Codeine use could be a gateway to harder drugs

I APPLAUD the Pharmacists’ Association of the Western Cape for taking a stand to curtail the abuse of codeine, having written to the medicines control council requesting the rescheduling of codeinecontaining substances because of the growing prevalence of codeine abuse among young people. This should be supported nationally by all.

Doctors were perturbed by the number of youth that were requesting scripts for codeine tablets and codeinecontaining cough syrups.

The problem of codeine addiction has been taken very seriously in America for the past two decades and they have struggled to solve it, because it is so difficult to police.

I have learnt that many patients are unaware they are addicted to codeine. They buy tablets regularly, erroneously believing they are treating their headaches. Some consume as many as 500 codeinecontaining tablets a month.

These patients have what is regarded as medicine misuse headaches or MMH. Codeine, being an opiate can, on withdrawal, lead to severe headaches, because the brain craves the codeine. For this reason most people addicted to codeine will wake up with severe rebound headache after their bedtime dose wears off. This leads to poor quality of sleep; poor work performance; a feeling of irritability due to a lack of sleep and, in some cases, depression.

People addicted to small doses of codeine can be safely weaned off their dependence with intensive psycho education. Patients with a severe addiction can be treated with safe opioid replacement therapies, so help is at hand.

I do not believe punitive laws and strict controls achieve as much as sustained education about the dangers of codeine and other substances. The abuse of codeine by young people can have a serious effect on their concentration, leading to irritability and eventually poor performance in their grades.

The greatest fear is that codeine can become the gateway drug to the more potent and highly addicting opioid, heroin.

Parents are strongly urged to watch out for signs of addiction in their children, which – apart from an excess of packaging or syrup bottles in the rubbish bin – could include asking for extra pocket money, lying, becoming argumentative, grades dropping and truancy.

I have had to deal with a young adult who was addicted to codeine cough syrups. The evidence was in the bins but the young man refused to admit that he had a problem. When confronted about his addiction, he went on the defensive and became aggressive. He is now showing signs of psychosis, a symptom common with amphetamine (tik) and cocaine and to some extent cannabis.

The only option left to the parents is to have the young man admitted as an involuntary patient for psychiatric evaluation and treatment.