The misuse of prescription and over-the-counter codeine-containing products is a global public health issue that needs to be addressed, said independent community pharmacies at the start of Drug Awareness Week.
As the SA National Council on Alcohol and Drug Dependence’s Drug Awareness Week kicked off yesterday, the Independent Community Pharmacy Association (ICPA) has warned on the dangers of codeine addiction.
“Getting your hands on opioids isn’t always the shady street corner drug deal we picture in our minds,” said Jackie Maimin, ICPA chief executive.
The ICPA said codeine, commonly found in cold, cough medicines and headache tablets, is the most regularly used legal and readily available opioid in the world, and South Africa is one of the few countries in the world where codeine is still available over-the-counter.
As a result, codeine has become the drug of choice for many, particularly teenagers – who have taken to mixing codeine containing cough syrup with soft drinks.
The symptoms of codeine abuse include nausea, mood swings, decreased appetite, itching, drowsiness, constipation, abnormal heart rate, feeling tired and weak, isolating from friends and family, ignoring commitments and responsibilities, problems at school or work and unexplained absences from school or work.
“Over long periods of time, codeine abuse can cause an increase in lung infections, bowel damage, sleep disorders, irregular heart rate, and even brain damage. As the person becomes increasingly preoccupied with obtaining and taking the drug, relationships and responsibilities suffer,” said Maimin.
The ICPA said that although some people think codeine is relatively harmless, at high enough doses it can lead to respiratory failure, coma and even death.
The organisation added that this risk is especially high when codeine is combined with alcohol or other opioids by people trying to reach a better high, and that the risk is high in those whose brains have not yet fully developed
“Despite the ease with which codeine can be obtained, it is still a dangerous drug that can cause lives to spiral out of control. It is derived from the opium poppy plant and is related to the drug heroin. In the body it becomes morphine, and it can take as little as two weeks for dependence to start,” warned Maimin.
However, not all cases of codeine abuse and dependence are intentional, for recreational purposes. According to the ICPA, codeine addiction among adults usually starts out unintentionally, with the use of cough syrups or headache tablets.
“Regular use of codeine containing painkillers, for example, can lead to rebound headaches that only seem to respond to the codeine-based painkillers, thus causing a cycle of dependence on that particular medication. As time goes on, stronger doses are required more frequently to get the same pain-relief and so the cycle inadvertently begins,” the ICPA said.
Because of the growing problems with codeine abuse, there is a programme in place to try to regulate the sale of codeine in South Africa that requires customers to provide their ID number when purchasing codeine containing medications.
“The Codeine Care Programme has been effective in curbing a lot of unnecessary codeine sales. However, it is not a catch-all, and South Africans need to be educated and aware of the risks of this slippery-slope addictive substance and know what signs of dependence and addiction to look out for,” said Maimin.
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