ASK THE PHARMACIST | What are the potential dangers of codeine?

Codeine is an easily obtained legal substance found in many over-the-counter medications in combination with other ingredients. It is an effective painkiller and cough suppressant used to treat colds and flu, headaches, other mild to moderate pain, dry cough and sinusitis.

Since codeine is a central nervous system depressant, it can potentially cause feelings of relaxation, drowsiness, slowed heart rate and, in large doses, euphoria. Originally derived from the poppy plant, codeine is classified as an opioid and the chemical structure is very similar to morphine and hydrocodone. Once swallowed, a small amount of codeine is converted to morphine in the body. It is habit-forming owing to its calming and euphoric effects.

The South African Health Products Regulatory Authority (Sahpra) is reviewing the scheduling status of codeine which may affect whether we will be able to continue to buy it without a doctor’s prescription. The reason for the review is the increasing recreational use of codeine-containing medicine — especially by the youth.

“Purple Drank, Lean or Sizzurp” is a party-drink made popular by certain celebrity rappers. It is a mix of codeine cough syrup, popular fizzy soft drinks and sweets, such as sour worms, jelly sweets or hard candy. Many teenagers consume it together with alcohol to experience extreme calm (to the point of disassociation from one’s body) and euphoria. Those using it long-term or in large quantities risk serious harm to their health or even death.

Sahpra is aware of the illegal sale of codeine-containing cough syrups through various outlets and is working with industry bodies on ways to monitor these products.

In terms of the 1961 Single Convention on Narcotics, codeine is an internationally controlled substance and its use is monitored by the International Narcotics Control Board.

A respiratory depressant, codeine slows your breathing rate. At large doses this may cause you to breathe very weakly or stop breathing completely, both of which can lead to death if emergency medical treatment is not provided in time. Other dangerous results of an overdose include seizures and coma.

Some of the possible short-term side effects of codeine are drowsiness, low blood pressure and dizziness, constipation and stomach cramps, nausea, dry mouth, and blurred vision. Long-term side effects include liver and kidney damage, depression, anxiety, fatigue, impaired memory, and muscle spasms.

With misuse, the user becomes tolerant and needs more codeine to achieve the desired results. With prolonged use, it becomes necessary to use codeine just to feel normal. Stopping long-term codeine use may cause withdrawal symptoms — for example, joint pain, extreme irritability, depression, sweating and chills, and abdominal discomfort.

Make sure you use codeine-containing products safely and only when necessary for medical indications. Take your medicine exactly as directed; do not take more than the recommended dose or more often than prescribed. Immediately seek medical advice if you experience breathing difficulties after taking a codeine-containing product and do not use it together with alcohol.

Read the medicine labels and leaflets of all medications that you are consuming at the same time so that you do not unintentionally overdose on codeine as more than one these medications may contain codeine. Ask your pharmacist if you have any questions or concerns.

Do you have a question for our pharmacist? Email: pharmacist@timeslive.co.za

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