“I dreamt my mother ripped my face off with her fingernails, cut some of my fingers and toes off, and ripped my arm off”, said a lady who had become addicted to codeine. Martinak et al (2015) reported that this fellow carried out a failed attempt to stab her mother and engaged in other violent acts as a result of her delusion. Codeine is seemingly harmless and relatively less habit-forming than other opiates such as heroin and cocaine, but overuse can result in physical and psychological dependence, psychiatric disorders, and fatalities can result from acute overdose. Research have shown that codeine abuse may sustain addiction or increase the risk of relapse in patients addicted to other drugs. There is no prove of a unique clinical benefit of codeine that surpasses the risk and consequences of its abuse and which can justify the administrative cost of a special governmental undertaking to control it. Codeine should simply be banned.
In January 2018, a committee instituted by the Pharmaceutical Council of Nigeria (PCN) was inaugurated by the minister of Health, Isaac Adewole to control the use of codeine in Nigeria. Though long overdue, it is nevertheless heart-warming that attention is now being paid to this huge problem. But, is it an effective and efficient use of time and resources for this committee to “control” what is not fundamentally indispensable? Would it not be more useful if the committee, and indeed government direct their energies towards addressing the underlying issues that drive illicit demand for drugs, treat and rehabilitate those affected, and address the chaotic drug distribution system in the country? If codeine is taken off the table and efforts are channelled towards building a sustainably resilient system, it would be less likely for another drug of abuse to permeate and gain prominence in the future. Some hearts may ache by my call for codeine ban, but this is what would best serve the interest of the larger Nigerian society. A problem with the potential of destroying an entire society should not be treated with kid’s glove.
In recent times in Nigeria, there have been a surge in crime and shocking incidences of suicide and murders. These may not be unconnected with the rise in drug abuse. The Senate of the Federal Republic of Nigeria raised the alarm in 2017 of the menace of codeine abuse particularly in the Northern part of Nigeria. Those suffering from dependence on codeine are said to include young girls and married women and by some estimates, an average addict takes some 3 to 8 bottles of codeine containing syrup daily. We have nothing to lose if Codeine is
banned except that it would mean an end of the party for those benefitting financially from the status quo.
Some may argue that codeine is their drug of choice for cough and others may talk about its use in pain management. Unfortunately, there is no evidence to show that codeine has no better substitute in these conditions. Codeine is not more effective than placebo in reducing cough, and yet characterized by risks of acute intoxication and dependence (Freestone and Eccles, 1997; Reilly et al, 2015). It has also been demonstrated in studies that codeine is not more effective than other commonly available and safer analgesics.
A fundamental principle in the health professions is Primum non nocere, meaning First, do no harm! The risk of harm in codeine use is enormous and outweighs the benefit especially if viewed from the society-wide perspective. Apart from the risk to the health of the individual, codeine overuse has social consequences. For example, a policeman with motor and cognitive impairment may indulge in extrajudicial killing (“accidental discharge”), a father or mother with psychosis can become a monster at home, a paranoid legislator would waste productive time in physical combat in the parliament, and most importantly, the youths on whose shoulders the nation should be lifted may become social misfits. Essentially, the net effect of codeine is negative. Being a drug with no considerable benefit and yet highly prone to abuse with serious consequences, it should be banned.
Tiwadayo Braimoh (e-mail: firstname.lastname@example.org) is a Pharmacist and Health Development Specialist. He presently studies at the London School of Economics and Political Science (LSE) and the London School of Hygiene and Tropical Medicine (LSHTM).