Cough

Updated 18 March 2016

Why SA continues selling 'most abused over-the-counter drug'

The Medicines Control Council tells Health24 that it is tackling the abuse of codeine, which is used in Broncleer cough syrup, but it can't pull it from the market.

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Codeine, which is used in Broncleer cough syrup and said to be the most abused over-the-counter drug in South Africa, can't be withdrawn from the market, according to the Medicines Control Council (MCC).

Read: The most abused over-the-counter drug in SA

Codeine is an opioid medication used for the relief of mild to moderate pain and to suppress coughing. It can be found in a range of cough mixtures and other medications, including Myprodol and Mybulen, Benylin C, Syndol, AdcoDol, Tensodol, Sinutab C, and Sinumax Co among other products.

In public interest

"The MCC tackled the problem of codeine abuse in 2015 by reducing the pack size and quantity of codeine per dosage," the MCC's Registrar of Medicines Dr Joey Gouws told Health24.

"In public interest, the MCC can not withdraw codeine from the market as some patients do benefit from the drug. However through restricted control and access the intention is to allow for access but under greater supervision of healthcare providers," she said.

Stronger pain medication and cough syrups are the main codeine-containing medicines that can be bought over the counter, Professor Sarel Malan, the Director of the School of Pharmacy at the University of the Western Cape, told Health24.

"Some cold and flu medication may also contain codeine or something similar. To buy any of these, pharmacist intervention is required by law and in all cases the buyer is required by law to provide personal detail."  

Prof Malan noted that claims of codeine being the most abused over-the-counter drug in SA are probably correct, but he added: "It is primarily obtained from unscrupulous pharmacists or where pharmacists don't effectively practice within the law and Good Pharmacy Practice standards."

'Pharmacy hopping'

Asked if codeine should be available only through a prescription for it to be better regulated, Prof Malan disagreed, pointing out that control by pharmacists should be better enforced and supported.  

"Initiatives like to codeine Care project initiated by community pharmacist and which is currently voluntary, could be made compulsory – this would effectively ensure that the buyer could not walk from pharmacy to pharmacy (do pharmacy hopping) and buy codeine-containing medicine from more than one pharmacy in a specified time."

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

He suggested that everybody in the healthcare team needs to communicate and work together to stop the abuse of common medicine.  

"Codeine-containing medicine, as many others, has a very important place in the treatment of day to day ailments and making this inaccessible would just put additional burden on our health system.  

"It would be sad if the abuse by a relatively small percentage of people lead to this and other effective medicine not being available to the rest of the population who uses it responsibly," said Prof Malan.    

Health24 resident doctor, Dr Owen Wiese explained in an article on Health24 that part of codeine is converted to morphine by a complicated enzyme process that happens mainly in the liver.

Tolerance and eventual abuse

Dr Wiese warned that abusing codeine, in whatever form, could be detrimental to one’s health.

Continuous use of codeine, he said, can lead to tolerance and eventually abuse of the medication.

"Like other opioid medications, abuse can result in vomiting and nausea, constipation, drowsiness. In severe cases respiratory depression can occur," he said.

eNCA's investigative current affairs show CheckPoint reported last year that Broncleer cough syrup which is manufactured by Adcock Ingram Pharmaceuticals is being abused by people seeking a cheap high.

It accompanied the Hawks on a bust in Germiston where they confiscated hundreds of boxes of the syrup.

While the sting was underway, a woman drop by at the dispensary claiming that she was collecting Broncleer to the value of R100 000 for her brother.

CheckPoint reported that the owner of the depot purchased more than 200 00 units of Broncleer, estimated to be worth over R1.7 million. He was subsequently charged for contravening the Medicines Related Substance Act.

Also read:

Youth gets high on cough medicine

Robotripping: how cough syrup addiction nearly killed me

Coughing up blood: when should you be concerned?

That lingering cough could be bronchitis

 

Ask the Expert

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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