What's that bottle of cough medicine really doing in your home?

The face of drug addiction in Nigeria, West Africa is gradually changing. A recent news-media report revealed the increasing strength of the simple and family friendly cough mixture in the world of 'highs' that some young people inhabit.

Parents are none the wiser and the irony is that your older teenage child or young sibling could be so quickly hooked on something that they believe is less harmful than the usual suspects - weed, coke or heroin etc.

The extent of the report makes for interesting reading.

At time of writing, we have no official statement from the NDLEA, Nigeria’s National Drug Law Enforcement Agency on the degree of abuse of Codeine but what is explored in this post are the effects and complications of abuse of this drug.

Different age groups are affected - from young teens to older adults – men and women – although it has a certain appeal to females.

They have acquired a taste for the use of Codeine but do they know this:

Codeine is a serious drug. When taken, it quickly converts to Morphine in the body in an unpredictable way.

Morphine is a powerful drug that is obtained from the Opium Poppy plant, well known for its addictive property and medicinal uses.

However, the unpredictable metabolism to the drug Morphine is the reason Codeine is avoided in children, under-12 years.

In the US, The FDA-drug label for codeine now includes a boxed warning that states:

“Warning: Death related to ultra-rapid metabolism of codeine to morphine. Respiratory depression and death have occurred in children who received codeine following tonsillectomy and/or adenoidectomy and had evidence of being ultra-rapid metabolizers of codeine due to a CYP2D6 polymorphism”

This can also include breast feeding babies of mothers who could be ultra -rapid metabolisers and a higher than expected amount of codeine can be found in the breast milk and proceed to affect the babies.

Of interest, Codeine is strongly related to the street drug Heroin which is made from Morphine, and in the form used for medical purposes (Diamorphine), which is more potent or 'stronger' than Morphine.

Per the Electronic Medicines Compendium, and an article by Lauren Dean MD on Codeine Therapy and CYP2DG Genotype , there are groups of people in the population who are ‘ultra-rapid metabolisers’ of Codeine.

Africans (North Africans and Ethiopians) top the group and the rate at which they do this is 2-4 times compared to the rate found among Caucasians and even less for African Americans and Asians. This is thought to be related to genetic differences leading to the various prevalence among several groups.

Hence groups that have the genotype that causes ultra-rapid metabolism reach higher than expected Morphine levels much quicker than other population sub groups - and end up with a higher risk of illness from toxic/dangerous levels.

Generally opiate drugs are well used as pain medicines, treating some types of cough or for diarrhoea, but also induce a warm relaxed feeling or ‘high’ creating the attraction for abuse.

In excess doses of Codeine, you find the same responses that will apply to Heroin and Morphine including:

Confusion, sleepiness, shallow breathing, reduced appetite, and constipation, and it may cause death from breathing problems.

Please check the cough mixture your loved one is using and be sure it’s for the right reasons.

Stay Well!