Naloxone narratives: Characterizing harm reduction discourse on TikTok
Though life-saving opioid overdose reversal medications are widely available, annual drug overdose deaths remain at all-time highs, and increased education about how to access and administer naloxone (also known as Narcan) is needed. Popular social media platforms may represent a means through which to provide such harm reduction education. This study explored naloxone content on the short video-sharing social media platform, TikTok.
The number of national drug overdose deaths per year has risen to more than 100,000 in recent years, and opioid use is implicated in approximately 3 out of every 4 of these deaths. Naloxone (also known by the brand name Narcan in its nasal spray formulation) is an empirically supported, life-saving medication that temporarily reverses the effects of opioid overdose. Despite the increasing availability of naloxone – including standing prescriptions in pharmacies and over-the-counter availability in some US states – annual drug overdose deaths have generally remained stable. While many individuals are aware of the existence of naloxone, they often do not know how to access or administer the medication during an overdose. This highlights a need for increased education.
There is a growing reliance on social and web-based technologies for information amongst the general public, including health-related information. In fact, the majority of individuals search for answers to health-related questions online, often using popular search engines like Google and social media platforms like TikTok, a short-video sharing platform with hundreds of millions of global active users. This is true even for questions more sensitive in nature (e.g., those pertaining to substance use). Unfortunately, there is a mix of high- and low-quality information, or even misinformation, presented to individuals online. Moving forward, it will be crucial to explore and characterize the types of health-related content individuals are exposed to via the online information ecosystem and to shape the health-related narratives being presented to global audiences via these online technologies. With this in mind, the present study explored naloxone-related videos on TikTok to explore themes present within this content and how the videos were being used to educate the public on harm reduction.
HOW WAS THIS STUDY CONDUCTED?
The researchers extracted all public videos posted between June 5, 2020 and October 4, 2022 using either of two hashtags: #narcansaveslives or #naloxonesaveslives. Hashtags are used to help organize and locate content on specific topics. The two hashtags used for this study were intended to capture videos related to advocacy for naloxone. This resulted in a sample of 977 videos, from which the researchers extracted a random subsample of 100 videos for subsequent manual qualitative content analysis exploring themes within the videos. The researchers created transcripts for each video and exported them into a spreadsheet with other video- (e.g., text included in the video) and account-level variables (e.g., account description). One of the researchers reviewed 10 of the videos to develop an initial version of the codebook. Then, two team members met to discuss, refine, and finalize the codebook before proceeding to final coding procedures. During coding, the researchers considered both visual (e.g., setting) and audio (e.g., types of sound and music used throughout the video, emotions evoked) elements of the videos. The researchers also coded for whether the videos were reactions to other videos as well as their tone and whether any personal experiences or specific drugs were mentioned. Of note, there were no quantitative results presented on how frequently certain content or themes were observed. After coding videos, the two authors met to discuss their findings and to synthesize qualitative themes described below.
WHAT DID THIS STUDY FIND?
Harm reduction advocates are using TikTok to educate others about opioid use and harm reduction strategies
Harm reduction TikTok content includes information on the prevalence of opioid use and the availability of naloxone. For example, some creators cited statistics on annual opioid overdose deaths. Others documented their own harm reduction efforts depicting themselves distributing naloxone and fentanyl test strips to individuals that use opioids directly in their communities. It was less common for videos to demonstrate how to use naloxone or to provide specific information on how to access the opioid overdose reversal medication. However, there were some videos depicting individuals opening harm reduction kits and instructing viewers on how to administer naloxone during an overdose.
Creators actively worked to address misinformation and reduce stigma
Another theme present in the videos was the countering of misinformation. In these videos, harm reduction content creators often responded directly to other posts using duets whereby a user’s video is displayed side-by-side with the video being responded to. For example, harm reduction content creators expressed frustration with the spreading of misinformation about overdosing from touching fentanyl. Other videos portrayed efforts to reduce stigma toward those struggling with addiction.
