(Extract from an article on the ICPA website by Jackie Maiman)

The misuse of prescription and over-the-counter codeine-containing products is a global public health issue that needs to be addressed.

Codeine, commonly found in cold and cough medicines as well as headache tablets, is the most regularly used opioid in the world, and is legal and readily available to purchase over the counter. Codeine addiction levels are steadily on the rise in SA – particularly amongst our youth.

South Africa is one of the few countries in the world where codeine is still available over-the-counter, and because it is less stringently regulated than other opiates such as morphine and oxycodone, getting and abusing it is relatively easy.

Because of this, codeine has become the drug of choice for many, including teenagers – who have taken to mixing codeine containing cough syrup with soft drinks – and abuse levels are believed to have reached crisis proportions

Signs and symptoms of codeine addiction:

• Nausea
• Mood swings
• Decreased appetite
• Itching
• Drowsiness
• Constipation
• Abnormal heart rate
• Feeling tired and weak
• Isolating from friends and family
• Ignoring commitments and responsibilities
• Problems at school or work
• Unexplained absences from school or work

“Over long periods of time, codeine abuse can cause a decrease in lung infections, bowel damage, sleep disorders, irregular heart rate, and even brain damage. As the person becomes increasingly preoccupied with obtaining and taking the drug, relationships and responsibilities suffer. The person may lose friends, have difficulties with family members, and find it difficult to make it to school or work. Constant drowsiness and mood swings make it nearly impossible to focus,” says Maimin.

Although some people think codeine is relatively harmless – particularly youngsters who want to start experimenting with what they perceive to be a seemingly innocuous substance – at high enough doses it can lead to respiratory failure, coma, and even death. This risk is especially high when codeine is combined with alcohol or other opioids and, worryingly, many people try to reach a better high by doing exactly this. Because codeine and alcohol are both central nervous system depressants, combining them can lead to dangerous levels of depression in the brain. The risk is particularly high in youths whose brains have not yet fully developed and such abuse can lead to permanent damage.

“Despite the ease with which codeine can be obtained, it is still a dangerous drug that can cause lives to spiral out of control. It is derived from the opium poppy plant and is related to the drug heroin. In the body it becomes morphine, and it can take as little as two weeks for dependence to start,” warns Maimin.

But not all cases of codeine abuse and dependence are intentional for recreational purposes. According to the ICPA, codeine addiction amongst adults usually starts out unintentionally, with the use of codeine-based cough syrups or over-the-counter headache tablets. Regular use of codeine containing painkillers, for example, can lead to rebound headaches that only seem to respond to the codeine-based painkillers, thus causing a cycle of dependence on that particular medication. As time goes on stronger doses are required more frequently to get the same pain-relief and so the cycle inadvertently begins.

“Because of the growing problems with codeine abuse, there is a programme in place to try regulate the sale of codeine in South Africa that requires customers to provide their ID number when purchasing codeine containing medications. This allows pharmacists to check if a person is a repeat purchaser and stops people being able to go from pharmacy to pharmacy buying up codeine products,” explains Maimin. “The Codeine Care programme has been effective in curbing a lot of unnecessary codeine sales however it is not a catch-all, and South Africans need to be educated and aware of the risks of this slippery-slope addictive substance and know what signs of dependence and addiction to look out for.”

For anyone who needs help with codeine abuse please contact the South African National Council On Alcoholism And Drug Dependence (SANCA) on 011 892 3829 or 076 535 1701. You can also email or visit CONTACT US | sanca (

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