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

Global increases in misuse of pharmaceutical opioids are a public health concern. Over-the-counter (OTC) morphine preparations are sold in the UK. A netnographic study explored online reporting of misuse of OTC morphine-based medicines. A systematic internet search was conducted using the terms; “J Collis Browne’s Mixture”; “J Collis Browne”; “Chlorodyne”; “Gee's Linctus”; “Morphine Squill”; “Kaolin & Morphine Mixture”; and “Opiate Squill Linctus” in combination with “forum”. Following application of exclusion criteria and removal of duplicates, 105 fora threads on 11 publically available online fora were analysed using the EPP method. Key decision-making factors for misuse was grounded in legal availability, curiosity and when in withdrawal. Consumptive effects included euphoria, nausea, vomiting and sedation, and were dependent on tolerance. Concern for harm associated with product additives (squill, kaolin) was reported. Decantation extracted morphine from kaolin-based products. Concerted sourcing efforts included multiple pharmacy accessing, appropriate customer profiling and falsifying medical screening. Displacement to online purchasing occurred, with concern for online sharing of customer information. Development of real-time pharmacy monitoring should incorporate national online pharmacy chains. Continued surveillance of internet drug fora as medium for knowledge exchange and indigenous harm reduction for the misuse of OTC medicines is warranted