In predominantly Muslim Bangladesh, many people drink cough syrup as an alternative to alcohol and addiction to the medication is a problem.
The cough syrups that are favoured are the ones that contain codeine, which is banned in the country.
However, addicts can still access bottles that are smuggled across the border from India, where it is not illegal.
Drugstores in Bangladesh only carry cough medication that contain substances used to replace codeine, which can have a similar effect but is less addictive.
Bangladesh’s Rehabilitation and Assistance Centre for Addicts (Baraca) said most of the patients at their centre are addicted to codeine from cough syrups which find their way through the porous 4100km border with India.
One addict who gave his name as Shafiq, described his addiction to the most popular cough syrup called Phensedyl, which costs around 100 rupees ($1.5) in India but fetches significantly more in Bangladesh, where it is banned.
“When I take Phensedyl, I feel that I am very strong, I feel very energetic and after some time when the feeling ends, I feel very sick, less energetic, and to solve that problem I was again taking Phensedyl and I spent 12 years taking Phensedyl this way,” he said.
The non-governmental organisation said addicts stay at the centre for four months and pay about $125 per month for rehab.
“First we take the treatment plan depending on the physical condition of the patients. To cover the withdrawal period, it takes 10 to 12 days and sometime a bit more time than that. After finishing that period, they enter into the main therapeutic community. In total, we complete the course of treatment in four months,” said Jakiul Alam, who works at the centre.
Data is sketchy on the extent of the addiction in Bangladesh, but surveys conducted by academics and non-government organisations (NGOs) point to as many as 1.5 million people in the country, or around four percent of people with substance abuse problems, being addicted to cough syrup.
A pharmacology expert, Mohammad Sayedur Rahman, said despite the ban on codeine cough syrups, addicts are still drinking others which give a similar high, but are less addictive.
“Addiction is a common problem in Bangladesh and to address that problem, in 1982 the government banned cough syrups particularly Phensedyl, that contains codeine and chlorpheniramine. But later on that Phensedyl are being supplied or smuggled from India to Bangladesh to keep supply to the addicts. At some point of time, due to collaboration between Bangladesh and India, the smuggling reduced and some of the capital punishments were given. Therefore the addicts, they tried substances that contains similar things like Phensedyl, particularly codeine was replaced by pholcodin or pseudoephedrine, they try with that, and chlorpheniramine is available as antihistamine,” he said.
Rahman said the danger is that many cough syrup addicts eventually move on to heavier substances like methamphetamine and heroin.
Regulators in India have been privately pressuring major drug firms to better police how they sell a popular codeine-based cough syrup to tackle smuggling and addiction.
They want to make it easier for law enforcement agencies to track both cough syrup abuse in the country and bottles smuggled to neighbouring Bangladesh.
Last year, the International Narcotics Control Board (INCB) set up to implement U.N. drug control conventions billed the abuse of medicines containing narcotics and their smuggling from India as one of the “greatest drug-related challenges” facing South Asia.
About 83,000 bottles of codeine-based cough syrups were seized in India in the six months through March. In meetings with companies, Indian regulators called the “menace of abuse” a “growing concern”. (Reuters)
