Cough

Updated 12 August 2016

Clamping down on SA's most abused over-the-counter drug

BronCleer, a cough syrup that contains the drug codeine – a painkiller similar to morphine – has a new formula that aims to curb its misuse.

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The fact that South Africans are getting high on codeine-based cough syrup such as BronCleer has prompted Adcock Ingram to introduce a different formula.

Similar to morphine

Codeine is considered to be the most misused over-the-counter (schedule 2) drug sold in South Africa, giving users one of the cheapest highs around. Codeine is a highly effective pain killer, similar to morphine.

Health experts have warned that abuse of codeine can cause life-threatening respiratory depression, constipation, vomiting, nausea, drowsiness, restlessness and even death.

The drug, which is meant to relieve mild to moderate pain and to suppress coughing, is also found in a range of other medications, including Myprodol and Mybulen; Benylin C; Syndol; AdcoDol; Tensodol; Sinutab C; and Sinumax.

The abuse of codeine-based cough mixtures has widely been reported both domestically and internationally.

No change in efficacy

Werner van Rensburg, Managing Director of the Over the Counter (OTC) Division of Adcock Ingram said: “The diversion of the product has been beyond our control, so it needed an approach to reduce the attractiveness of BronCleer with codeine to potential abusers.”

He said as result of the improved formula, there is a change in the taste of BronCleer with codeine. "But as all the active ingredients in the product remain the same, consumers can be assured that there is no change in the efficacy,” said Van Rensburg.

The key change to the formula of BronCleer is that it now contains only 0.5% alcohol. Adcock said the effective level was previously higher due to a combination of solvents. It pointed out that alcohol is a common solvent used in cough syrups and is normally used in levels up to 10%.

"The alcohol is a necessary ingredient as its action in this instance is to help dissolve the other ingredients in the solution," Dr Johann Kruger, past president of the Pharmaceutical Society of SA, explained to Health24.

Read: How cough syrup addiction nearly killed me

By decreasing the amount of alcohol in the formula, he said Adcock has decreased the possibility of potential addiction.

Codeine content remains unchanged!

"The simultaneous use of alcohol plus codeine plus the antihistamine in Broncleer has a synergistic effect on each other, meaning that when added together, the potential for addiction is increased."

Kruger emphasised that codeine is a safe and effective medication, but if used for the wrong indication, in the wrong dosage and for too long a period, it can, like many other types of medication, lead to addiction.

Dr Eric Decloedt, who is a clinical pharmachologist in the department of medicine at Stellenbosch University, told Health24: "Lowering the alcohol content will not prevent abuse of the product for its codeine content." However, he added: "A lower alcohol concentrations potentially makes this formulation less attractive for those wishing to inappropriately take the contents for the alcohol content."

Read: Alarm over cough syrup drug abuse among Cape Town learners

Health24 recently reported how learners in Cape Town have been experimenting with a dangerous mixture, known as "sizzurp", "purple drank", "syrup" or "lean".

It involves cough syrup mixed with pain pills, cold drinks, crushed sweets and possibly alcohol. This formula is inspired by American pop culture where it has been popularised in songs.

Curbing illegal trade

eNCA's investigative current affairs show CheckPoint accompanied the Hawks more than a year ago on a bust in Germiston where they confiscated hundreds of boxes of BronCleer.

While the sting was underway, a woman showed up to collect BronCleer, allegedly for her brother, to the value of R100 000.

CheckPoint reported that the owner of the depot purchased more than 200 000 units of Broncleer, estimated to be worth over R1.7 million. He was subsequently charged for contravening the Medicines Related Substance Act.

Adcock Ingram told Health24 that it is committed to supporting the correct use of their products. It said that ongoing reports of BronCleer abuse have caused great concern to the company and stakeholders.

Read: Rapper admits to taking 90 codeine pills a day!

Spokesperson Vicki St Quintin said the company has taken various actions during the last eighteen months when the problem of codeine-based BronCleer misuse became apparent.

"Actions have included monitoring sales of the product and cooperating with the police, in conjunction with the Medicines Control Council Law Enforcement, to try to curb the illegal trade outside the approved distribution network."

She said various actions have been taken by the authorities, including the successful arrest of parties involved in illicit trade.

"This is public knowledge as there have been various media reports relating to these incidents. That is why a different approach was needed and led us to the reformulation of the product."

Also read:

Why SA continues selling codeine medication

Coughing up blood: when should you be concerned?

Drug warning: Crystal meth sold as sweets to schoolkids

 

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Cough Expert

Professor Keertan Dheda has received several prestigious awards including the 2014 Oppenheimer Award, and has published over 160 peer-reviewed papers and holds 3 patents related to new TB diagnostic or infection control technologies. He serves on the editorial board of the journals PLoS One, the International Journal of Tuberculosis and Lung Disease, American Journal of Respiratory and Critical Medicine, Lancet Respiratory Diseases and Nature Scientific Reports, amongst others. Read his full biography at the University of Cape Town Lung Institute.

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