What health problems can come from cough syrup addiction?

Cough syrup – or codeine linctus – could be made prescription-only over concerns of addiction among people misusing it.

It follows reports of people taking the medicine recreationally for its opioid effects, rather than its intended purpose as a cough suppressant, the Medicines and Healthcare products Regulatory Agency (MHRA) says.

The regulator has launched a consultation among health professionals and members of the public to ask how they would feel about the medicine only being available if prescribed by a GP.

Currently, codeine linctus can be bought over the counter in pharmacies, however it must be under the supervision of a qualified pharmacist.

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This is designed to prevent abuse, but some pharmacies have been found to be too lax with their checks and to sell unusually high volumes of the product.

Since 2018, the MHRA has received 116 reports of recreational drug abuse, dependence and/or withdrawal to codeine medicines, including codeine linctus, with the regulator warning of a "risk of overdose" among users.

What are the risks of cough syrup?

Codeine is broken down in the body into morphine, which provides its medicinal effect, but not everyone is able to metabolise codeine.

Others may break it down more quickly and experience significant side effects – putting them at risks of toxic effects or addiction, the MHRA says.

Cough syrup may make a person feel dizzy and sleepy, which can influence the ability to drive safely. It is an offence to drive if codeine has affected someone’s ability to drive safely.

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Codeine linctus can slow down breathing rate, cause constipation, allergic reactions, confusion and withdrawal reactions after cessation.

It may also cause the person to lose sight of how much they have consumed, increasing the risk of accidental overdose.

The NHS urges people to call 999 if they have difficulty breathing or short, shallow breathing, or if they have a fit or seizure after taking the medicine. In rare cases it is also possible to have a serious allergic reaction to codeine.

What's it like to be addicted to codeine?

Following the news of the MHRA's consultation, which runs until 15 August, Conor Browne, a biorisk consultant from Belfast, shared his experience with codeine addiction and how easily he fell into it.

"My dependence and subsequent addiction began in a very common way; I had sustained a serious injury, and was prescribed co-codamol (30mg codeine / 500mg paracetamol) by my GP," he tweeted.

"Of course, as many people do, I developed a taste for the codeine and began 'supplementing' my prescribed dose with OTC codeine-containing medications (including codeine linctus).

"Codeine metabolises to morphine in the body, so, as you can imagine, the shift from dependence to addiction can happen very quickly - it did for me.

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"I then developed a not-uncommon side effect to codeine – acute urinary retention – and, as such, had to withdraw cold turkey, rather than by tapering (tapering wasn't an option because of the risk of going into acute urinary retention again).

"The following three months in 2002 were the worst in my life. Acute opioid withdrawal is appallingly unpleasant - the restless legs alone (from where the expression 'kicking the habit' derives) are torture, not to mention the crippling anxiety and insomnia.

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"So, a word of advice: be very careful with codeine-containing medications, and if you catch yourself for even a second thinking, 'this is a good feeling', when you take it, or, if you find yourself craving it, even just a little bit, have an honest chat with your doctor. Trust me - it's shockingly easy to get hooked."

What to do if you think you're addicted to codeine

The NHS advises people to speak to their doctor if they think they might be addicted to codeine. From there, they can refer them to specialist services for drug addictions.

You can also contact drug helplines such as Talk To Frank for confidential advice and support.

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