WHAT ARE THE IMPLICATIONS OF THE STUDY FINDINGS?
Findings from this study indicate that individuals are using TikTok to share personal experiences and to educate others about the prevalence of opioid use, availability of naloxone, and how to access and administer the opioid overdose reversal medication. However, while harm reduction creators posted educational content about naloxone availability, results suggested it was less common for videos to convey information on where and how to specifically access naloxone and how to administer the medication during an overdose. Prior evidence suggests that individuals tend to be more aware of naloxone, but less comfortable with accessing and administering the medication. Thus, increased social media content clarifying on processes and additional resources pertaining to obtaining and using naloxone may be a more targeted approach through which to enhance naloxone adoption.
Consistent with prior research illustrating the spread of online misinformation about overdose risk from casual contact with fentanyl, findings from the present study also highlight the presence of opioid-related misinformation on TikTok and efforts by harm reduction creators to counter this misinformation on the platform. This finding is in line with broader themes of health-related misinformation on social media platforms and highlights a continuing need to monitor and address this issue. TikTok and other popular social media platforms represent a potentially valuable mechanism through which to disseminate health communication messaging about harm reduction to diverse global audiences. However, with the proliferation of mis- and disinformation on these platforms, it is crucial that public health organizations, government entities, social media influencers, and other stakeholders work in tandem to promote narratives supported by scientific evidence. For example, organizations like the National Institute on Drug Abuse could fund scientists to partner with platforms and social media influencers to create and disseminate high quality, empirically supported messaging capable of reaching a broad online audience.
Data were collected from a single social media platform using only two hashtags and thus may not broadly represent harm reduction content on social media.
The study provides a limited description of the codebook development and validation process and there was no data presented on interrater reliability to account for the subjective nature of manual content analysis. There was also no effort to report descriptive statistics related to the presence or absence of various themes within the data, making it difficult to discern how prevalent various coding themes were within the sample of 100 videos. There was also no effort to determine how engagement with posts varied across themes.
BOTTOM LINE
TikTok and other social media platforms are being harnessed by harm reduction content creators to reach a vast audience with messaging serving to educate the public on the prevalence of opioid use and the availability of empirically supported harm reduction strategies, such as naloxone (also known by the brand name Narcan in its nasal spray formulation). Increased efforts to use social media platforms for health communication messaging may represent a valuable means through which to educate the public on harm reduction and to combat opioid-related misinformation and stigma.
For individuals and families seeking recovery: For those personally struggling with opioid use or who have friends or family struggling with opioid use, naloxone is a readily available life-saving opioid overdose reversal medication. Findings from this study indicate that harm reduction creators on TikTok regularly post educational content about naloxone that may be helpful. However, content specifically providing instructions on how to access Narcan and how to administer it during an overdose is less common on TikTok. For questions pertaining to naloxone access and use, it may be helpful to refer to additional resources.
For treatment professionals and treatment systems: It may be valuable for licensed professionals to create and promote educational content on TikTok and other social media platforms related to accessing naloxone and how to administer the life-saving medication. Given that social media is rife with misinformation, increasing the amount and reach of information stemming from credible sources citing accurate and reliable harm reduction information is needed.
For scientists: Social media is increasingly being used by individuals as a source of health-related information. Prior research illustrates both the harms and potential benefits at the intersection of social media and substance-related behaviors. There is a need for further research on how to best leverage these platforms to minimize their harms and to maximize the benefits, such as by contributing to efforts to educate the public on harm reduction and addiction recovery more broadly. Additionally, given individuals are using these platforms to gather health-related information, and these platforms are rife with misinformation, it is crucial for scientists to contribute to the overall narratives on these platforms by correcting misinformation and communicating the science for a lay audience.
For policy makers: Increased funding for health communication efforts is warranted. Given that individuals are seeking health-related information online, including on social media platforms, and that they have been shown to be influenced by the content they are exposed to on these platforms, it is crucial to ensure health-related narratives on these platforms are driven by evidence-based information designed to educate the public, rather than misinformation designed to cause confusion or to prey on the vulnerabilities of individuals. Encouraging partnerships between public health organizations, social media influencers, and other stakeholders could be one means through which to contribute empirically supported messaging to broad audiences on these platforms.
