Many South Africans may not be aware that they have likely encountered codeine at some point in their lives. Codeine can be found in various over-the-counter pain relievers, such as Nurofen Plus and Solpadeine, as well as numerous cough syrups. It is also available in its purest form through a prescription to address chronic pain. When used as directed, codeine is generally well tolerated. However, its easy accessibility and high addictive potential make it susceptible to misuse.

According to the Office for National Statistics, codeine-related deaths have nearly doubled over the past decade, with two-thirds of drug poisonings resulting from misuse. In the United States, codeine is the most widely used opioid medication and plays a central role in the opioid epidemic (1). So, what steps can be taken to prevent this trend in South Africa? Why are people vulnerable to codeine misuse? What are the associated risks, and how can safer usage be promoted? Let’s delve into codeine misuse in the South African context.

Understanding Codeine Misuse

Codeine misuse is characterized by the consumption of a higher dose than prescribed or the use of codeine in unintended ways. Some individuals may accidentally take excessive amounts due to difficulties in following instructions or memory problems. However, in most cases, codeine misuse is a deliberate act driven by addiction.

As an opioid, codeine shares the same potential for abuse as morphine and heroin. It acts similarly, blocking pain signals in the brain and inducing feelings of euphoria. With regular use, individuals can develop a tolerance to codeine, leading to increased cravings. This addiction prompts individuals to seek additional sources to obtain codeine and explore methods to intensify its effects.

Indications of codeine misuse include:

  • Consuming higher doses or using codeine more frequently than prescribed.
  • Enhancing the potency of codeine by combining it with alcohol or other drugs.
  • Feigning greater pain or inventing illnesses to obtain more codeine.
  • Seeking multiple doctors or private clinics simultaneously.
  • Altering the form of codeine, such as crushing, snorting, or injecting, to enhance its effects.
  • Purchasing codeine from illicit sources, including the “dark web” or street dealers.

Reasons for Codeine Misuse

Codeine serves as a treatment for mild to moderate pain and as a cough suppressant. Whether obtained from a local pharmacy or prescribed by a healthcare professional, several reasons can contribute to codeine’s allure:

  • Chasing the High: Users may misuse codeine in an attempt to replicate the euphoric or calming sensations they initially experienced. Some individuals become accustomed to these pleasurable effects and seek to intensify them.
  • Self-Medication: Codeine misuse can stem from a desire to self-medicate against stress, anxiety, chronic pain, or depression. Individuals facing trauma or neglect may misuse codeine as a means of escaping their problems.
  • Peer Pressure: The influence of friends and peers can play a significant role, particularly in the digital age. Online discussions about codeine misuse and its glamorization on platforms like Instagram and Twitter can influence illegal sales (2).
  • Ease of Access: Although codeine has been available by prescription in many countries for years, the recent increase in codeine abuse cases has led to calls for even stricter regulations. Even though it is a highly abuse-prone drug, online sales of codeine remain largely unregulated.
  • Fear of Withdrawal: Many individuals recognize their codeine problem but find it challenging to quit due to severe withdrawal symptoms. These symptoms can include diarrhea, stomach pain, hot sweats, chills, aches, mood swings, and depression, perpetuating the cycle of codeine misuse.

Risks of Excessive Codeine Consumption

The dangers of excessive drug consumption are widely acknowledged. For instance, actor Matthew Perry disclosed that his colon ruptured due to his prolonged painkiller addiction. Prolonged codeine use can lead to various physical and mental health issues, including chronic constipation, stomach problems, liver and kidney damage, hormonal imbalances, anxiety, and depression. However, there are other risks associated with codeine misuse that may not be as readily apparent:

  • Respiratory Depression: While rare, this is one of the most perilous risks of codeine misuse. As opioids have a calming effect on the central nervous system, excessive codeine use can significantly slow down breathing, which can even be fatal in extreme cases.
  • Codeine Overdose: Codeine is often prescribed in limited quantities for a reason. Misusing codeine can lead to overdose, characterized by severe symptoms such as extreme drowsiness, confusion, shallow breathing, slow heart rate, and loss of consciousness. In some instances, codeine overdose can result in a coma or death.
  • Psychological Issues: Consuming high doses of codeine can negatively affect cognitive functions such as attention and concentration. It can also numb the brain’s ability to experience pleasurable activities, potentially contributing to mental health problems such as anxiety and depression.
  • Impact on Work and Social Life: Codeine misuse can strain personal relationships, as individuals who are trying to conceal their dependence on codeine may become deceptive and secretive. Additionally, the cognitive and physical effects of codeine can affect one’s work performance.
  • Risky Substance Combinations: The most significant risk arises when codeine is combined with alcohol or other drugs. Alcohol and other opioids, whether over-the-counter painkillers or illicit substances, have similar effects on the central nervous system as codeine. When combined, they amplify sedation, depress respiration, and increase the risk of overdose.

Promoting Safe Codeine Use

Promoting the safe use of codeine involves collective efforts by individuals, healthcare professionals, and regulatory authorities. Implementing various measures can contribute to safer codeine usage:

  • Clear Dosage Instructions: Provide clear instructions regarding the correct dosage, frequency, and duration of codeine use.
  • Awareness of Risks: Raise awareness about the potential risks and adverse reactions associated with codeine use.
  • Warning Labels: Place clear warnings on labels and packaging to inform users of codeine’s potential dangers.
  • Regulatory Measures: Implement stricter guidelines to restrict access to codeine, particularly in light of its high abuse potential.
  • Medicine Review Programs: Establish programs to identify potential codeine misuse and provide appropriate interventions.
  • Pharmacist Involvement: Collaborate with pharmacists to ensure that users receive sound advice and explore alternative treatments where applicable.
  • Accessible Addiction Treatment: Make addiction treatment services more accessible to individuals grappling with codeine misuse.

If you are concerned about your codeine consumption or worried about someone else’s codeine addiction in South Africa, remember that help is available. Always consult with a healthcare professional and follow a proper treatment plan to gradually taper off opioids, thus avoiding dangerous withdrawal symptoms.