Lots of codeine could have effect of heroin – but soft drink mixture makes no difference

Worried parents in South Africa have been sharing a Facebook post warning of a new risk of drug addiction.

It’s a screenshot of a WhatsApp message with a photo of four children lying on the ground as though unconscious.

The message reads: “Please warn the kids not to take coke from their friends or any other drink they mix it with cough meds that contain codeine and it got the same effect like heroin so please send the message to all contacts with or without schoolkids. It’s very dangerous.”

Does codeine cough syrup mixed in soft drinks have the same effect as heroin?

‘Purple drank’ mixture

A reverse image search reveals that the picture was originally used in social media posts in South Africa. The four girls were photographed on Monday 19 August 2019, having passed out at Julius Crescent Park in Retreat, Cape Town, according to local news reports. A local councillor, Kevin Southgate, is credited by news reports with having sounded the alarm.

The four girls were suspected to have taken a drink called “lean”, a mixture of soft drinks or soda (cooldrink in South Africa) and cough syrup containing codeine, a highly addictive substance. Another common ingredient is promethazine.  Other names for the drink include “syrup”, “sizzurp” and “purple drank”.

Codeine addiction has also been reported in Kenya, Nigeria and Zimbabwe. Codeine-based cough syrup has been banned in Ghana, and its import and production prohibited in Nigeria.

Morphine, codeine and heroin

Codeine is an opioid, a type of pain medicine either made from poppy plants or synthesised in a laboratory. Opioids can have serious side effects.

Codeine is also known as methylmorphine, created from morphine through a process called methylation, according to the UN Office on Drugs and Crime.  It is widely used in cough medicine.

Morphine is also used to make heroin (also known as diacetylmorphine) through the process of acetylation. Heroin can also be created from codeine

According to the 2007 book Pain Management, “heroin has a high addiction potential and it is not known to have any real advantage over morphine”.

‘Effect almost like heroin’

Can codeine be as potent as heroin? Heroin is reported to be around three times as strong as morphine by a number of sources. According to a 2017 article in the Washington Post, morphine is three times as strong as codeine.

Africa Check spoke to Dr Kipkerich Koskei, a former head of the Pharmacy and Poisons Board of Kenya. He said heroin was more potent than codeine.

“All of them are derivatives of morphine. Of course, heroin is superior, it is the most active of the three compounds. So you would expect the effects of codeine in cough syrup would be similar to heroin depending on the quantities and kind of addiction.” 

We asked Kipkerich if adding codeine cough syrup to soft drinks would make the drug more potent.

“I doubt. Soda is just like any other solvent. It would be just like adding water or sugar. But if you were to take a lot of codeine in cough syrup, the effect would almost be like heroin depending on the volume you have taken.” – Vincent Ng’ethe


 

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