The number of national drug overdose deaths per year has risen to more than 100,000 in recent years, and opioid use is implicated in approximately 3 out of every 4 of these deaths. Naloxone (also known by the brand name Narcan in its nasal spray formulation) is an empirically supported, life-saving medication that temporarily reverses the effects of opioid overdose. Despite the increasing availability of naloxone – including standing prescriptions in pharmacies and over-the-counter availability in some US states – annual drug overdose deaths have generally remained stable. While many individuals are aware of the existence of naloxone, they often do not know how to access or administer the medication during an overdose. This highlights a need for increased education.
There is a growing reliance on social and web-based technologies for information amongst the general public, including health-related information. In fact, the majority of individuals search for answers to health-related questions online, often using popular search engines like Google and social media platforms like TikTok, a short-video sharing platform with hundreds of millions of global active users. This is true even for questions more sensitive in nature (e.g., those pertaining to substance use). Unfortunately, there is a mix of high- and low-quality information, or even misinformation, presented to individuals online. Moving forward, it will be crucial to explore and characterize the types of health-related content individuals are exposed to via the online information ecosystem and to shape the health-related narratives being presented to global audiences via these online technologies. With this in mind, the present study explored naloxone-related videos on TikTok to explore themes present within this content and how the videos were being used to educate the public on harm reduction.
HOW WAS THIS STUDY CONDUCTED?
The researchers extracted all public videos posted between June 5, 2020 and October 4, 2022 using either of two hashtags: #narcansaveslives or #naloxonesaveslives. Hashtags are used to help organize and locate content on specific topics. The two hashtags used for this study were intended to capture videos related to advocacy for naloxone. This resulted in a sample of 977 videos, from which the researchers extracted a random subsample of 100 videos for subsequent manual qualitative content analysis exploring themes within the videos. The researchers created transcripts for each video and exported them into a spreadsheet with other video- (e.g., text included in the video) and account-level variables (e.g., account description). One of the researchers reviewed 10 of the videos to develop an initial version of the codebook. Then, two team members met to discuss, refine, and finalize the codebook before proceeding to final coding procedures. During coding, the researchers considered both visual (e.g., setting) and audio (e.g., types of sound and music used throughout the video, emotions evoked) elements of the videos. The researchers also coded for whether the videos were reactions to other videos as well as their tone and whether any personal experiences or specific drugs were mentioned. Of note, there were no quantitative results presented on how frequently certain content or themes were observed. After coding videos, the two authors met to discuss their findings and to synthesize qualitative themes described below.
WHAT DID THIS STUDY FIND?
Harm reduction advocates are using TikTok to educate others about opioid use and harm reduction strategies
Harm reduction TikTok content includes information on the prevalence of opioid use and the availability of naloxone. For example, some creators cited statistics on annual opioid overdose deaths. Others documented their own harm reduction efforts depicting themselves distributing naloxone and fentanyl test strips to individuals that use opioids directly in their communities. It was less common for videos to demonstrate how to use naloxone or to provide specific information on how to access the opioid overdose reversal medication. However, there were some videos depicting individuals opening harm reduction kits and instructing viewers on how to administer naloxone during an overdose.
Creators actively worked to address misinformation and reduce stigma
Another theme present in the videos was the countering of misinformation. In these videos, harm reduction content creators often responded directly to other posts using duets whereby a user’s video is displayed side-by-side with the video being responded to. For example, harm reduction content creators expressed frustration with the spreading of misinformation about overdosing from touching fentanyl. Other videos portrayed efforts to reduce stigma toward those struggling with addiction.
WHAT ARE THE IMPLICATIONS OF THE STUDY FINDINGS?
