REDUCING CODEINE COUGH SYRUP MEDICINE CONSUMPTION TO CONTROL CODEINE ABUSE IN THAILAND

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REDUCING CODEINE COUGH SYRUP MEDICINE CONSUMPTION
TO CONTROL CODEINE ABUSE IN THAILAND

• Naiyana Patcharapisarn
• Narcotics Control Division
• Food and Drug Administration

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Abstract
Reducing Codeine Cough Syrup Medicine Consumption
to Control Codeine Abuse in Thailand Naiyana
Patcharapisarn Problem Statement Increasing
codeine cough syrup medicine abuse has been
reported for over a decade in Thailand.
Surveillance data showed increasing codeine cough
syrup medicine purchasing through drugstores,
especially in the Southern region of Thailand.
Accordingly, Notifications and Ministerial
Regulation of the Ministry of Public Health were
launched throughout the country to control
codeine cough syrup medicine abuse in December
2002 and in June 2003. Objective To assess
codeine cough syrup medicine consumption reported
before and after launching the Notifications and
Ministerial Regulation of the Ministry of Public
Health through surveillance data. Design
Retrospective design. Intervention Ministry of
Public Health regulations implemented throughout
the country. Setting and Population Total
amounts of codeine cough syrup medicine
consumption reported by manufacturers, importers
and distributors in Thailand to the Food and Drug
Administration were reviewed and analyzed across
time concerning the types of medical services and
regions between July 2000 and November 2003.
Outcome measure Average volume of codeine cough
syrup medicine consumption reported per month,
per region and per type of medical services were
measured before and after launching the
regulation. Results There was an increasing
trend in codeine cough syrup medicine consumption
before late 2002, especially in Bangkok and the
southern part of Thailand. Then, a sharply
decreased consumption from an average of
861-ml/month/1,000 population in November 2002 to
an average of 90.7 ml/month/1000 population in
February 2003 was noted. Consumption of codeine
cough syrup medicine was reduced throughout the
country and is clearly seen in the southern part
of Thailand. In 2003, the proportion distributed
to drugstores was reduced throughout the
country. Conclusions Notifications and
Ministerial Regulation from the FDA effectively
controls codeine cough syrup medicine abuse.
First, there is a reversed trend of codeine cough
syrup medicine consumption from an increasing to
a marked decreasing consumption in the entire
country, especially in the Southern part of
Thailand. Second, reducing the distribution of
the codeine cough syrup medicine consumption to
drugstores is effective.
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Background
Although Codeine has been used as medicine but it
is also one of narcotics due to the biologic
property of drug dependency. In Thailand, the
Codeine cough syrup medicine has been classified
as Narcotic in schedule III, by the Narcotic Act
A.D.1979. Extensive abuse of the Codeine cough
syrup medicine by teenagers, especially via
drugstores, has been reported through the media
for over a decade in this country. Thus, the
Ministry of Public Health launched the
Notifications in December A.D. 2002 as well as
the Ministerial Regulation in June A.D.2003 in
order to reduce the Codeine abuse throughout the
country as follow 1.The Notification No.179
A.D.2002 To reduce the total usage of Codeine to
be used for medicinal and scientific purposes
throughout the Kingdom to 1,000 Kg within the
year A.D.2003 2.The Notification No.180
A.D.2002 To set a strict control over the
manufactured or imported quantity of the Codeine
formula

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Background (continue)
3.The Notification No.181 A.D.2002  Specify the
amount of the Narcotics in schedule III-codeine
formula, which could be suspected that, possess
for dispose 4.The Ministerial Regulation by the
Ministry of Public Health To regulate the
disposal of the Codeine formula only in the
private hospitals and the public
healthcare. The measure to control the Codeine
cough syrup medicine in this country is regulated
by the Food and Drug Administration (FDA), the
Ministry of Public Health. Legally, licensed
importers, manufacturers and distributors have to
report the Buy-Sell of Narcotics in schedule III
to the FDA monthly and annually. Surveillance on
these data may reflex an effect on reducing
Codeine abuse such as decreasing the Codeine
disposal in the market.
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Objective
This study aimed to assess codeine cough syrup
medicine disposal reported to the FDA before and
after launching the Notifications and Ministerial
Regulation of the Ministry of Public Health
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Methods
We examined the trend of Codeine cough syrup
medicine disposal reported to the FDA from July
A.D.2000 to November A.D.2003, the period
including pre and post launching the
Notifications and Ministerial Regulation of the
Ministry of Public Health by surveillance data.
Stratification of Codeine cough syrup medicine
distributions by areas in the country and types
of healthcare sectors were also examined.
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Results
There was an increasing trend in codeine cough
syrup medicine consumption before launching the
Notifications, especially in Bangkok Metropolis
and the southern part of Thailand. Two turning
pointes have been noted according to the overall
Codeine disposal across time. The first turning
point was noted with a sharply decreased
consumption after launching the Notifications in
December A.D.2002. The second turning point was
also observed with a slightly further decreased
consumption after launching the Ministerial
Regulation in June A.D. 2003. According to the
areas, consumption of codeine cough syrup
medicine was most reduced in the southern part of
Thailand. The Codeine disposal was reduced markly
in drugstores compared to the other sectors of
healthcares.
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Amount of Codeine Cough Syrup Medicine reported(
per 1000 population per month)
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Stratification by areas ( per 1000 population
per month)
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Stratification by types of health care services
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Implication
The impact on Codeine use in medical practice
as potent analgesic and cough management by the
Notifications and the Ministerial Regulation
should be further investigated.