Analysis of the 25 threads revealed that they originated from various requests for help and guidance based on the narrative summaries provided. These included recurrent themes of side effects, both negative and positive, and strategies used to resolve problematic use and a variety of often negative emotions, such as stigma, shame, and embarrassment from those creating threads. Responses to original posts often offered support based on the lay responder’s similar experiences and associated empathy; responses also offered anecdotal suggestions to either seek formal health care treatment or use informal means of stopping codeine use (see Table 1).

Threads varied considerably in terms of characteristics, with the number of posts varying between 3 and 202; some posts were active for only a few days, but in some cases additional contributions were identified weeks or years later. Thread titles also varied and were often quite dramatic in tone, succinctly summarized the problem, and often posed a question. The majority of sampled posts related to individuals seeking help for themselves, but some involved a partner or relative (see Table 1). Threads also varied in terms of tone, style, interactions between posters, and the content and opinions of the posters. Contributors frequently used specific Mumsnet abbreviations such as OP (ie, original poster), DP (ie, dear partner), or XP (ie, ex-partner) to refer to others; they also used common phrases such as TBH (ie, to be honest) and AIBU (ie, am I being unreasonable), suggesting familiarity with website conventions. A recurrent theme was deleted posts across the threads; it was not possible to analyze such content or understand why posts had been deleted. One instance was identified where a Mumsnet moderator had become involved, but it was not clear why this had happened. The emerging themes are described in more detail in the following sections; participant names are not presented, and illustrations of quotes are paraphrased. Although this study sought insights into those who expressed self-reported “addiction,” the less pejorative term misuse will be used in the findings.

Threads usually involved a combination of descriptions of a problem involving codeine in the original post and subsequent requests for help and support. Original posts contained narratives that varied in the level of detail but often used emotive language and captured aspects such as why codeine had been used; how it was obtained; side effects experienced; and, for some but not all, what had been done to manage problematic codeine use. The latter reflected an important temporal aspect of the original posts, indicating the current situation of the person using codeine; this appeared to vary, with some reporting a problem that had recently been identified and others describing problems over a much longer time period. The excerpt below illustrates how the original post summarized the latter:

This was typical of almost all posts in ending with a request for help. It also illustrates how users appeared to have an awareness of a problem, specifically addiction, and how those responding to posts offered similar and often candid reflections of themselves, as in the quote below:

Concerns about anonymity were common; users referred intentionally to name changing and altering their usual forum username to another to avoid being recognized. Some original posters used terms such as ashamed, worried, or embarrassed to describe themselves in pseudonyms. Original posters referred to using such online forums for help and support as they did not feel they had support and encouragement in other aspects of their lives:

The majority of forum users stated that they had originally started taking codeine due to a problem that had required a health professional interaction. They described codeine use being initiated from a doctor’s prescription or from receiving advice from a pharmacist to take codeine combined with ibuprofen or paracetamol. The former presentations reflected conditions such as musculoskeletal problems and obstetric complications; the latter included more self-limiting conditions:

For some, codeine appeared to have been used alongside several other analgesics, but only occasional references were made by original posters and respondents about other addictions, such as dependency to alcohol or tobacco, and even less frequently about illegal substances. The doses consumed were only mentioned in some posts and respondents did not often seek such information. A recurrent theme in posts related to how codeine was acquired; for some, this was merely descriptive and involved reference to different durations of prescribing. Other accounts involved alternative routes to obtaining codeine, such as the use of multiple pharmacies or ordering online to avoid suspicion or detection:

A second key emerging theme related to the duality of side effects related to codeine use. Positive effects were reported not only in terms of codeine’s ability to relieve pain and allow individuals to function, but also in relation to perceived positive side effects, such as improving mood, inducing euphoria, and reducing anxiety. These were also associated with a perceived increased ability to cope. Posts invariably included more negative aspects related to negative side effects. These varied in type and intensity but included constipation, headache, sickness, lethargy, stomach pains, and a lack of concentration. The following original post illustrates this in relation to contrasting codeine side effects and the impact on the poster, particularly at work:

Requests for help often arose because of difficulties managing negative side effects of codeine. These were particularly acute in relation to withdrawal symptoms when individuals had recognized the need to reduce or stop their use of codeine. These were described by users who had attempted to stop codeine previously as well as by the original poster, as they often updated their thread with their progress. Side effects reported in relation to codeine withdrawal included headaches, gastrointestinal problems, flu-like symptoms, and general malaise:

In every thread, at least one user offered advice and support to the original poster but, as noted, the total number of respondents and posts varied considerably. Analysis did not reveal any obvious pattern as to whether aspects of the original post led to more or fewer responses. On most occasions, multiple users wrote positive comments even if they had no knowledge on the topic, as typified by a respondent:

Support responses could be distinguished from specific treatment advice, provided more general encouragement, and relied on psychological or emotional responses to try and reassure the original poster:

In contrast, other users gave more opinionated responses and warnings, which appeared to be intended to shock the original poster and to encourage action:

The other category of response related to more specific treatment advice. Two distinct categories of treatment advice were apparent, involving either self-treatment or engaging with treatment services. Of the former, two main types emerged relating to either tapering, involving reducing the dose of codeine gradually over a period of time, and using the cold turkey method , which involved an abrupt cessation of codeine. Some users gave experiences of both options and how to carry out such methods, such as involving supportive people and indicating how to gradually reduce the dose over time. Such advice was often experiential and appeared to be based on a respondent’s own attempts or from those they knew:

Other users suggested alternative medicines to assist with stopping codeine; examples included using essential oils, acupuncture, exercise, and yoga. Again, these appeared to be suggested based on experiential success by those offering the advice. However, some advice appeared to be more controversial and triggered more opinionated exchanges and responses from others:

Some respondents self-identified as having a health professional background and offered varying levels of detail and advice. At times, this professional knowledge and insight was used to influence or guide a thread in terms of correcting previous advice given, as typified in this exchange:

Many users, including professionals, replied to this message:

More commonly, though, original posters were advised to seek additional professional help beyond the forum. In some cases, this related to advice about where to seek help from other online forums where benefits were suggested, often allowing anonymity to be retained. In other responses, advice was given about other services such as Narcotics Anonymous and specialist drug services:

Two related and negative aspects of codeine misuse emerged in relation to concerns about it being stigmatizing as well as resulting in shame. Stigma often arose when comparisons were made between codeine and illicit drugs users. There was a perception that codeine misuse shared similarities to the use of illicit drugs such as heroin, despite being legal, and carried some of the stigmatizing negative societal views of illicit drug addiction:

References to being ashamed were very common in posts and, as noted previously, this arose in relation to changed usernames that contained such wording. In addition, a common manifestation of shame related to a desire to keep addiction secret from family members, doctors, and friends. Users expressed concern about the consequences of their addictions being on medical records, especially when they had responsibilities such as children and jobs. Others did not want to seek help from their doctor due to perceived negative consequences:

Codeine addiction appeared to place a strain on relationships with partners and family members. On multiple occasions, users became upset and expressed worry about the impact of addiction on their children, as well as the risk that their children may be taken away from them.

A further negative cluster of themes concerned views about who was perceived to be responsible for codeine addiction and where blame lay. Views differed and some arguments arose between individuals about this issue. Some commented that the person taking the codeine should be responsible for their own actions:

In contrast, others identified blame as arising with doctors for not giving proper advice and information about medicines with the potential for abuse and addiction:

The final theme concerned the relative absence of updates within threads about how the original poster’s situation had developed over time, even in those with many posts and over long time periods. Few users posted progress updates, but these were often only in the short term. A characteristic of all posts was the distinct absence of resolution or closure about the situation described in the original post. The following quote illustrates a post when an update was provided:

Where such progress was reported, other users offered their continued support, and sometimes other users posted at a later date asking about the original poster’s situation. Some respondents did describe their own experiences; in these, there was often more of a sense of finitude in contrast to the original post. These tended to be historic and were often also positive experiences that respondents offered as encouragement, linking to the earlier themes around support.

