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SA's silent codeine addiction uncovered

Durban - Cough mixtures and pain killers have emerged as a drug of choice for many South Africans, often unintentionally and with devastating effects.

Many who misuse the drugs, particularly those that contain codeine, say they are unaware of the addictive potential of the drugs until they started constantly looking for their "helper".

File picture: Antoine de Ras. Credit: INDEPENDENT NEWSPAPERS

This is according to the findings of a study to be presented at a Public Health Association conference in East London.

The study looked at the misuse of over-the-counter drugs that contain codeine, which include some cough mixtures and pain killers, by interviewing patients at drug abuse treatment centres in KwaZulu-Natal, Gauteng and the Western Cape.

Some abusers revealed that they used multiple pharmacies ("pharmacy shopping") to avoid being discovered as a drug abuser.

In April this year, the abuse of codeine-containing cough mixtures and pain tablets was raised as a problem in Durban.

A Durban pharmacist reported that children were combining the two medicines to create "toxic party drugs".

According to the latest statistics from the South African Community Epidemiology Network on Drug Use (Sacendu), released in February this year, 2% or 225 patients at drug abuse treatment centres had reported the misuse of codeine-containing drugs with most in the Gauteng region between January and June last year.

The South African National Council on Alcoholism and Drugs said the actual figures could be significantly higher as most people abusing the drugs did not seek help because they did not think they had a problem.

According to the study, codeine is a methylated morphine derivative that occurs in the poppy seed. It can have sedative and euphoric effects.

Most patients who participated in the study said they had started taking their medications to manage physical pain as a result of conditions such as arthritis, migraine and severe headaches or to relieve pain after surgeries.

Some took the drugs to treat depression and anxiety.

Most of the patients said they had not been aware of the addictive quality of the codeine-containing drugs and the related dangers and addiction had been a gradual process.

One of the respondents reported how her use of the drug grew.

"It escalated from a prescribed dose that said two or three times a day. I would just take six or eight at one time. In the beginning it wasn't a problem but as things started to go wrong, that would be my helper and I would run to my helper," she said.

Pharmacies were the primary source to obtain the drugs, with most users saying that they purchased over the counter and some got scripts from doctors.

The users said they would do "pharmacy shopping" and look for several different pharmacies in their areas so they could avoid suspicion.

Some said they were also aware of "corrupt" pharmacies.

The study recommended that there be a further drive to inform patients of the dangers of misuse and provide alternative drugs, and to ensure there was proper monitoring of the misuse of the products.

According to Sanca, most people did not acknowledge that they had a problem as the medications were viewed as safe and legal.

The council referred to the drug abuse as "silent addictions" because it can be easily hidden.

"People can easily hide this type of addiction and it takes a long time for family or loved ones to realise there is a problem. We also live in a chemically oriented society that finds it socially acceptable to use these legal medications, making it easy to hide and use," said Adrie Vermeulen, convener of the Sanca Treatment Portfolio.

The council also warned that parents should monitor what medications they had in their homes. According to Sanca, teenagers have "fishbowl" parties using medication taken from medicine cabinets at home which is mixed with alcohol and other drugs.

Dr Lochan Naidoo, who has previously served as the president of the International Narcotics Control Board and who founded a drug abuse treatment centre, said South Africa had a major problem.

"It needs to be treated as a health issue."

He said codeine-containing drugs were not a problem when used to treat genuine pain such as in terminal illnesses, but the problem emerged when they were used for "headaches" or other common ailments.

Naidoo said that making the drugs more difficult to obtain could lead to even worse problems where people in withdrawal would turn to illicit drugs to get their fix. "It is not anyone's fault when they get addicted to these prescription drugs. There needs to be better patient-centred care where doctors engage more."

According to Sanca's website, the warning signs for misuse include:

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