Is my cough medicine safe?

This hardly seems the time of year to be thinking about cough syrup. But in an unseasonal move, the health authorities have just announced they will be looking at whether certain cough medications should only be available on prescription.

“It might seem far-fetched to some to make cough syrup a prescription medicine, but codeine linctus is ultimately an opioid and can make the user experience similar feelings of euphoria as other opioid drugs would,” says Nuno Albuquerque, head of treatment for the UK Addiction Treatment Group. The problem has been increasing due to criminals on social media promoting the misuse of codeine.

Statistics certainly bear out a growing problem. In 2021, there were 277 fatal or seriously adverse reactions to the drug, and 243 in 2022. So far this year there have been 95 recorded cases.

However, people who set out to misuse the drug are far from the only ones who can become addicted. Here’s what you need to know.

What type of cough medicine is being looked at?

The Medicines and Healthcare products Regulatory Agency (MHRA) is particularly investigating codeine linctuses – syrups containing the ingredient codeine phosphate. As an opioid, codeine phosphate offers powerful pain relief, but can foster a dependency.

Syrups containing codeine phosphate are currently licensed as “pharmacy medicines”, which means they are available to purchase over the counter from a pharmacist. You can’t find them on the shelves – you have to ask for them. In the event of them being reclassified as prescription-only, you’ll need a script from a doctor.

But people do abuse them. The MHRA says it has received 116 reports of recreational drug use, addiction and withdrawal problems specifically related to this specific kind of cough syrup since 2018.

Covonia and Care+ are the brands most associated with codeine linctus cough syrups in the UK – although they make non-codeine syrups too –  but brands like Benylin and Buttercup do not make these kinds of syrups.

What kind of cough medicine should you take instead?

The good news is that even if codeine linctus is taken off the shelves, most people won’t notice a huge difference, thinks Phil Day, the superintendent pharmacist at Pharmacy2U.

“You won’t find any serious pharmacist recommending codeine linctus for a cough,” says Day. He says it is only given to patients “who specifically ask for it. It’s a medicine that has been available over the counter for a long time, but most pharmacists will keep it in a drawer at the back or simply won’t stock it at all. The statement from the Royal Pharmaceutical Society and all the other professional bodies is that we as an industry simply don’t think codeine is very effective.”

How easy is it to become addicted to cough medicine?

“With the right person and the right substance, you can become addicted after trying it once,” explains Kate Bithell, the head of nursing at Delamere addiction rehab clinic. This is the case even if  you don’t have a history of addiction, experts say.

Opiate-based medications react particularly quickly in the brain, and hence are particularly addictive. “As soon as you take them, they activate opioid receptors in the brain, nerve cells and spine, and that causes the brain to fire off endorphins and neurotransmitters to give the user a happy feeling,” says Bithell. 

These are pain-killers, but codeine-based medications also reduce anxiety and give a heightened sense of pleasure, wellbeing and happiness. That’s addictive. Even before you become physically addicted, there’s this emotional or psychological pull. That’s when the physical addiction sets in and your brain starts telling you, ‘If I don’t get more of this, I will die.’”

How at risk am I?

Codeine-based medications like those found in cough syrup won’t affect everyone the same way. Bithell says she has seen patients who have become addicted after one or two uses, and others who have run a full course and never touched it again. 

She says, “It depends on how a person’s brain works, whether they have a dependent nature. If they have a past history of addiction – to smoking, for example – that can be a warning sign as their brain is used to thriving off substances.”

Recent studies have found that up to 60 per cent of people are genetically predisposed to opioid addiction, so the risk of addiction is seen as being severe, according to the Royal Pharmaceutical Society.

What are the signs you’re addicted?

If you are taking codeine linctus and you’re worried about addiction, ask yourself whether you feel dependent. “You’re no longer taking something for a specific use, you’re taking it because you feel you can’t cope without it,” says Bithell. 

“You need it to get up in the morning, to go into a meeting, to feel like yourself. If you come off at that stage, you’ll notice withdrawal symptoms.” 

These can include shaking, sweating, mind fog and anxiety. After people stop taking it, it can also slow down the breathing rate and cause constipation, allergic reactions and confusion.

I’m still worried for my family. Are there any non-drug solutions to a cough?

According to Day, the best advice from pharmacists is simply to soothe the cough and wait for it to resolve on its own. He recommends honey and lemon or glycerol linctuses, which can easily be found on shelves. “Those aren’t medically active, they’re just soothing, they coat the throat and make you less likely to have the irritation that will prompt a cough,” he says.

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