This study has provided a unique insight into how an internet forum is used by individuals to seek and receive help and support in relation to self-reported addiction to codeine and of the harms that can occur. This sample of Mumsnet users appeared to be candid, in terms of both the degree to which original posters offered often highly personal but anonymized accounts of problematic codeine use, as well as from those responding and offering their own experience and opinions and even challenging others. Self-reported addiction to codeine appeared to involve considerable anxiety for individuals, and side effects were a particular concern.

Study limitations relate to the use of only one medicine, codeine, and one internet forum; it is possible that other medicines and forums may have different user profiles and narratives [18]. The term addiction used in relation to codeine was self-reported; doses consumed were often not stated so may not reflect a clinically recognized addiction. User profiles were anonymous, so details relating to gender, age, and socioeconomic status could not be ascertained. As noted by Rier [31], the veracity of accounts provided could not be checked, nor did this study specifically seek to analyze the quality of information provided [18]. Further research is suggested involving other medicines and other sites.

Several themes in this study are suggestive of previously identified characteristics of prescription and over-the-counter medicine addiction, including the initial legitimate reason for starting codeine, which has also been identified among over-the-counter medicine misuse [6]. Posts also described the change in use and exploitation of what were perceived as positive effects, such as a “fuzzy effect” and euphoria; these data share similarities with some of the trip narratives described in more recreational drug use online posts [13]. Similarly, experiences of negative side effects also reflected those previously reported [7,32]. Strategies to address the problem also reflected what previous research has identified. Both individual and informal approaches, such as gradually reducing use or stopping use immediately, appeared most commonly as what had been tried or what had been suggested by others. Of note was that many suggestions were made about seeking formal addiction treatment support but with concerns from original posters about confidentiality [6].

Although this study did not seek to assess the quality of advice provided, there appeared to be variation in the quantity and type of treatment advice provided. However, there was also evidence of what have been termed counterbalancing comments, which have been argued to offset poor-quality advice; these have been identified in other online sites for health conditions [18]. However, given the relative absence of updates and conclusions to the original poster’s narratives, it is not possible to comment on the degree to which the original poster acted on the advice given. This finding, along with original posters initially seeking to use such public online sites as well as explicit concerns about not wanting to be identified via formal services, suggests that more still needs to be done to best support individuals affected by codeine, particularly in terms of treatment options. Concerns about existing treatment and support have emerged in previous research in relation to codeine and other medicines [6,33]. While this study does not offer specific recommendations for treatment change, it suggests that these online sites may represent important opportunities to provide support and their use should not be underestimated.

This research has additional implications for practice and further research. A key implication relates to the need to raise awareness among patients and the public regarding the harms related to codeine. A second implication and related recommendation is that online resources could be used more; there may be potential for online forums to be monitored and for more active support to be offered based on the content posted. Research involving nonsuicidal self-injury and analysis of posts about this topic on sites such as Instagram revealed that searches could detect problematic posts and that current warnings provided could be further enhanced [34]. There are opportunities for online forums to consider adding such warnings based on keywords relating to codeine addiction and other implicated medicines. Further research would be needed to consider the benefits and acceptability of such schemes. With regard to digital recovery, this research also has implications for how individuals affected by medicine misuse may gain benefits from social media sites by obtaining treatment or recovery information, as previous research has suggested [22]. This would also require further research and evaluation, particularly to address this study’s findings of absent endings.

Codeine is an important analgesic available both by prescription and over-the-counter in the United Kingdom and around the world. This study offers further evidence that the use of codeine can become problematic; caution is needed in relation to prescribing and supplying codeine as well as in being vigilant in changes in use among patients. This study provides a unique additional insight into how a popular public internet forum can be used by individuals to explore problematic codeine use. In particular, the interactive nature of the forum offers a range of opportunities for others to provide advice and support. However, while this was often very positive, some negative comments emerged and treatment advice also varied. Self-reported codeine addiction was associated with considerable negativity in terms of the harms and side effects reported, the impact it had on individuals, and the associated blame and stigma. Increasing understanding of this issue is still needed for both health professionals and the public, but there may be unique opportunities in the online forums themselves to offer additional support and information. Uncertainty about treatment options suggests that more guidance and support is needed for those affected to help them overcome their problems.