Dr Lochan Naidoo, founder of Jullo, a substance abuse rehabilitation centre in Merebank, said substances most frequently mentioned by young adults are often obtained from home medicine cabinets, diverted prescriptions or informal networks.
Image: Meta AI
EXPERTS are raising concerns over the alarming rise in codeine misuse among South African youth, linking early exposure to prescription medications with long-term addiction risks.
As the South African Health Products Regulatory Authority (Sahpra) reviews the scheduling status of codeine following the growing non-medicinal use of codeine-containing medicines, experts have warned that the situation was becoming “out-of-control”.
Dr Lochan Naidoo, founder of Jullo, a substance abuse rehabilitation centre in Merebank, and president of the South African Federation of Mental Health, said their statistics showed that addicts were first exposed to mood-altering substances during their school years through prescription medication.
“When we take detailed histories from young adults entering treatment, a consistent pattern emerges where many report that their first exposure to mood-altering substances occurred during their school years through prescription medication.
“In clinical addiction practice, we rarely treat schoolchildren directly, as most in-patient programmes are designed for adults. Substances most frequently mentioned by young adults include alprazolam (Xanax), codeine-containing cough mixtures, and mixtures such as 'Lean', which is a mixture of cough syrup and soft drinks.
“These drugs are often obtained from home medicine cabinets, diverted prescriptions or informal networks. The concern is that these medications act on the same reward pathways in the brain as alcohol and opioids (drugs with a known potential for dependence),” he said.
“For example, benzodiazepines can dangerously potentiate alcohol, while codeine activates opioid receptors similar to stronger opioids such as heroin,” he added.
Naidoo said even a single experience of emotional relief or euphoria could become a powerful memory in vulnerable adolescents.
He said adverse childhood experiences, such as family conflict, absent caregivers, violence or emotional neglect, greatly increase the likelihood that a young person would seek escape through substances.
“South Africa also faces structural risks, including the diversion of pharmaceuticals, inconsistent monitoring of scheduled medicines, and the normalisation of mood-altering substances in everyday culture. By the time individuals seek treatment in adulthood, the consequences are often already visible.
“The consequences include relationship breakdown, work instability and health complications. Prevention therefore requires early family engagement, responsible prescribing, safe storage of medications at home, and stronger community awareness of how early exposure shapes lifelong addiction risk,” Naidoo said.
Dr Keresha Govender from the DSK Group, a non-profit organisation on the North Coast, said the challenge of over-the-counter medication and availability had become a high risk factor for vulnerable schoolchildren.
She said they were seeing an increase in cases and were working with pupils, parents and teachers to curb the cases.
“This issue warrants more resources. We have had the opportunity to work with multidisciplinary teams in schools that have reached out to us, addressing community awareness of the long-term side effects, and also how this impacts on cognitive and emotional development of young children.
“The challenge is that these over-the-counter medicines like cough syrups are easily accessible not just in pharmacies, but also stores that deliver to homes. It is becoming out of control.
“Trying to regulate them without adequate policy and support is a massive challenge. At present, we can only drive the importance of vigilance in homes, schools, and also stores and pharmacies. Awareness, monitoring and evaluation have to be our primary focus until we can institute enough support to get policy and procedures to align,” Govender added.
In a statement in January, the Sahpra said it was reviewing the scheduling status of codeine following the growing use of the non-medicinal use of codeine-containing medicines.
“Codeine is an internationally controlled substance in terms of the 1961 Single Convention on Narcotics, and its use is monitored by the International Narcotics Control Board. In order to import or export such products, a permit must be issued by the Sahpra. Codeine-containing cough syrups are regulated in terms of Schedule 2 and Schedule 3 to the Medicines Act. Unless prescribed by an authorised prescriber, these products can only be sold by a registered pharmacist, or a post-basic pharmacist’s assistant under the personal supervision of a pharmacist, at a licensed pharmacy.
“The Sahpra is aware of illicit sales of codeine-containing cough syrups through other outlets, and is working on the means to monitor suppliers of these products,” the press release read.
In 2024, the Sahpra released a new draft guideline to curb the misuse of codeine.
Under the new draft guideline, the Sahpra would be able to request sales dat and other information from manufacturers, suppliers or distributors of any scheduled medicines. This would allow it to track the flow of codeine from the manufacturer to the dispensary, be it a clinic, pharmacy, hospital or doctor’s practice.