1. REDUCING CODEINE COUGH SYRUP MEDICINE CONSUMPTION TO CONTROL CODEINE ABUSE IN THAILAND Naiyana Patcharapisarn Narcotics Control Division Food and Drug Administration

2. 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.

3. 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

4. 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.

5. 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

6. 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.

7. 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.

8. Amount of Codeine Cough Syrup Medicine reported ( per 1000 population per month)

9. Stratification by areas ( per 1000 population per month)

10. Stratification by types of health care services

11. 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.