Cough medicine is the most abused over-the-counter drug in South Africa.
Teens are getting addicted to a mixture of cough medicine and sugary drinks. It is called “Lean” on the streets. It is an easy way to “get drunk quickly.” At high doses, they give the abuser a feeling of not being in one’s own body. Experts estimate that as many as 600,000 South Africans could be addicted to this “purple drink”. Cough medicines contain codeine which in high doses mimics a heroin high.
Teens who want to get high use 10 – 25 times the recommended dosage. It is a massive problem in schools nationally. Learners take 2-litre cool drink bottles containing this mixture to school, and while it seems they innocently drink cool drinks during the day, they are drinking “Lean” and are high all day. “The codeine cough-syrup surge is seen as a warning of a burgeoning social problem, underscored by rampant truancy at schools and plummeting marks”, says Zanele Zama of Cape Talk.
New regulations implemented from 1 February 2018 states that all medicines containing codeine will require a prescription; there will no longer be access to over-the-counter codeine-containing medication without a prescription. Codeine abuse can cause opioid tolerance, dependence, addiction, poisoning, high doses, and death.
Opiates have been used for thousands of years for both recreational and medicinal purposes. The most active substance in opium is Morphine—named after Morpheus, the Greek god of dreams.
Morphine is a naturally occurring substance derived from the opium poppy plant and was extracted in pure form in the early 19th century. It is a powerful but very addictive painkiller. Morphine was widely used in the American Civil war to alleviate pain, and many soldiers became addicted. By the 1830s, the use of opium supplied by China reached an all-time high in Britain. When the Chinese tried to suppress the opium trade, the “First Opium War” broke out in 1839 when Britain send warships to China.
Morphine was created in 1874 by chemists who tried to find a less addictive form of heroin. Unfortunately, heroin had twice the potency of Morphine, and heroin addiction soon became a severe problem.
Methadone was first synthesised in 1937 by German scientists. They searched for a painkiller that would be easier to use during surgery, with less addiction potential than Morphine or heroin.
Both Methadone and codeine are on the World Health Organization’s List of Essential Medicines, the safest and most effective medicines needed in a health system. In addition, Methadone is believed by many to be even more addictive than heroin.
Codeine (also an opiate derived from the opium poppy) is a less potent drug than Morphine. Codeine may be extracted directly from opium, but most codeine is produced from Morphine, another opium derivative. “Codeine can be synthesised (human-made), was first isolated in 1830 in France by Jean-Pierre Robiquet, to replace raw opium for medical purposes. It is used mainly as a cough remedy.”
New painkillers came on the market with approval from the Food and Drug Administration: Vicodin in 1984, OxyContin in 1995 and Percocet in 1999. These are all synthetic (human-made) opiates that mimic (imitate) the body’s painkillers.
Oxycontin is used to help relieve severe ongoing pain (such as due to cancer)
Street names: Lean, Syrup, Sizzurp, Drank, Purple Drank, Barre, Purple jelly, Texas tea, Dirty Sprite or Tsikuni.
“Codeine is now regulated – pharmacists have to capture the ID number of patients or passport number. The data will sit on the central database, and we will be able to see pharmacy hoppers who use codeine.” Ahmed Bayat, COO – Independent Community Pharmacy Association
Despite these regulations, this is a growing problem, and drug centres see more and more under 18’s coming who is addicted to cough syrup. There is a medicine market, and it is still easily accessible. Parents might not think twice if they find cough syrup in their teen’s book bag. Beware of the potential abuse of cough syrup, especially if your child hasn’t been sick and you haven’t bought the syrup for that reason.
Purple drank is a slang term for a concoction that includes a prescription-strength cough syrup inconsistent with its labelling as a recreational drug. The mixture became popular in the hip hop community in the southern United States, originating in Houston.
