Abuse of codeine-containing cough syrups: a report from India

Aim. To study the socio-demographic and clinical profile of patients seeking treatment for abuse of codeine-containing cough syrups (CCS). Design. Observational; case series. Setting. An addiction clinic in North India. Participants. Forty-six consecutive treatment-seeking patients of DSM-III-R-diagnosed dependence on CCS, from January 1994 to June 1995. Measurements. Semi-structured interview schedule for patients and their family covering socio-demographic and clinical variables. Findings. All patients were male. Many were young (mean age 27 years), with completed school education (85%) and from urban backgrounds (80%). The mean age of starting CCS use was 23 years. Initiated commonly through friends (89%) and often for curiosity (63%), 89% of the patients progressed to daily use of CCS in less than 6 months (54% in less than a month), and in quantities much higher than prescribed limits. Opioid-like withdrawal was reported by 92%. Concurrent use of other substances, psychiatric co-morbidity and HIV-related risk behaviour were present in 72%, 24% and 45%, respectively. Most of the patients reported a 'stimulant' effect of CCS ('alert', 96%; 'more active: 94%). Conclusions. The combination of an opioid and a sympathomimetic agent in the CCS may cause a special, distinct euphoretic effect. This effect, along with the low price, easy availability and 'pure' preparation of CCS, may be responsible for the rapidly rising popularity of the CCS as drugs of abuse in India.