Dr Dominique Stott, executive of medical standards and services at PPS, said: “Medication can be regarded as an abused substance when it is used for purposes which it was not intended for or when a patient becomes addicted to the effects.
"Such medication may even be obtained over the counter, such as codeine-containing pain tablets and cough mixtures.
"The side-effects of using this medication, can become addictive and require increasing amounts for the user to get the same effects.
“For example, it can be easy to become addicted to pain medication when one suffers from chronic pain.
"Addicted individuals’ doctor-hop to obtain the medicine they want, as there is no central database to record the dispensing of these medications.
“A doctor might not be aware that their patient also sees other doctors who are providing the same scripts and the patient could be taking vast quantities of tablets”, she said. The South African Community Epidemiology Network on Drug Use showed in 2015 that the abuse of over-the-counter (OTC) and prescription medicine, such as slimming tablets, analgesics, and benzodiazepines such as diazepam and flunitrazipam were erious issues.
Treatment admissions for over-the-counter and prescription medicine, as a primary or secondary drug of abuse, were between 1% (in the northern region of Mpumalanga and Limpopo) and 6% (Eastern Cape). During this reporting period, 225 (2%) of patients across the country reported the non-medical use of codeine, with 87 of the patients coming from Gauteng.
According to Jackie Maimin, acting chief executive of the Independent Community Pharmacy association, codeine use, in particular, often starts out innocently with the use of codeine-based cough syrups or over-the-counter headache tablets.
“Because codeine is less stringently regulated than other opiates, such as morphine and oxycodone, acquiring and abusing it is comparatively easy.
"Though less potent, codeine provides effects similar to morphine.”
“As an opiate, codeine-use has a high risk of its users developing a tolerance and eventually a dependence on it. Although many people begin using codeine to relieve a legitimate condition, regular use frequently leads to abuse as tolerance develops and some codeine users turn to the drug to cope with physical pain and eventually their emotional pain as well,” warns Maimin.
For some, codeine is only part of a larger addiction. Sometimes, it is the gateway drug into addiction to other substances, especially other opiates such as oxycodone or morphine.
ToughLove SA, a self and family help group supporting people out from drug addiction, explained that drug addiction was a complex disorder that was characterised by compulsive drug use. “Every drug produces different physical effects, but the common result is that repeated use can alter the way the brain functions.
Stott also affirmed that dependence on medication such as codeine, oxycodone and benzodiazepines was overtaking illegal drugs in addiction centres.
“It is also established that patients with psychiatric disorders, such as chronic anxiety or depression, can attempt to self-medicate. This becomes a problem in the treatment of the patients as there is not only the psychiatric disorder to treat but also the dependence on an additional substance.”
It was important, she said, that people did not turn to chemical substances as a way of dealing with their challenges and found alternative ways to relieve stress. “Those who feel overwhelmed, even when healthier habits are incorporated into their lives, should seek advice in stress management,” she said.