Findings from this study indicate that individuals are using TikTok to share personal experiences and to educate others about the prevalence of opioid use, availability of naloxone, and how to access and administer the opioid overdose reversal medication. However, while harm reduction creators posted educational content about naloxone availability, results suggested it was less common for videos to convey information on where and how to specifically access naloxone and how to administer the medication during an overdose. Prior evidence suggests that individuals tend to be more aware of naloxone, but less comfortable with accessing and administering the medication. Thus, increased social media content clarifying on processes and additional resources pertaining to obtaining and using naloxone may be a more targeted approach through which to enhance naloxone adoption.
Consistent with prior research illustrating the spread of online misinformation about overdose risk from casual contact with fentanyl, findings from the present study also highlight the presence of opioid-related misinformation on TikTok and efforts by harm reduction creators to counter this misinformation on the platform. This finding is in line with broader themes of health-related misinformation on social media platforms and highlights a continuing need to monitor and address this issue. TikTok and other popular social media platforms represent a potentially valuable mechanism through which to disseminate health communication messaging about harm reduction to diverse global audiences. However, with the proliferation of mis- and disinformation on these platforms, it is crucial that public health organizations, government entities, social media influencers, and other stakeholders work in tandem to promote narratives supported by scientific evidence. For example, organizations like the National Institute on Drug Abuse could fund scientists to partner with platforms and social media influencers to create and disseminate high quality, empirically supported messaging capable of reaching a broad online audience.
Data were collected from a single social media platform using only two hashtags and thus may not broadly represent harm reduction content on social media.
The study provides a limited description of the codebook development and validation process and there was no data presented on interrater reliability to account for the subjective nature of manual content analysis. There was also no effort to report descriptive statistics related to the presence or absence of various themes within the data, making it difficult to discern how prevalent various coding themes were within the sample of 100 videos. There was also no effort to determine how engagement with posts varied across themes.
BOTTOM LINE
TikTok and other social media platforms are being harnessed by harm reduction content creators to reach a vast audience with messaging serving to educate the public on the prevalence of opioid use and the availability of empirically supported harm reduction strategies, such as naloxone (also known by the brand name Narcan in its nasal spray formulation). Increased efforts to use social media platforms for health communication messaging may represent a valuable means through which to educate the public on harm reduction and to combat opioid-related misinformation and stigma.
For individuals and families seeking recovery: For those personally struggling with opioid use or who have friends or family struggling with opioid use, naloxone is a readily available life-saving opioid overdose reversal medication. Findings from this study indicate that harm reduction creators on TikTok regularly post educational content about naloxone that may be helpful. However, content specifically providing instructions on how to access Narcan and how to administer it during an overdose is less common on TikTok. For questions pertaining to naloxone access and use, it may be helpful to refer to additional resources.
For treatment professionals and treatment systems: It may be valuable for licensed professionals to create and promote educational content on TikTok and other social media platforms related to accessing naloxone and how to administer the life-saving medication. Given that social media is rife with misinformation, increasing the amount and reach of information stemming from credible sources citing accurate and reliable harm reduction information is needed.
For scientists: Social media is increasingly being used by individuals as a source of health-related information. Prior research illustrates both the harms and potential benefits at the intersection of social media and substance-related behaviors. There is a need for further research on how to best leverage these platforms to minimize their harms and to maximize the benefits, such as by contributing to efforts to educate the public on harm reduction and addiction recovery more broadly. Additionally, given individuals are using these platforms to gather health-related information, and these platforms are rife with misinformation, it is crucial for scientists to contribute to the overall narratives on these platforms by correcting misinformation and communicating the science for a lay audience.
For policy makers: Increased funding for health communication efforts is warranted. Given that individuals are seeking health-related information online, including on social media platforms, and that they have been shown to be influenced by the content they are exposed to on these platforms, it is crucial to ensure health-related narratives on these platforms are driven by evidence-based information designed to educate the public, rather than misinformation designed to cause confusion or to prey on the vulnerabilities of individuals. Encouraging partnerships between public health organizations, social media influencers, and other stakeholders could be one means through which to contribute empirically supported messaging to broad audiences on these platforms.
