Cough syrup or codeine linctus, a widely available over-the-counter medication, may soon face restrictions due to mounting concerns about its addictive nature and potential for serious health problems. The UK medicines safety regulator has received an increasing number of reports highlighting drug abuse and dependence on codeine-containing medicines, prompting a call for reclassification as a prescription-only medication to address the fears of misuse. Pharmacists also express concerns about the risk of overdose associated with codeine linctus.
Codeine linctus, an oral solution or syrup containing codeine phosphate, is commonly sold in pharmacies as a cough remedy. However, some individuals are misusing it for its opioid effects, fueling an addiction to pain-relieving medication. The Medicines and Healthcare products Regulatory Agency (MHRA) emphasizes the need for stricter regulations surrounding codeine linctus to ensure its proper use.
Dr. Alison Cave, Chief Safety Officer of the MHRA, emphasizes the effectiveness of codeine linctus as a medicine but warns about the major health consequences resulting from its misuse and abuse. The problem has escalated over the past five years, with a surge in reports of misuse and criminal activity linked to codeine, often driven by social media promotion. Since 2018, the MHRA has received 116 reports of recreational drug abuse, dependence, and withdrawal related to codeine medicines, including codeine linctus. Alarming numbers of serious and fatal adverse reactions have also been reported, with 277 in 2021, 243 in 2022, and 95 already in the current year.
In response to these concerns, the MHRA has initiated a consultation process to gather input from healthcare professionals and the general public regarding the possible restriction of codeine linctus to prescription-only status. Pharmacists welcome this move, citing “insufficient robust evidence” supporting the safe use of codeine linctus for treating coughs. They also express significant concerns about its potential for misuse, addiction, and the associated risk of overdose.
Prof. Claire Anderson, President of the Royal Pharmaceutical Society, highlights the availability of alternative non-codeine-based products for treating dry coughs, which often resolve on their own. Studies suggest that up to 60% of people worldwide may be susceptible to opioid dependence. The regulation of cough syrups has been a topic of concern in India as well, where certain domestically manufactured cough syrups were linked to deaths in The Gambia and Uzbekistan. As a precautionary measure, the Indian government has mandated sample testing for cough syrup makers prior to exporting their products.
Codeine works by blocking pain signals to the body through its action on the central nervous system and the brain. It also alleviates anxiety and stress resulting from pain. While it can be effective when other painkillers fail, long-term use of codeine carries the risk of addiction. As a result, doctors advise patients on how and when to discontinue codeine use if required. It is important to note that codeine should not be administered to children under 12, unless otherwise instructed. The public consultation on codeine linctus will run until August 15, 2023.