Heroin and codeine link a big worry, study finds

THE GLOBAL misuse of prescription or over-the-counter (OTC) pain relievers – including those containing codeine, which has been linked to heroin – has been labelled an increasing public health issue.

A study, published in the South African Medical Research Journal and conducted by experts at the South African Medical Research Council, University of Cape Town, Stellenbosch University and the Waterford Institute of Technology in Ireland, aimed to understand the extent of treatment demand related to the misuse of codeine or codeine dependence in South Africa.

Data was collected from centres taking part in the South African Community Epidemiology Network on Drug Use last year. A total of 17 260 admissions were recorded. Of those, 435 people were admitted for codeine misuse or dependence as a primary or secondary substance of abuse. The youngest was 11 and the oldest 70. More than 74 percent of patients were male.

Of the admissions recorded, 124 were in Gauteng, 104 in the Eastern Cape and 92 in the Western Cape.

The study said South Africa was considering introducing regulations to reduce the amount of codeine in a tablet to 10mg and to up-schedule norcodeine and acetylcodeine.

“The availability of OTC codeine products has compromised efforts to quantify and address hidden codeine misuse. Codeine misusers vary: some are dependent on codeine, aware of their dependence but using it in response to cravings and avoiding withdrawals,” the study found.

Others unknowingly misused it within the recommended limits but did so frequently and regularly to treat withdrawal-associated headaches; and some deliberately disobeyed codeine product instructions for intoxication purposes. Codeine was also being used as a substitute for heroin, and that warranted further investigation, the study found.

Shuaib Hoosain, treatment coordinator at the Sultan Bahu Centre in Mitchells Plain, Cape Town, said that often when heroin users couldn’t afford the drug, they would buy codeine instead.

Anton Wessels, the director of Start to Stop, said both were opiates and had similar effects. Many people addicted to heroin had started off with a slight addiction to pain medication.

Charles Parry of the Medical Research Council said that in some cases, users of codeine moved on to substances like heroin. “In our research we found that 11 percent of people in treatment, where heroin was their primary drug of abuse, also reported misusing or being dependent on codeine.

“Misuse of codeine is largely a hidden problem. I believe it is highly likely that misuse is increasing, given how easy it is to purchase products (containing codeine,” he said.