Factors associated with prescription and over-the-counter drug misuse and overdose among users in online communities: a qualitative study

Background Non-medical use of prescription drugs (NMUPD) and over-the-counter (OTC) drug misuse have become significant public health concerns in China. Online communities have emerged as platforms where users share drug misuse and overdose related experiences. However, research on the mechanisms and process of knowledge dissemination within these communities, psychological vulnerabilities, behavior characteristics and cognitive processes of the community users remain limited. This study aimed to explore factors associated with users’ drug misuse and intentional overdose behavior within a Chinese online forum. Methods A qualitative thematic analysis approach was adopted. A purposive sample of 160 self-reported narratives was collected from a Chinese online forum where users post and archived drug misuse and intentional overdose experiences. Thematic analysis was conducted using MAXQDA 2020 software. Available demographic and drug use data were also extracted. Results Dextromethorphan (38.8%), amantadine (23.8%), and pregabalin (23.1%) were the most frequently reported drugs involving misuse and overdose in the forum. Three main themes were produced: Theme 1: Self-identified “experienced users,” comprised three subthemes: Knowledge disseminator and harm reduction practitioner, Trust and emotional links, Ethical tension between claims and actions. Theme 2: Psychological distress, emotional problems and suicide attempts, comprised two subthemes: Self-treatment for mental or emotional problems, Overdose as a suicide attempt. Theme 3: Cognitive biases sustaining overdose, comprised two subthemes: Positive perceptions and expectancies on overdose experience, Ignorance of negative information. Conclusion This qualitative thematic study explored how community authority, psychological vulnerabilities and cognitive characteristics impact on drug misuse and overdose behaviors in an online forum. Future prevention should leverage the trusted community authority role by training community-engaged peer educators to deliver evidence-based drug-related risk information to realize the aim of harm reduction.