Dr Michelle King educates us about OTC and prescription medication misuse, especially pain medication containing codeine or meprobamate.
Misuse of medication is defined as “the problematic consumption of medication outside of acceptable medical practice or medical guidelines, when self-medicating at higher doses and for longer than is advisable, for intoxicating purposes, and when risks and adverse consequences outweigh the benefits.”1
The most commonly misused over-the-counter (OTC) and prescription medications in South Africa are those that contain codeine. For example, cough mixtures (e.g. Broncleer or Benylin), and pain tablets (e.g. Stilpane, Myprodol, or Adco Dol).2 So much attention is given to the dangers of opiates, such as Tramadol and Oxycodone, that the dangers of codeine are overshadowed.
Misuse of OTC and prescription medication is a hidden problem as, unfortunately, the current prevalence is not known. The only data that we have access to is from the South African Community Epidemiology Network on Drug Use (SACENDU), which looks at admission rates to treatment centres.
In 2014, 2,5% of admissions were for codeine abuse2, either in the form of cough mixture or pain medications. Data shows that the average age of use is 33 years, and women tend to use this group of medications more than men.
The challenge with these figures is that they don’t give us a true picture of what is happening. Only patients that seek help from rehab centres are included in the data. We don’t know how many people out there have not realised that they have a problem, or who might have received out-patient treatment.4
Why is medication with codeine so dangerous?
The danger with most medications that contain codeine is that they can be bought over the counter, which may give you the false belief that they are safe.5 Secondly, you might not even realise that you have become addicted to them.5
Without clear guidance on how to use these medications safely, you are not properly informed about the risks and long-term health conditions associated with them, such as rebound headaches, gastro-intestinal bleeding, perforated gastric ulcers, liver damage, inflammatory bowel conditions, kidney toxicity, pancreatitis, low potassium5, and even depression and dysphoria.6
This group of medication has a high potential for addiction if they are used for longer than the recommended 10 days. Physical tolerance will develop over time, and when the medication is stopped, you go into emotional and physical withdrawal.7
Meprobamate is another ingredient that is highly addictive, and is found in some pain medications, such as Stilpane.10 This is a commonly prescribed pain medication. In fact, in 2011, one third of patients were prescribed meprobamate-containing pain medications; 70% of which was Stilpane.
No one plans on abusing this type of medication when they start using it. 8,9,10 It’s an unseen problem which can affect respectable, professional and high functioning people. Trying to keep your usage a secret can prevent you from seeking help.6,11
During the COVID pandemic, you might be less likely to want to spend time speaking to pharmacists or doctors, and as a result, you are less likely to ask questions about the medication you have been prescribed.
Both out-patient and in-patient treatment programmes are available. Many addiction centres request pre-screening for COVID for all their clients to reduce the risk of infection should you be admitted.
Treating your pain just with medications that contain codeine or meprobamate can result in dependency. Never just take a pain pill if you have chronic pain. Rather, seek other treatments. For example, physiotherapy or pain neuroscience education to use alongside your pain medication, or instead of pain medication.8 For a list of practitioners who are trained in treating chronic pain, visit trainpainacademy.co.za
Now more than ever, you need to take care of yourself, as the social isolation and ongoing anxiety and stress can push your codeine use from where you are using it to treat your pain, to where you are using it to numb you, or give you a state of euphoria to help you get through the day.
- Casati A, Sedefov R, Pfeiffer-Gerschel T. Misuse of medicines in the European Union: a systematic review of the literature. European addiction research. 2012;18(5):228-45.
- Dada S, Burnhams NH, Van Hout M, Parry C. Codeine misuse and dependence in South Africa–learning from substance abuse treatment admissions. South African Medical Journal. 2015;105(9):776-9.
- Coombes H, Cooper RJ. Staff perceptions of prescription and over-the-counter drug dependence services in England: a qualitative study. Addiction Science & Clinical Practice. 2019;14(1):41.
- Pasche S, Myers B. Substance misuse trends in South Africa. Human Psychopharmacology: Clinical and Experimental. 2012;27(3):338-41.
- Carney T, Wells J, Bergin M, Dada S, Foley M, McGuiness P, et al. A Comparative Exploration of Community Pharmacists’ Views on the Nature and Management of Over-the-Counter (OTC) and Prescription Codeine Misuse in Three Regulatory Regimes: Ireland, South Africa and the United Kingdom. International Journal of Mental Health and Addiction. 2016;14(4):351-69.
- Van Hout MC, Rich E, Dada S, Bergin M. “Codeine Is My Helper” Misuse of and Dependence on Codeine-Containing Medicines in South Africa. Qualitative health research. 2017;27(3):341-50.
- Carney T, Wells J, Parry CDH, McGuinness P, Harris R, Van Hout MC. A comparative analysis of pharmacists’ perspectives on codeine use and misuse – a three country survey. Substance Abuse Treatment, Prevention, and Policy. 2018;13(1):12.
- Kinnaird E, Kimergård A, Jennings S, Drummond C, Deluca P. From pain treatment to opioid dependence: a qualitative study of the environmental influence on codeine use in UK adults. BMJ Open. 2019;9(4):e025331.
- Kimergård A, Parkin S, Jennings S, Brobbin E, Deluca P. Identification of factors influencing tampering of codeine-containing medicines in England: a qualitative study. Harm Reduction Journal. 2020;17(1):63.
- Truter I. Prescribing of meprobamate-containing combination analgesics in South Africa. South African Family Practice. 2016;58:1-6.
- Parry CD, Rich E, van Hout MC, Deluca P. Codeine misuse and dependence in South Africa: Perspectives of addiction treatment providers. South African Medical Journal. 2017;107(5):451-6. Reddy, S.P., James, S., Sewpaul, R., Sifunda, S., Ellahebokus, A., Kambaran, N.S. & Omardien, R.G. (2013) Umthente Uhlaba Usamila: the 3rd South African National Youth Risk Behaviour Survey 2011. Cape Town: South African Medical Research Council.SPSP
MEET THE EXPERT – Dr Michelle King
Dr Michelle King qualified as a psychiatrist in 2007. Since then she has completed post-graduate diplomas in chronic pain management and palliative medicine, both through UCT. She is part of an interdisciplinary pain clinic and palliative care team. Dr King believes in empowering people so that they can take charge of their physical and mental health, and as a result, live their lives to the fullest.