COVER STORY: C-Company: Silent Killer on Prowl

THE LIGHT OF ANDAMANS | VOL 35 | ISSUE 29 | 16 MARCH 2012

COVER STORY:

C-Company: 

Silent Killer on Prowl

Thousands of youngsters and teenagers have fallen to the addiction of Opium derivative - Codeine Phosphate based cough syrups which are eating into the vitals of the society. Its high time the Administration wakes up and takes serious note of the magnitude of the issue.

By Zubair Ahmed

 The C-Companies (Corex-addicts) are the new groups of teenagers and children, roaming around us everywhere, addicted to cough syrups, a new fad catching up very fast. The society as well as the administration is caught totally unaware about the magnitude of the problem and the dangers lying ahead.

They brush the catastrophe under the carpet. The Directorate of Halth Services has never undertaken any comprehensive survey to deal with it. 70 to 80 percent of the addicts identified use easily available prescription drugs and substances like alcohol based cough syrup, painkillers and eraser fluid.

Medicinal opiates like Codeine, Corex and Rexcof and prescription drugs like Alprax and Spasmo Proxyvon are available across the counter in medical shops that have mushroomed over 10-15 years. Despite being banned elsewhere in the country, variants of these drugs are sold in "huge quantities" in our Islands.

A large number of teens including small kids are today addicted to codeine based cough suppressants and many deaths on this account have been reported.

Shafiq (name changed), the only son of a lower middle class family after graduation struggled hard to land up a job. Finally after sacrifices from his family with meagre resources, he landed a job with Municipal Council. His father stood by him and sold off his ancestral land to get his son a job.

Shafiq who was quite happy with his job in the council fell into the trap of bad company. In the meantime, he got married and became the proud father of two little sons. However, he was not even five years into the job when he developed chest problems. His parents did not know what the matter was. His wife too was unaware of the illness or its cause. Shafiq did not have any visible vices. Nobody knew that Shafiq was addicted to cough syrups, and was taking about 3-4 bottles daily. He was admitted into the hospital where, after a few days, he breathed his last.

Rasheed (28) succumbed to this addiction a couple of years ago. Mohit another teenager lost his life. The dead body of another young addict was found lying near Tiranga Park a couple of years back. Once addict, it becomes very hard to get out of it. They are doomed for life. In any given village, one will find more than 20-25 kids who consume codeine phosphate based cough syrups to get high.

There are two types of people who consume cough syrups - One group who wants to get relief from their chronic bouts of cough. Another group won't cough in their lifetime as they consume the syrup daily. Unfortunately, the second group might not survive long. And there are two types of cough syrups available as over the counter drug - Codeine Phosphate based and non-codeine based.

Rexcof, Biorex, RC, Rancof, Corex, Phensedyl and Mit's Linctus Codeine are codeine based drugs, available in pharmacy shops. Legally, all these drugs can only be obtained by a physician's prescription, but everyone knows that more than 90% of the product is sold without any prescription.

High doses of codeine are just as dangerous as any illegal drug. In fact, many teens use it to mimic the euphoric and hallucinogenic effects of ecstasy. They try to have an almost psychedelic experience similar to designer drugs. It's out there everywhere and people don't realize what a powerful and dangerous drug it is when taken in high doses.

However, try to get a bottle of Rexcof from any pharmacy, they won't give you. Instead, ask for a "Bada wala" and wrapped in a paper, you will get a 100 ml bottle of Rexcof for Rs 70/-

I tried getting a bottle of Rexcof from a pharmacy shop in Junglighat. They did not give me. I sent one of my young friends to the same shop after a while and he brought a bottle wrapped in a paper.

About 15-20 thousand of bottles of cough syrup are sold every month in the Islands. No doctors in the Islands prescribe Rexcof. Except a couple of pharmacy shops in Port Blair and surrounding areas, everyone secretly stock large quantity of this particular cough syrup. LoA team visited about 15-20 hangouts around the city and the rural areas and was dumbfounded to find large quantity of empty bottles lying everywhere.  The first thought that struck us was do the entire cough patients gather at one point and take their medicine? Or is it part of mass drug administration? And why only bottles of Rexcof, when generally, the syrup popular was called Corex? The curiosity led us to a pharmacist.