The number of national drug overdose deaths per year has risen to more than 100,000 in recent years, and opioid use is implicated in approximately 3 out of every 4 of these deaths. Naloxone (also known by the brand name Narcan in its nasal spray formulation) is an empirically supported, life-saving medication that temporarily reverses the effects of opioid overdose. Despite the increasing availability of naloxone – including standing prescriptions in pharmacies and over-the-counter availability in some US states – annual drug overdose deaths have generally remained stable. While many individuals are aware of the existence of naloxone, they often do not know how to access or administer the medication during an overdose. This highlights a need for increased education.
There is a growing reliance on social and web-based technologies for information amongst the general public, including health-related information. In fact, the majority of individuals search for answers to health-related questions online, often using popular search engines like Google and social media platforms like TikTok, a short-video sharing platform with hundreds of millions of global active users. This is true even for questions more sensitive in nature (e.g., those pertaining to substance use). Unfortunately, there is a mix of high- and low-quality information, or even misinformation, presented to individuals online. Moving forward, it will be crucial to explore and characterize the types of health-related content individuals are exposed to via the online information ecosystem and to shape the health-related narratives being presented to global audiences via these online technologies. With this in mind, the present study explored naloxone-related videos on TikTok to explore themes present within this content and how the videos were being used to educate the public on harm reduction.
HOW WAS THIS STUDY CONDUCTED?
The researchers extracted all public videos posted between June 5, 2020 and October 4, 2022 using either of two hashtags: #narcansaveslives or #naloxonesaveslives. Hashtags are used to help organize and locate content on specific topics. The two hashtags used for this study were intended to capture videos related to advocacy for naloxone. This resulted in a sample of 977 videos, from which the researchers extracted a random subsample of 100 videos for subsequent manual qualitative content analysis exploring themes within the videos. The researchers created transcripts for each video and exported them into a spreadsheet with other video- (e.g., text included in the video) and account-level variables (e.g., account description). One of the researchers reviewed 10 of the videos to develop an initial version of the codebook. Then, two team members met to discuss, refine, and finalize the codebook before proceeding to final coding procedures. During coding, the researchers considered both visual (e.g., setting) and audio (e.g., types of sound and music used throughout the video, emotions evoked) elements of the videos. The researchers also coded for whether the videos were reactions to other videos as well as their tone and whether any personal experiences or specific drugs were mentioned. Of note, there were no quantitative results presented on how frequently certain content or themes were observed. After coding videos, the two authors met to discuss their findings and to synthesize qualitative themes described below.
WHAT DID THIS STUDY FIND?
Harm reduction advocates are using TikTok to educate others about opioid use and harm reduction strategies
Harm reduction TikTok content includes information on the prevalence of opioid use and the availability of naloxone. For example, some creators cited statistics on annual opioid overdose deaths. Others documented their own harm reduction efforts depicting themselves distributing naloxone and fentanyl test strips to individuals that use opioids directly in their communities. It was less common for videos to demonstrate how to use naloxone or to provide specific information on how to access the opioid overdose reversal medication. However, there were some videos depicting individuals opening harm reduction kits and instructing viewers on how to administer naloxone during an overdose.
Creators actively worked to address misinformation and reduce stigma
Another theme present in the videos was the countering of misinformation. In these videos, harm reduction content creators often responded directly to other posts using duets whereby a user’s video is displayed side-by-side with the video being responded to. For example, harm reduction content creators expressed frustration with the spreading of misinformation about overdosing from touching fentanyl. Other videos portrayed efforts to reduce stigma toward those struggling with addiction.
WHAT ARE THE IMPLICATIONS OF THE STUDY FINDINGS?
