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

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.

Heaven and hell--a phenomenological study of recreational use of 4-HO-MET in Sweden.

The psychoactive substance 4-HO-MET (4-hydroxy-N-methyl-N-ethyltryptamine) with psychedelic qualities is one of many legal so-called Internet drugs. The aim of this qualitative study was to establish an understanding of what characterizes its recreational use. Very little is known about the effects of this substance. Twenty-five anonymous Swedish experience reports (from persons aged 18-30 years) from public Internet forums were analyzed using the Empirical Phenomenological Psychological Method. The analysis produced 37 categories that were compiled into nine general themes: (1) motivation, preparation and expectation; (2) initial effects; (3) change of perception; (4) unfiltered awareness and intensified flow of information; (5) lateral cognition; (6) border between subject and object is erased; (7) heaven; (8) hell; and (9) subsiding effects. An understanding of the chronological happenings, called The Process, appeared out of the general structure. Drastic changes in cognitive, emotional and bodily functions were described. The motivation for use seemed to be driven by a strong curiosity. The experiences shifted between "heaven" and "hell," but participants appeared satisfied and ready to repeat the experience. The experiences described show great similarity with classic psychedelic substances as LSD or psilocybin. More research is needed about health hazards or possible therapeutic potentials.

Alarming attitudinal barriers to help-seeking in drug-related emergency situations: Results from a Swedish online survey.

BACKGROUND: New troublesome drug trends constitute a challenge for public health. Sweden has the second highest drug-related mortality rate in Europe. This calls for an investigation into the help-seeking attitudes of young adults to early middle-aged individuals asking how they would act in acute drug-related emergency or overdose situations. METHODS: In total, 1232 individuals completed an online survey promoted on Sweden's largest discussion forum Flashback.org. Their free-text responses were analysed according to inductively generated categories. RESULTS: Around 60% of the sample would act as expected and contact emergency care without hesitation. However, approximately 32% of the sample showed palpable resistance and would put off seeking help and use emergency care only as a last resort due to, for example, fear of legal repercussions and stigma. Moreover, 8% displayed a total lack of confidence in public healthcare and would avoid it at all costs or entirely disregard it as an option due to the alleged risk of negative consequences and experienced restrictions on their personal freedom. CONCLUSIONS: While the inevitable criminalisation and stigmatisation associated with Sweden's "zero tolerance" drug policy putatively serve as deterrents to drug use, our results demonstrate that these measures may also contribute to attitudes which discourage help-seeking. Such attitudes may at least partly explain the growing and comparatively high number of drug-induced deaths. Therefore, attitudinal and structural barriers to acute help-seeking in drug-related emergency situations should be acknowledged and investigated further in order to minimise harm.

The diverse reasons for using Novel Psychoactive Substances - A qualitative study of the users' own perspectives.

BACKGROUND: The increasing number of legally ambiguous and precarious Novel Psychoactive Substances (NPS) constitutes a challenge for policy makers and public health. Scientific and more in-depth knowledge about the motivations for using NPS is scarce and often consist of predetermined, non-systematic, or poorly described reasons deduced from top-down approaches. Therefore, the aim of the present study was to explore and characterize the users' self-reported reasons for NPS use inductively and more comprehensively. METHODS: The self-reported reasons of a self-selected sample of 613 international NPS users were collected via an online survey promoted at the international drug discussion forum bluelight.org and later analyzed qualitatively using inductive thematic analysis. RESULTS: The analysis showed that the participants used NPS because these compounds reportedly: 1) enabled safer and more convenient drug use, 2) satisfied a curiosity and interest about the effects, 3) facilitated a novel and exciting adventure, 4) promoted self-exploration and personal growth, 5) functioned as coping agents, 6) enhanced abilities and performance, 7) fostered social bonding and belonging, and 8) acted as a means for recreation and pleasure. The consumption of NPS was also driven by 9) problematic and unintentional use. CONCLUSION: The present study contributed to a more comprehensive understanding of the users' own and self-reported reasons for using NPS, which needs to be acknowledged not only in order to minimize drug related harm and drug user alienation but also to improve prevention efforts and reduce the potentially counter-intuitive effects of strictly prohibitive policies.

The users of Novel Psychoactive Substances: Online survey about their characteristics, attitudes and motivations.

BACKGROUND: The increasing number of Novel Psychoactive Substances (NPS) constitutes a challenge for public health agencies and researchers worldwide. Scientific studies about NPS and their users are limited and there is a need to explore the general motivations for NPS use but also to examine if and how the motivations differ between substances from separate effect classes. The aim of the present study was to investigate the characteristics, including attitudes and motivations, of a self-selected sample of international NPS users. METHODS: An online survey containing questions about drug use history, attitudes, motivations for use, and WHO-5 Wellbeing Index was promoted at the drug discussion forum bluelight.org. The data was analysed using SPSS. RESULTS: The sample consisted of 619 international NPS users with overall good emotional well-being despite extensive experience of both traditional and novel drugs. The main incentive for use of NPS in general was pleasure and enjoyment. However, going beyond the general approach to NPS revealed significant variations between drug groups. For example, the use of hallucinogens was substantially motivated by self-exploration and spiritual attainment and showed very low levels of addiction potential while the use of opioids and especially GABA activating substances was mainly motivated by coping and showed much higher levels of addiction potential. Synthetic cannabinoids were the least appreciated and least likely to be used again, and were mainly motivated by circumstances such as availability and legality. CONCLUSION: Understanding the different motivations for NPS use in terms of drug groups could enable more effective prevention and consequently a reduction in harm.

"Chasing the high" - experiences of ethylphenidate as described on international internet forums.

Ethylphenidate is a novel psychoactive substance with undocumented effects, risks, and motivation for use. In this study, we investigated the experience of ethylphenidate by analyzing self-reports published on Internet forums, which revealed seven overarching themes: (1) compulsive redosing and addiction; (2) impacts on the mental state; (3) bodily agitation; (4) increased sociableness; (5) administration; (6) diverse evaluations based on intention; and (7) safety and precaution. Ethylphenidate appeared as a potent psychostimulant with an imminent abuse potential. It was mainly used for recreational purposes. The effects included not only pleasurable stimulation, euphoria, and cognitive enhancement but also indecisiveness, anxiety, and cognitive fragmentation. The users reported an increase in body temperature, heart rate, and blood pressure, but they also experienced profuse sweating and muscle tension. Ethylphenidate acted as a social lubricant, enhancing intimacy, communication, and social skills. Two opposing user mentalities were uncovered: (1) pleasure seeking and risk neglecting, and (2) safety-first orientation. This information could be of importance to legislators, public health personnel, and prevention strategists.

Fascination and Social Togetherness-Discussions about Spice Smoking on a Swedish Internet Forum.

Spice is a smoking mixture containing synthetic cannabinoids with psychoactive effects similar to herbal cannabis. It is sold on the Internet and has become popular among young people. The purpose of the present study was to investigate experiences of intoxication induced by Spice, as described on a Swedish internet-based discussion forum. A systematic search yielded 40 reports, which were analyzed using phenomenological method. A total of 7 themes (composed of 27 categories) emerged from the analysis: 1. Spice use as social ritual; 2. Social secretiveness; 3. Intoxication remarks; 4. Well-being and elation; 5. Altered perception of reality; 6. Fears and coping; 7. Unpleasant physical effects. The results show that smoking was a social activity mostly carried out in small peer-groups, and that the substances induced strong intoxication with both positive and negative effects. Despite fears and unpleasant effects, the intoxication was often considered fascinating and rewarding.