A pharmacist, who is a distributor too, on anonymity told LoA that by selling Corex, a proprietary drug manufactured by Pfizer, pharmacy gets only 10-12% margin, in Phensedyl, the margin is between 15-18%. But, Rexcof, product of Cipla is a generic drug which gives a huge margin of about 35-40%. In simple terms, if you sell a bottle of Rexcof, you make a profit of about Rs 30. And, from our investigation, we could gather that every pharmacy except a few, sells about 100-150 bottles of Rexcof daily. And they make a cool net profit of about Rs 3000-4000 a day! Why should they sell anything else?

And the worst part of our investigation was that the tens of thousands of bottles consumed are not by patients, but young addicts, most of them school and college students. They roam around the city in cars or gather at the meeting points and have their dose of cough syrup.

Behind ITF Ground, near Khaitan Function Hall, Junglighat Colony, Behind Hotel Gagan, Aberdeen Bazar, Mohanpura, Foreshore Road, Mini Stadium, Dollygunj, abandoned govt quarters and small joints in almost all rural areas, small c-groups gather and consume the deadly cough syrup.

This addiction does not discriminate between rich or poor parents, or even upper, middle or lower class. The abuse is spreading its tentacles throughout the Islands. In rural areas, the drugs are stocked in pan shops and provision stores and in the city, its there in every pharmacy.

Its an expensive addiction and needs about Rs 70-150 daily and here comes the role of parents. "Parents are so careless and generous that they are pushing their own children into death traps," said the pharmacist.

"Reported cases may be sporadic," says another local pharmacist.

The abuse goes unreported as parents aren't as likely to recognize their teens' abuse of lawful drugs, as they are likely to spot the use of illicit drugs, like marijuana or liquor. In areas like Tusonabad, Ograbraj, Wimberly Gunj, Mannarghat etc; people, particularly young men and students take these cough syrup in a big way.

"There are no physical activities for small children nowadays and they are also not seen playing games anywhere," rues a concerned parent whose child is a victim of cough syrup. "I was not aware of my child's addiction, and I have myself bought him the syrup thinking he needs the medicine, but when I came to know of such a habit from others, I kept a tab on him. But I don't know how to save him."

The abuse is rampant in rural areas and in communities, where liquor consumption is a taboo. Due to the fear of being noticed using liquor and alcoholic drinks, teens have hit up on the idea of using legally available substitutes. All over the Islands, it is visible to naked eye that abuse is on the rise. Earlier, petty shops in our Islands use to stock major cough syrups, but, realizing the huge profit, pharmacies have taken a lead today. Ready availability of such drugs in nearby shops in rural areas tempts students to initially taste and later fall into the trap.

“Once trapped, there is no escape,” says Rahul, an addict. He needs about 2 bottles daily. His hands shiver and face perspires and only solution is daily dose of the syrup.

The lack of concern about the society and particularly the young generation is another reason for rise of such habits. "I know one teacher who used to sell cough syrups to students," said a student of a reputed school in Port Blair. "There are places in Port Blair, where they serve cough syrups for Rs 10/- per serving to students," he said.

There are many bizarre addictions too. A small layer of Iodex spread on bread is also tried by students. "All these experiments come from students who go for studies to mainland," said a shopkeeper, who is also a social activist. Apart from cough syrups, dilutor, which comes with a whitener brand Erazex manufactured by Kores is used for sniffing. It's very popular among students studying in Middle and Secondary classes.

Tablets like Spasmo Proxyvon, Alprax and Alprazolam were also in vogue till recently. 

Speaking to LoA, Dr S K Paul, Director, DHS said that he will keep a tab on the pharmacies and drug license holders. "However, without proper legal framework, it would be very difficult to control it," he said. Is it not the time responsible people, agencies, civil society and the administration sit up and devise ways and means to fight this plague, which is eating into the vitals of the society big time?

