A silent addiction

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Your teenage son walks in from school with a dazed look in his eye and a lazy smile on his face. He is high as a kite! You can tell by the clumsy way he shuffles in, his school bag hanging off one shoulder. But there’s no smell of alcohol, no sweet stink of marijuana, and no track marks under his sleeve.
There is a new drug in town. A steady, stealthy wave is sweeping through the country silently swallowing our youth in a tsunami of addiction.

Worst of all, you probably have it your cupboard right now.
Cough medicine addiction is the latest fad. Using it even has a cool name –“Linning!”
You may have seen it on social media, “We’re going to Jim’s place for a Lin party.”
“Linning always calms me down.”

The scary part is that this drug is readily available and affordable (N$40 for 100ml).
By definition, addiction is a state characterized by compulsive engagement in rewarding stimuli, despite adverse consequences. (American Society for Addiction Medicine (2012)). Addiction to seemingly innocuous common household products is nothing new. We have witnessed the surge and fall in popularity of glue sniffing addictions, huffing (inhaling methylated spirits, tippex and other solvents), dusting (inhaling computer cleaning products), drinking mouth wash, licking hand sanitiser for alcohol, and even soaking gummy bears in vodka. Teenagers can get very creative!

All of these behaviours share one common factor – the products are readily accessible with no legal repercussions and relatively inexpensive. Any teen can walk into a supermarket or pharmacy and purchase them without raising eyebrows. However, these addictions are now seen as a gateway to harder drugs like marijuana and crack.
Namibia is catching up with international trends, now with our very own drug cartels dealing cough syrup to teens at schools and universities. Because of the apparent safety of cough syrup, most addicts are not even aware they are addicted. Linning is deceptively innocent.

The cough syrup is mixed into a soft drink like Fanta, and taken as a beverage.
Users report feelings of euphoria, excitation and sedation. The lassitude that comes with Linning guarantees restful sleep at least for that night. However, innocent as it may seem – the addiction grows with dependence and the need to continuously increase the doses to reach that first high.

What are the dangers?
While cough medicine does come in handy during the winter sniffles, silencing that worrisome cough and buying parents a couple more hours of sleep, when taken in large doses it can be quite lethal. Take for instance Lenazine Forte, a cough syrup that is frequently abused. The listed ingredients and their side effects include: Codeine phosphate – a habit forming drug derived from opium. Closely related to morphine and heroine. Codeine is metabolised in the liver to morphine (translation – has the same effect as a morphine drip used to treat moderate to severe pain in cancer patients). Besides the allergic reactions that may occur, such as hives, difficulty in breathing and swelling of tongue and throat, in high doses codeine causes respiratory depression, sedation and bradycardia. Apnoea and death may ensue.

Ephedrine hydrochloride – mimics the effects of adrenaline in the body. It has been misused and abused widely by athletes and bodybuilders. Ephedrine has been used in the synthesis of methamphetamine. In overdose it commonly causes nervousness, anxiety, hallucinations, breathing difficulty, high blood pressure (resulting in bleeding into the brain), chest pain, disturbance in heart rhythm and difficulty or painful urination. It has been linked to death in young children. (Bedford Laboratories. Ephedrine sulfate injection, USP (50 mg/mL) prescribing information. Bedford, OH; 1998 Aug.)

Promethazine hydrochloride – works by changing the actions of chemicals in your brain The most common side effects are sedation and incoordination. Other possible side effects include tightness of chest, blurred vision, muscular weakness and tinnitus (ringing in the ears).

All of these drugs are highly habit-forming and dependence rapidly develops.
Cough syrup abuse has been in the news before. A story appeared in YOU Magazine in April 2010 about a 45-year-old addict who had been addicted for at least 20 years and acquired serious liver and kidney disease from his addiction.

What can be done?
Is the battle lost then? Is there anything that can be done to stem this scourge?

• To nip this problem in the bud, raising awareness is key, awareness among the users, among parents, and awareness among retail pharmacists.
• The pharmacists are uniquely placed to spot repeat customers. The picture above showing a dozen bottles should not exist. There is absolutely no situation that requires any person to purchase a dozen bottles at once!
• Community policing may help to deter dealers from selling to gullible youth.
• The family may be the best line of defence. Parents should be concerned if they notice any changes in sleep patterns, unnecessary aggression and anxiety in their children.
• Lobbying the Namibia medicines authority to re-schedule such cough syrups to prescription only medicines may help to cut the supply and keep track of regular users.

In the end, it lies with the user. Please seek help early if you or your child has been using cough syrup recreationally, and not aware of the danger it poses to one’s health.

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