of self-reported experiences, in which many different aspects of intoxication were depicted in great detail. The users emphasized both positive and negative experiences. The last theme incorporated the efforts of the communities to prevent and minimize harm by sharing information about potential risks of the harmful effects or contraindications of a substance. Also, online support and guidance were given to intoxicated persons who experienced bad or fearful reactions.

Conclusions

The findings showed that the discussions were characterized by a social process in which users supported each other and exchanged an extensive and cumulative amount of knowledge about NPS and how to use them safely. Although this publicly available knowledge could entail an increase in drug use, the main characteristics of the discussions in general were a concern for safety and harm reduction, not for recruiting new users. Drug-related Internet forums could be used as a location for drug prevention, as well as a source of information for further research about NPS.

Background

A profound shift in the market for recreational drugs has occurred. The availability and number of unregulated novel psychoactive substances (NPS) have continuously increased and expanded into a global phenomenon[1–3]. For four consecutive years, the European Union early warning system on drugs has detected a record high and growing number of new substances and online vendors. In total, 280 substances, including stimulants, synthetic cannabinoids, hallucinogens, dissociatives, and sedatives, are currently being monitored by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). However, NPS prevalence is somewhat uncertain since the increase of substances could reflect an improved capacity for detection and monitoring[4]. Moreover, the limited number of demographic studies is often based on different substances or nonrepresentative samples and shows varying results across populations[5–7]. A survey[5] investigating the use of NPS among youth in Europe found that an average of 5% had experience of use, a number that differed significantly among nations. Most sources indicate that users are primarily young males[8, 9], although a recent study[10] reported that middle-aged adults constituted a quarter of the sample.

NPS, also referred to as “legal highs”, “designer drugs”, or “research chemicals”, often mimic the effects of corresponding illicit drugs and are intentionally produced to circumvent existing drug laws[11]. Legal responses are to some extent ineffective, partly because clandestine chemists quickly adapt to and exploit new legislations by marketing substances with slight molecular deviation but preserved psychoactive effect[12–14]. In addition, NPS are often sold surreptitiously as, for example, “bath salt” or “plant food” and labeled “not for human consumption” in order to avoid legislative attention. Furthermore, the use of the Internet as a marketplace, rather than the streets, is believed to impede regulatory actions and promote availability[1].

There are very limited information and published data on NPS available to either users or health-care personnel[15, 16]. These substances have rarely or never been subjected to studies on humans or animals, which make them highly unpredictable. Long-term effects, dependency potential, toxicological risks, or possible contraindications are largely unknown. In addition, content declaration or warnings about side effects or hazardous substance interactions are mostly lacking[17]. In order to provide knowledge of these substances, and patterns of human use, data from other sources like the Internet have been suggested and utilized for scientific studies[16, 18–20]. For example, self-reports posted on public Internet forums have been analyzed to investigate the characteristics of experience with substances as 4-HO-MET, MXE, and “Spice”[21–23]. Although anecdotal data from the Internet have been claimed to be biased or unreliable[16, 19], our recent NPS study[24] based on Internet discussion forum data showed that the results were highly congruent with the findings of studies based on clinical data.

Regardless of the degree of validity, publicly available content on the Internet is an undeniable reality, which remains the major source of information for youths with sensitive or health- and drug-related issues of concern[5, 25, 26]. Internet discussion forums provide a global and anonymous environment in which sharing of drug-related information is a prominent feature. Other documented forum characteristics include social cohesion and support, as well as a focus on harm reduction[27, 28]. Another study[21] has also emphasized the social togetherness among closed groups of NPS users, which highlights a need to share and discuss with peers. Hence, there are strong reasons to further investigate drug-related Internet communities and the ongoing discussions in greater depth. It is important to examine what users are talking about explicitly, as well as investigating any implicit features of the discussions in general, not only to understand the reality facing young people online but also to examine the possibilities for future research and prevention strategies.

The aim of this study was to explore, define, and characterize the discussions about novel psychoactive substances on international Internet forums.


Results

The analysis of post-frequent and drug-related discussions on international Internet forums generated 51 categorized topics based on 13,082 user posts, which were combined into four overarching themes of discussion: (1) uncovering the substance facts, (2) dosage and administration, (3) subjectively experienced effects, and (4) support and safety. The themes are presented below with some representative quotations.

Uncovering the substance facts

This theme incorporates the users’ discussions about specific NPS and their objective properties and appearance. A wide variety of known NPS, such as different types of synthetic cannabinoids, stimulants, dissociatives, and hallucinogens, were discussed. See Table 2 for a full list of NPS found in the thread titles of this study. There were also discussions about branded NPS in which the actual psychoactive component was concealed or unknown, which resulted in elaborate speculations about the content: “Vendor will not reveal the molecule”. / “I have used both chemicals and believe they are different. ‘Sunshine’ is not Methylone either”.

