Crackdown on codeine: SA authorities launch digital tracking to combat abuse and illicit trade

The regulation of codeine has become a major headache for health authorities in South Africa due to an alarming increase in the abuse of the opioid pain reliever, which is also used in some over-the-counter cough and cold medications.

In response to high levels of codeine abuse, particularly rife among young people, the South African Health Products Regulatory Authority (SAHPRA) and other health authorities have hatched a new plan to track the supply of the drug from manufacturers to patients.

Pharmacies and other bodies that dispense medicine, will now be forced to digitally record the ID numbers of people buying or collecting codeine.

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Codeine abuse and ‘pharmacy, clinic and doctor hopping’

“The initiative aims to ensure that all persons who are dispensed codeine medicine are recorded on a system that is available across pharmacies and other dispensaries to curb pharmacy, clinic or doctor hopping by people who abuse codeine,” said SAHPRA’s spokesperson Madimetja Mashishi. 

He added that the initiative also aims to ensure that people are only dispensed the legal limit to assist various ailments that they may be facing.

Initiative to target illegal codeine dealers

Dr Sham Moodley, who chairs a multistakeholder forum on codeine misuse, told online health publication Spotlight that not only would the initiative help health workers to stop the accidental or intentional misuse of codeine among patients, but it would also combat the illegal market for the drug.

Legally, codeine can only be sold by a registered pharmacist (including interns) or an assistant under their supervision, yet it appears that large quantities of the drug are being channeled into illicit or unregistered outlets.

Allegations of codeine smuggling Ex-Bok Hannes Strydom

Before the late Rugby World Cup-winning Springbok Hannes Strydom’s death in a car accident in November 2023, Carte Blanche aired an episode which centered around allegations that he profited handsomely from a codeine-smuggling syndicate. 

At the time of his death the ex-Bok lock owned the Pharma Valu group consisting of several pharmacies and a pharmaceutical wholesaler based in Pretoria.

According to the shock claims which Strydom denied, the 58-year-old businessman was accused by Pharma Valu employees of being the mastermind behind an operation in which thousands of bottles of codeine-based cough syrup – destined for the black market – were allegedly sold under the counter.

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Teens getting high on codeine concoction: What is Purple Drank or Lean?

Codeine-containing cough syrups, which can be bought without a script, are a particular target of misuse, especially among young people who mix codeine cough syrup and a fizzy drink like Sprite.

The drug concoction is known as Lean, Purple Drank or Sizzurp.

Crunk (cough syrup and codeine-containing painkillers) is another addictive mix abused by schoolchildren.

Research conducted in four township schools in Mpumalanga and the Free State found that about a quarter of Grade 10 to 12 learners surveyed said they had used codeine-based cough mixtures to get high.

Children who have tried it, typically started when they were 15 to 17, and were largely unaware of the side-effects and highly addictive nature of codeine.

Prof Nadine Harker, deputy director of the substance use programme at the South African Medical Research Council (SAMRC), explained that children often use Purple Drank aka Lean “as part of codeine parties” and that the drug provides “entertainment and escapism”.

Health complications of codeine misuse

At large doses, codeine can induce a range of warm, fuzzy and euphoric feelings, but it can also come with health complications, particularly when used over a prolonged period.

These include confusion, breathing problems, damage to the liver and gastrointestinal issues, like constipation, bleeding and peptic ulcers (sores that line the stomach or small intestine). Overdosing may be fatal.

‘Accidental’ dependance

Because codeine has genuine medical applications, some people can also become dependent on it accidentally.

In one study, patients at rehabilitation centres in South Africa told researchers they began taking codeine-based pills, such as Stilpayne, Mybulen and Adcodol, to manage pain after surgery or simply in response to severe headaches and migraines.

However, over time they had come to rely on the drug as an emotional crutch to deal with depression and stress, without realising they were getting hooked.

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