Codeine is known to have little addictive effect at antitussive doses of 15-30 mg taken every 3-4 hours with a dose limit of 120mg per day. One then begins to wonder how a bottle of codeine-containing cough syrup as little as 5.7 mg-10 mg in 5ml could be enough to trigger the dopaminergic reward centres of the brain. Aside from the pharmacogenomics of its metabolism, where fast metabolisers rapidly convert it to morphine which is responsible for most of its effects, Some of these cough syrups may actually contain more codeine than claimed by the manufacturers even as almost every brand of cough syrup has its own codeine generic circulating in the drug market and one is tempted to ask if the manufacturers have good intentions for producing this just as they have cashed into the cosmetic appeal of triple action creams.
It is becoming an open secret that demands for codeine cough syrups is not linked to its antitussive nor euphoric benefit. A good observer will notice that codeine containing cough syrups are requested for alongside items like condoms, boost, and energy drinks by mostly males when they have their female friends around. As a centrally acting drug, codeine can alter brain activities. Ejaculation during sexual act is as a result of relay messages from the brain to the periphery signalling it has reached its excitatory limits. Sexual perverts have discovered this to their own advantage as it makes them “last longer”. What I will like to call intended anorgasmia is because the chemical transmission of the brain is altered by the presence of the drug and ejaculation will only take place after the peak concentration drops which is between thirty minutes to 1 hour. In the long run, this becomes a problem as chronic usage of codeine has been confessed by addicts to have a negative effect on libido leading to erection and orgasm problems. This numbing effect could lead to other societal problems.
It is bad news for those who are on medical prescription of codeine and other analgesics as post-operative medications especially because they have to take them for long time enough for this effect to manifest. The prescriber or dispenser may not warn of this adverse effect as even our reference books claim ignorance of this side effect. Lack of libido after surgeries especially following fatal accidents are usually misinterpreted as secondary depression. It is mostly as a result of analgesic preparations such as DF118 and other opiod medications like tramadol.
With the growing cases of male impotence in the country and the market being flooded with all sorts of sexual enhancers, NAFDAC may have to keep a tab on the rate at which these cough syrups are being manufactured and distributed. Pharmacists should be able to tell those genuinely in need of this codeine cough syrups. You don’t need to be long experienced in the profession to distinguish the addicts. The tremor readily gives them away.