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Over-the-counter codeine linctus cough syrups have been reclassified as prescription-only medicines due to the risk of abuse, dependency and overdose, the Medicines and Healthcare products Regulatory Agency (MHRA) announced last month.

Following a recommendation made by the Commission on Human Medicines to the MHRA in 2018 , the agency undertook a consultation last year with healthcare professionals and patients to canvas views on reclassification. This followed 116 Yellow Card reports since 2018 that indicated instances of the medicine being abused.

Codeine linctus is cough syrup licenced to treat dry cough and contains the opioid codeine phosphate. Reports were made of the medicine being used recreationally for its opioid effects when mixed with alcohol in a drink with other medicines. It has been called various colloquial names like ‘Purple Drank’, ‘Lean’, ‘Sizzurp’ or ‘Dirty Sprite’.

The cough syrup’s misuse was the subject of several studies from the early 1990s, particularly in its association with rap music, and has recently received renewed media attention.

The MHRA has warned that use of codeine in combination with central nervous system depressants can have serious risks such as loss of consciousness, respiratory suppression and death.

A total of 992 responses were received during the MHRA’s consultation period, of which 587 (59%) respondents agreed that codeine linctus should be reclassified to a prescription-only medicine.

“Taking into account the reports we have received in relation to abuse, we have reclassified codeine linctus to a prescription-only medicine for the benefit of patients, carers and healthcare professionals across the UK,” said Dr Alison Cave, Chief Safety Officer at the MHRA.


Further reading

MHRA: Codeine linctus to be reclassified to a prescription-only medicine because of risk of abuse and addiction

MHRA: Public consultation on the proposal to make codeine linctus available as a prescription-only medicine

MHRA: MHRA launches public consultation on reclassification of opioid-containing cough medicine

“Purple Drank” (Codeine and Promethazine Cough Syrup): A Systematic Review of a Social Phenomenon with Medical Implications

The Independent: Cough syrups could be made prescription-only over addiction fears

MHRA: Codeine linctus (codeine oral solutions): Proposal to reclassify to prescription only