In the USA, codeine has been outlawed from cough syrups since the 1970s by the FDA. “A substance called dextromethorphan (DXM) replaced codeine in cough medicines. At very high doses, it can mimic the effects of illegal drugs like PCP and ketamine. Teens are more likely to abuse cough medicines because they can get them easily and without a prescription. What’s more, kids can learn where to buy the drug and how to use it to get high online,” according to WebMD.com.
The physiological effects of purple drank on the user are to produce mild “euphoric side effects, “accompanied by “motor-skill impairment, lethargy, drowsiness, and a dissociative feeling from all other parts of the body”. The codeine, which is an opiate, produces a feeling of euphoria. The cough syrup also contains a drug called promethazine, which acts as a sedative.
When kids talk about these products, the most common street names they use are “syrup,” or “drank,” or “lean”. So if you get a kid talking about “Leaning on Syrup,” or even talking about, “Gonna go get me some Syrup,” these ought to be keywords to parents that these kids are using codeine cough syrup.
Dangers of using the drug:
Dangers arise in higher dosages because promethazine is a depressant of the central nervous system, and codeine is a respiratory depressant. When codeine is taken in enormous amounts, it can cause one to stop breathing – respiratory or cardiac arrest. Using alcohol and other drugs alongside purple drank increases the chance of problems. The drink includes a “massive” amount of opiate codeine, addictive in high doses. “There are occasions where one can see a student in withdrawal because their bodies shake. It especially concerns, because the drug is taken on an empty stomach to enhance the high potency.”
The legal age for dispensing schedule 1 and 2 medications is 14 years old, so it is up to parents to monitor and educate their kids about the dangers of this mixture.
Purple drank is confirmed or suspected to have caused the deaths of several prominent users.
Lil Wayne: The rapper spent several days in hospital in March 2013 after suffering from a string of seizures, allegedly from drinking a dangerous concoction of promethazine and codeine.
How to prevent addiction to cough medicine
Teens, in particular, are abusing the drink because it’s easily accessible to them. They can buy all of the ingredients used to make the dangerous drink over the counter. The homemade drug is “popular” because “there is no smell, it has many attributes to contribute to an intense high, there are minimal side effects and symptoms unless you know what to look out for, and of course, it isn’t illegal.
What you can do as a parent:
- Warn your children about the dangers of abusing over-the-counter (OTC) medicines. Some teens believe that OTC medicines are safer to abuse because they are legal.
- Keep track of the medicine in your home that contains codeine and how much medicine is in each bottle.
- Don’t buy extra over-the-counter medicines to stock up.
- Would you mind not allowing your children to keep over-the-counter medicines in their bedroom, backpack, or school locker?
- Watch your children’s internet use, keeping an eye out for websites visited that discuss over-the-counter or other drug abuse. They not only learn how to mix and use the medicine too high on the internet; they order a prescription via the internet for home delivery.
- Use OTC and prescription medicines responsibly yourself.
- Locking up any medications you may have at the house, throwing out old prescriptions and talking to your children about the dangers of this drink and drugs are some of the best practices to keep your kids away from the stuff.
Drug detection times ¹
Please use these figures as a guide only:
Codeine: 1 day in urine and up to 12 hours in blood
Symptoms of codeine abuse
Symptoms of codeine abuse will vary among users depending upon the amount used and the length of drug abuse. Signs of codeine abuse include:
- Mood swings
- Increase in the amount of time sleeping
- Decreased appetite
- Increased hospital visits
- No longer caring for loved ones
- “Doctor shopping” or visiting several doctors to obtain more codeine prescriptions.
- Prescription forgery
- Stealing prescriptions or opiates from friends and family
- Healthcare fraud
- Lying to cover-up amount used
- Blue tinge to lips and fingernails
- Muscle twitches
- Nausea and vomiting
- Dry mouth
- Urinary retention
- Respiratory depression
- Decreased libido
- Memory loss
- Lack of emotions
Effects of Withdrawal
Someone who is physically dependent upon codeine should not attempt to stop using without a trained medical professional’s supervision. The immediate cessation of codeine can cause many withdrawal effects.