It was very common to compare the NPS discussed with traditional counterpart drugs or previously occurring NPS and rate them accordingly. Another recurring topic was how and where a substance was acquired: “I really want to try this, could anyone post where to get it?” to which another user responded: “Hello, you have an email”. Selling drugs via the forums or linking to sites that offered drugs was officially not allowed, so these discussions were mostly moderated or continued nonpublicly: “Can someone pm [Personal Message] me a vendor in the US?” Different vendors were nevertheless mentioned in talks about their offered products or in discussions related to price, shipping, and the overall evaluation of the vendors’ service. General discussions about NPS availability were also found, which often included descriptions of where the NPS was encountered, such as online or in real life. In addition, the reports of availability were closely linked to discussions of the legal status in different countries: “Canada’s drug act does not list Ethylphenidate, and no analog law for Methylphenidate exists so you should be legally safe here”. Potentially legal consequences of possession or purchase of NPS were also mentioned.

Other more in-depth substance talk involved chemistry and pharmacology. Users speculated about how substances were built molecularly and how specific chemicals interacted with the brain and body to produce certain effects, for example, “Both stereoisomers are most likely active (as with amphetamine). In that case, it’s a matter preference: dopaminergic or noradrenergic effects. Choose for yourself”. The origin and history of certain NPS were discussed as well. Furthermore, users talked about how the use of certain chemicals could have contraindications with both traditional substances and other NPS. Related to pharmacology was the topic of tolerance from repeated use of the same substance and cross-tolerance between chemically similar substances.

Toxicity was also found to be of interest for the users, and many discussions focused on theoretical speculation of a substance’s overall harm potential: “The neurotoxicity of 4-Fluoroamphetamine derive from the release of large amounts of serotonin from the neuron, as well as general inhibiting effects of neuronal processes”. Moreover, discussions focused on the exterior appearance of different NPS and the assessed purity. Users described if the NPS was produced in the form of a pill, powder, or other. The users gave detailed reports on appearance, feel, smell, and taste. They also assessed the identity, quality, and purity from the appearance, for example, “My powder has a distinct benzene-like chemical odor and a blueish/greenish color. Unlike former yellowish odorless batches, I think this one might have impurities”.

Dosage and administration

This theme consists of topics related to circumstances surrounding the administration of NPS. Dosage was found to be a widely debated topic of discussion. Many opinions and estimations about dosing and re-dosing were stated. Users also asked for advice on specific dose recommendations with regard to individual traits as previous experience, body weight, built-up tolerance of the drug, etc. They also speculated about how the dose could affect the experience and intensity of effects and suggested different doses for specific purposes, for example, “I think 15 mg is perfect for moderate effects - great for watching movies! Then at 30 mg the visual impressions and euphoria increase dramatically”. The route of administration was given much attention. Users described several different ways in which different NPS were taken, such as nasally, intravenously, and orally. Opinions about the best way to ingest a specific substance were very common: “I don’t recommend insufflation and the taste is awful. Rectal administration is recommended for a rapid onset”.

Technical talk about things such as do-it-yourself smoking devices and weighing and purification of a substance were found: “Did you wash the crystals before recrystallization? If so, which solvent(s) did you use?” Taking a specific NPS in combination with other drugs and how the different effects would interact with or supplement each other were also discussed: “I want to experience Methylone, Mephedrone and MDPV in one go. Who has tried this or can give advice on dosage?”

The circumstances and surroundings in which the drugs were administered were shared among users. They also asked for, or proposed to others, several settings and recreational activities: “How would this substance suit a nightclub setting?” Users also discussed their expectations of the upcoming experience of NPS and their mood or state of mind when taking the drug. They were suggesting and sharing different purposes of using drugs, for example, study aid, recreation, self-medicating, curiosity, and personal development.


Conclusions

Discussions on drug-related Internet forums were characterized by a communal process in which users supported each other and exchanged an extensive and cumulative amount of knowledge about previously unfamiliar substances. The discussions uncovered the substance facts such as identity, origin, quality, legal status, acquisition, and pharmacology. Users also talked about circumstances related to the administration, including intentions, settings, individual dosing, safe combination of drugs, and administration techniques. Furthermore, a plethora of subjectively experienced effects were shared among users in a connoisseur-like manner. These reports were nuanced and comprehensive, which was suggested to reflect the users’ concern for support and safety. On the whole, harm reduction emerged as the main characteristic that permeated the discussions. In addition, users warned each other about potential risks and side effects and supported each other with advice and guidance. The findings in the present study contribute to the understanding of the online reality that faces youth in search of drug-related information. Also, the discussion forums could be used for drug prevention, as well as a source of information for further research about NPS.