Findings from this study indicate that individuals are using TikTok to share personal experiences and to educate others about the prevalence of opioid use, availability of naloxone, and how to access and administer the opioid overdose reversal medication. However, while harm reduction creators posted educational content about naloxone availability, results suggested it was less common for videos to convey information on where and how to specifically access naloxone and how to administer the medication during an overdose. Prior evidence suggests that individuals tend to be more aware of naloxone, but less comfortable with accessing and administering the medication. Thus, increased social media content clarifying on processes and additional resources pertaining to obtaining and using naloxone may be a more targeted approach through which to enhance naloxone adoption.
Consistent with prior research illustrating the spread of online misinformation about overdose risk from casual contact with fentanyl, findings from the present study also highlight the presence of opioid-related misinformation on TikTok and efforts by harm reduction creators to counter this misinformation on the platform. This finding is in line with broader themes of health-related misinformation on social media platforms and highlights a continuing need to monitor and address this issue. TikTok and other popular social media platforms represent a potentially valuable mechanism through which to disseminate health communication messaging about harm reduction to diverse global audiences. However, with the proliferation of mis- and disinformation on these platforms, it is crucial that public health organizations, government entities, social media influencers, and other stakeholders work in tandem to promote narratives supported by scientific evidence. For example, organizations like the National Institute on Drug Abuse could fund scientists to partner with platforms and social media influencers to create and disseminate high quality, empirically supported messaging capable of reaching a broad online audience.
Data were collected from a single social media platform using only two hashtags and thus may not broadly represent harm reduction content on social media.
The study provides a limited description of the codebook development and validation process and there was no data presented on interrater reliability to account for the subjective nature of manual content analysis. There was also no effort to report descriptive statistics related to the presence or absence of various themes within the data, making it difficult to discern how prevalent various coding themes were within the sample of 100 videos. There was also no effort to determine how engagement with posts varied across themes.
BOTTOM LINE
TikTok and other social media platforms are being harnessed by harm reduction content creators to reach a vast audience with messaging serving to educate the public on the prevalence of opioid use and the availability of empirically supported harm reduction strategies, such as naloxone (also known by the brand name Narcan in its nasal spray formulation). Increased efforts to use social media platforms for health communication messaging may represent a valuable means through which to educate the public on harm reduction and to combat opioid-related misinformation and stigma.
For individuals and families seeking recovery: For those personally struggling with opioid use or who have friends or family struggling with opioid use, naloxone is a readily available life-saving opioid overdose reversal medication. Findings from this study indicate that harm reduction creators on TikTok regularly post educational content about naloxone that may be helpful. However, content specifically providing instructions on how to access Narcan and how to administer it during an overdose is less common on TikTok. For questions pertaining to naloxone access and use, it may be helpful to refer to additional resources.
For treatment professionals and treatment systems: It may be valuable for licensed professionals to create and promote educational content on TikTok and other social media platforms related to accessing naloxone and how to administer the life-saving medication. Given that social media is rife with misinformation, increasing the amount and reach of information stemming from credible sources citing accurate and reliable harm reduction information is needed.
For scientists: Social media is increasingly being used by individuals as a source of health-related information. Prior research illustrates both the harms and potential benefits at the intersection of social media and substance-related behaviors. There is a need for further research on how to best leverage these platforms to minimize their harms and to maximize the benefits, such as by contributing to efforts to educate the public on harm reduction and addiction recovery more broadly. Additionally, given individuals are using these platforms to gather health-related information, and these platforms are rife with misinformation, it is crucial for scientists to contribute to the overall narratives on these platforms by correcting misinformation and communicating the science for a lay audience.
For policy makers: Increased funding for health communication efforts is warranted. Given that individuals are seeking health-related information online, including on social media platforms, and that they have been shown to be influenced by the content they are exposed to on these platforms, it is crucial to ensure health-related narratives on these platforms are driven by evidence-based information designed to educate the public, rather than misinformation designed to cause confusion or to prey on the vulnerabilities of individuals. Encouraging partnerships between public health organizations, social media influencers, and other stakeholders could be one means through which to contribute empirically supported messaging to broad audiences on these platforms.
