Most people have heard of codeine as a cough syrup ingredient, and many assume it is helpful. But how many people know that it is a highly addictive substance that becomes morphine once introduced into the body?
The European Union is aware of the problem and has introduced a recommendation that this narcotic should not be supplied to children, but it is a mealy-mouthed statement and it's up to each EU Member State to do their own thing -- with wildly different results.
And the EU ignores the elephant in the room: codeine is a highly addictive painkiller that has a negative impact on youth in the EU and the USA. The risk of addiction is barely mentioned in their recommendation.
What's the Problem with Codeine?
Codeine is an opiate similar to heroin that is used in cough syrup and other legal medicines. It is highly addictive and can be particularly dangerous when combined with other substances, such as antidepressants.
"Codeine can be used as a prop when heroin can't be sourced," explains Dr. Lesley Hanney, a Canterbury based therapist, "the developmental impact on babies born to heroin addicted mothers could be caused by the various concoctions they take, including cough syrup, rather than just the heroin."
Alcohol and codeine are a particularly hazardous pair, as the combination depresses the nervous system and increases the risk of liver disease.
Codeine is available "over the counter" in pharmacies in the UK and many other EU member states. It's easy to buy the narcotic and the EU is addressing the issue but seems unable to do anything about it.
The Secret Epidemic
The UK is facing a codeine addiction pandemic: A Daily Mail investigation reported that a third of British 18 to 24 year olds use codeine-based painkillers on a daily basis.
"Few people realise" writes Jonathan Gornall in the Daily Mail, "that codeine, available in a variety of over the counter painkillers, is a potentially addictive opiate - a narcotic, like morphine and heroin, derived from the opium-producing poppy plant."
The withdrawal symptoms - irritability, insomnia, restlessness, exhaustion, headaches, sweating and anxiety - are extremely difficult to deal with and so most users simply take more pills and remain addicted.
Big Pharma make a fortune out of codeine-based painkillers in the UK, selling an estimated 75 million pills in 2012, and governments find their sophisticated lobbying tactics extremely hard to resist. Is this why there are no public awareness campaigns about the risks of codeine?
According to the Daily Mail's investigation: "the government regulator says that it has never considered making codeine solely a prescription-only medicine."
Confusion Among the 28 EU Member States
The EU has made several attempts to restrict the use of codeine among children, and it has the power to restrict dangerous medications, but the results regarding codeine are erratic and disappointing.
In the UK low-dose codeine is available over the counter, without a prescription. In The Netherlands the drug is categorised in the "unacceptable risk category" with the likes of heroin and cocaine, and in Slovakia codeine is treated as a "3rd tier risk substance."
In new EU member states such as Romania there are few safeguards to enforce legislation and prevent over the counter sales of codeine syrup and pills:
"I have had dozens of patients addicted to codeine and most of them were teenagers," says Psychiatrist Dr. Emilian Voiculescu at The Mind clinic in Bucharest. "They can it get very easily from most pharmacies without a prescription. They knew very well how to ask for it: they just claimed to have a dry cough."
"Doctor Shopping" in Sweden
In Sweden, another EU member state, buying codeine over the counter is difficult: "Not all doctors can prescribe codeine based medicines as a specific form is needed," says Anna Sjöström, Castle Craig Hospital's representative in Sweden.
The Swedes also have a system in place to prevent what they call "doctor shopping":
"Medical prescriptions are monitored in Sweden," says Anna Sjöström, "if a patient lies to one doctor to get a prescription, and then goes to another doctor, his past record of prescriptions shows up on the computer."
Can the EU Make Any Difference?
We asked several therapists around the EU what they thought about the EU's proposed restrictions about codeine:
"I think it will have a positive impact," says Dr. Emilian Voiculescu in Romania. "Hopefully this will require that cough syrup should be sold only through secured and monitored prescription"
Brussels based psychiatrist Dr. Anca Paunica M.D. is less optimistic: "Efforts should be made to harmonise the legislation to allow control of codeine products for children and adolescents. It is highly unethical to allow codeine products to be available over the counter, without being monitored by a doctor."
My question is: why can't the EU impose its will on the member states and enforce a restriction, or even an outright ban, on what is obviously a highly addictive drug?
I spoke to the EU's European Medicine Agency in London and they didn't have a clear answer to this question. Instead they referred me to their recommendation, which apparently explains how EU member states should react:
"The recommendations will now go to the Co-ordination Group for Mutual Recognition and Decentralised Procedures-Human (CMDh), which will make a final recommendation and provide guidance to patients and healthcare providers. The CMDh is a body that represents Member States..."
If this had happened in the Houses of Parliament, British political reporters would have said "the issue has been buried by a Parliamentary committee" or "kicked into the long grass." And they wouldn't have been inspired by the name of the body that is supposed to restrict codeine across the continent -- the "Co-ordination Group for Mutual Recognition and Decentralised Procedures-Human." -- a name that doesn't make sense or inspire confidence that something might actually change.
This article was co-authored by Claudiu Revnic