SA under-prepared for rising codeine addiction

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RACoughSyrupCodeine addiction is on the rise in SA yet the country lacks people who are specifically trained to treat it, a SA Medical Research Council study has found, reports The Times.

The Times quotes Professor Charles Parry‚ lead researcher on the study which was headed by the SA Medical Research Council‚ as saying: “Misuse of and dependence on codeine-containing products is on the increase globally.” The problem “does not only lie with over-the-counter products where they are available‚ but also with inappropriate prescribing of codeine-containing medications‚” he said.

The report says while local figures were not available‚ recent stats released in the UK showed that codeine prescriptions had doubled from 12m to 24m in a single decade. Many codeine products had seen in an increase in prescription rising by a staggering 287% according to The Guardian‚ which reported on that statistics garnered from the UK’s National Health Service.

Anecdotal evidence from surveys suggest that in South Africa‚ cough syrups are the most commonly abused codeine-containing drugs, the report says.

“There appears to be a broad spread of individuals providing treatment for persons misusing or dependent on codeine‚” said Parry‚ “They have general training in the provision and management of opioid agonist treatment‚ but few have specifically been trained in the management of codeine-related misuse/dependence.”

The problems is made worse by addicts not seeking treatment for various reasons‚ including heavy denialism and seeing drug treatment centres as having such a negative stigma that they daren’t step inside. Said Parry: “The main barriers to patients entering treatment were seen as denial of having a problem‚ not being ready for change‚ mental health problems‚ stigma associated with going to a drug treatment centre‚ not knowing where to access treatment‚ and affordability”.

The research team concluded that further investigation is needed but “consideration should be given to campaigns that highlight that anyone can become dependent on codeine products used in the long term or excessively”. And‚ anyone literally means anyone – from the stay-at-home seeking relief for headaches‚ to patients being given heavy-handed scripts from doctors‚ to pupils with dodgy contents in their juice bottles.

The report quotes Plumstead High School principal Craig George as saying that pupils were using soft-drink bottles to disguise their concoction of codeine syrup laced with disprin and crushed sweets to get an instant high.

“We started observing the appearance of cough mixture bottles‚ not only at my school but other schools as well‚” said George. He also noticed pupils carrying their own soft-drink bottles to school‚ rather than buying from the tuck shop.

Background: General practitioners are referring patients with codeine-related problems to specialist treatment facilities, but little is known about the addiction treatment providers, the kinds of treatment they provide, and whether training or other interventions are needed to strengthen this sector.
Objectives: To investigate the perspectives of addiction treatment providers regarding treatment for codeine misuse or dependence.
Method: Twenty addiction treatment providers linked to the South African Community Epidemiology Network on Drug Use and the South African Addiction Medicine Society were contacted telephonically and asked 20 questions.
Results: While many participants had received training in pharmacological management of individuals with opioid dependence, only two had received specific training on codeine management. Between half and two-thirds of the treatment settings they worked in provided detoxification, pharmacotherapy, psychosocial treatment and aftercare. Very few treatment settings offered long-term treatment for codeine misuse and dependence. Participants indicated that over half of their codeine patients entered treatment for intentional misuse for intoxication, and dependence resulting from excessive or long-term use. The main barriers to patients entering treatment were seen as denial of having a problem, not being ready for change, mental health problems, stigma, and affordability of treatment. Participants identified a need for further training in how to manage withdrawal and detoxification, treatment modalities including motivational interviewing, and relapse prevention.
Conclusions: Gaps in training among treatment providers need to centre on how to manage withdrawal from codeine use and detoxification, motivational interviewing and relapse prevention. Interventions are needed to address barriers to entering treatment, including user denial.

Charles D H Parry, Eileen Rich, Marie Claire van Hout, Paolo Deluca

The Times report
SA Medical Journal abstract

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