/Codeine/

One of the most used opioid narcotics in the world is generally prescribed to treat mild-to-moderate pain, manage an annoying cough, and occasionally treat diarrhea. It’s synthesised from morphine through methylation and also known as methylmorphine.

A rehab centre in Port Elizabeth noticed a sharp rise in addicts to sizzurp.

Step Away Treatment Centre director Sandra de Villiers linked this to increased black market activity for Stilpane – which is smashed and sold in bags.

Another source who wishes to remain anonymous told explain how easy it is to get a hold of Stilpane in PE. While she did not know the specifics, she said that all the neighbourhood kids know about the drug abuse – and dealers are making about R12,000 per week selling the stuff.

Current legislation allows a refill every 10 days, limited to 40 tablets. But this doesn’t stop users from going to another pharmacy that very same day to purchase another 40 tablets. 

This is called “pharmacy shopping.”

Depending on how many pharmacy visits you could fit into one day, you could end up with 400 tablets if you visited only 10 pharmacies – and there is nothing stopping you from visiting another 10 pharmacies the very next day.

Each over the counter tablet contains 10mg of codeine, so then a box of 40 tablets is 400mg. 

Codeine abuse isn’t limited to Stilpane, though. Ever heard of lean, or drank? That’s codeine cough syrup mixed with a fizzy drink to deliver a buzz.

When codeine is broken down by the body it turns into morphine which is a much stronger painkiller from the opioid family and is used in the manufacture of heroin.

Just call it a crisis

Ashley Potts, former director for the Cape Town Drug Centre, told explain that the market is flooded with access to opioids, and that dispensing practices are often irresponsible. 

He stressed that there is help available for opioid addiction and believes the scheduling on some of the medications to be inappropriate.

“The challenge with over-the-counter medicine addiction is that it goes under documented. For every one person that comes to access help there are at least four to five others that are not getting the help that is needed,” he says. 

“Just the other day we had to help someone. It doesn’t matter if it is in the upmarket areas or lower, the problem is growing with little regulation and the costs being low to get these medications.”

Vincent Tlala registrar/CEO of the South African Pharmacy Council explained that all pharmacy professionals are expected to dispense all prescriptions in line with Rule 2.7 of the Rules relating to Good Pharmacy Practice.

While all pharmacist-initiated therapy of medicines schedule 2 and lower should be dispensed in accordance with Rule 2.11 – dose recorded, and the names of persons they are dispensed to, together with ID numbers to avoid repeat purchases and misuse.

“October 2022 statistics from the South African Community Epidemiology Network on Drug Use (SACENDU) indicate that there were 252 admissions for codeine misuse at drug treatment centres across the country,” said Tlala in a statement to explain. 

“We wish to emphasise that the codeine abuse crisis is not necessarily a crisis created by the legal channels of access to medicines (i.e., clinics, pharmacies, dispensing doctors and hospitals), the illicit trade in these substances is a documented reality.” 

He added that health professionals and pharmacists, especially, are highly trained professionals who are able to detect patterns of abuse and misuse, and will not provide a patient with medicines of abuse where is a clear history of misuse or risk of abuse.

Time to learn new tricks

The South African Society of Psychiatrists says that drug and alcohol abuse put a multi-billion-rand dent in the South African economy every year. 

But insufficient funding and an unwillingness to accept the latest global thinking on treating addiction as a medical condition is slowing the pace of intervention.

Something like one out of every five South African adults abuse mind-altering substances, with alcohol, painkillers (codeine) and dagga among the most misused.

Dr Eugene Allers, a member of the South African Society of Psychiatrists (SASOP) says the outdated approach focused on social rehabilitation and abstinence should be a small part of a multidisciplinary intervention.

“Sobriety is no longer considered the only measure of success, rather the ability of the patient to be free of illicit drugs, and functional,” he explains.

Allers adds that government’s latest legislation on prevention and treatment of drug and alcohol abuse, together with the national Drug Master Plan, is comprehensive and progressive, crossing boundaries of government departments and professional disciplines to address the issue from multiple perspectives – social, medical, criminal, psychological.

However, without sufficient funding by both the state and private healthcare providers, and acceptance of a medical approach to treatment, they lack the power to significantly address substance abuse in South Africa.

A lack of recent and comprehensive data on the extent and costs of alcohol and substance abuse in South Africa is a further barrier to developing scientific approaches to address the problem, and to monitor progress.

For now, our addicts are still under siege.

Featured image: Árpád Czapp/Unsplash

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