Codeine: The Opium Derivative

One of the constituents of these cough syrups is the habit forming drug Codeine Phosphate I.P. that falls under the narcotic drugs category, which belongs to the class of opium alkaloids and derivatives. Codeine provides relief by blocking the ascending pain pathways by binding to opiate receptors found in the CNS. It also helps suppress cough by direct action in the medulla

Individually it falls under the narcotics category but if manufactured with other ingredients as cough syrup it falls under the prescription drugs category. Though, these drugs are preparations of manufactured drugs, their possession, trade and consumption are subject to NDPS Rules. Violation of these rules would attract punishment under Section 21 of the Act.

The Codeine based drugs are so addictive that it forces dependence and withdrawal symptoms are also too dangerous. Nausea, vomiting, constipation; drowsiness, confusion; difficulty in micturition, ureteric or biliary spasms, urinary retention; dry mouth, dizziness, sweating, facial flushing, headache, vertigo, bradycardia, tachycardia, palpitations, orthostatic hypotension, hypothermia, restlessness, mood changes, decreased libido or potency, hallucination, miosis; raised intracranial pressure and muscle rigidity are the symptoms found in the addicts of cough syrups containing codeine.

Symptoms also include loss of balance, increased pulse, and hypothermia; severe high blood pressure, loss of consciousness, mania, loss of muscle control, coma, seizures, cerebral haemorrhages and stroke.

These drugs are potentially fatal too with respiratory depression and hypotension, with circulatory failure and even deepening coma.

Oblivious DHS

It's a serious issue, but we are not aware of its magnitude. We do not have a regular Drug Control Section and a proper setup. Three pharmacists are ex-officio notified as Drug Inspectors. We also do not have Drug Analyst or Public Analyst," said Dr Swapan Kumar Paul, Director, DHS, who is also the State Drug Controller.

When asked whether the Directorate have any information about the inflow and outflow of drugs which contain codeine phosphate, he said that he will try to find out and monitor the flow to ascertain the seriousness of the issue.

However one of the Drug Inspectors told LOA that they could not keep a watch on the flow of medicines because, apart from the distributors, others too bring the medicine in bulk quantity which goes unaccounted.

Dr Paul was keen to keep a tab on this issue and had summoned all drug license holders and asked them to submit stock status within a week.

Without proper regulations and a mechanism to check the inflow and outflow of such drugs, the Health Services too have miserably failed.

Moreover, medicines are outside the purview of Octroi, so its very easy to hoodwink the authorities and get whatever drugs they want to land with false invoices and documents.

'We will adopt a comprehensive approach to tackle this issue. We will involve health education division too to create awareness among school children," Dr Paul said.

It is notable that the Chandigarh Administration has banned Codeine based syrups; sale of Phensedyl and Corex in that UT.  Narcotic Drugs and Psychotropic Substances Abuse Act 1985, is stringently enforced in the city.

Whoever the agency to curb this menace, it is high time the authorities wake up to the situation and monitor the sale and usage of such medicines. The availability of such drugs at street-corner shops and even pharmacies must be checked and drugstores should also insist on prescriptions to prevent the drugs possible abuse.

The Camaraderie

The c-company has no parallels in camaraderie. It's a classless group very generous and helpful to each other. You can find a B-Tech graduate C-addict helping his labourer friend in the field. You will always find them in small groups of 4-5 members sitting over a cup of tea for hours together fondling with their mobile phones. As it's a very expensive addiction, they need money for their daily quota, taken care of by friends on rotational basis. To sustain the kick, they rely on sweets and double-mitta chai. Its additional expense. More or less, each one of them need about Rs 150 a day, which they manage through friends or steal from their houses.  A door is always kept open to recruit new members to the group.

"Those addicted of cough syrups are very obsessive in their work. A sweeper will keep cleaning the floor again and again. A designer will remain unsatisfied with his designs and keep changing it. I have seen a boy cleaning a glass for about 3 hours. Another guy who works with a service centre gives your bike a brand-new look," said Raju, an ex-addict who still cannot have regular food due to burning sensation in stomach due to overdose of cough syrups.