Hitting a Nerve

Drug abusers will find a way


Recently, when I logged on to see what medication refills had come in, I was greeted with a notice that Walgreens would no longer carry promethazine/codeine cough syrup. It wouldn’t surprise me if other pharmacies follow.

This doesn’t affect me much. As a neurologist I’ve never prescribed it, and as a patient I’ve never used it.

Dr. Allan M. Block, a neurologist is Scottsdale, Ariz.

Dr. Allan M. Block

The unwritten reason was likely because of its popularity for abuse. It is often mixed with various beverages and called “purple drank.” It has both social, and legal, consequences that can come back and bite the pharmacy.

A friend of mine commented that if everything that can be abused gets banned, all we’ll be left with are Tylenol and Preparation H. Another friend made the comment that it’s a shame, because codeine is a remarkably effective antitussive.

I agree with both of them, but Walgreens is pulling only the combo preparation off the shelves. Codeine and promethazine are still available. The former is on WHO’s list of essential medications.

Even if every pharmacy were to drop promethazine/codeine cough syrup, and it was withdrawn from the market, it wouldn’t keep people from abusing it. They’d still find a way to get the components and whip up some equivalent. Human innovation can be remarkable. All of us who trained in the inner city (which is pretty much all of us at some point) have seen people who drank mouthwash, hairspray, and who knows what else in desperation.

No one believes it’s going to stop drug abuse, but it will make it harder to have purple drank, which is often passed around as a low-level drug at parties. Putting Sudafed behind the counter has reduced, though not stopped, meth. Walter White can tell you that.

A patient of mine who’s a pharmacist also was talking about this. He’s in favor of it, as he’s tired of dealing with people trying to get it through faked prescriptions and bogus visits to urgent care pretending to have a cough, not to mention the additional paperwork and reporting requirements that a controlled drug carries.

I agree with it, mostly, but there are those who truly do need it at times, and who now will have to take it as individual components, or find a pharmacy that does carry it. The issue here becomes that, by punishing the abusers, you’re also punishing the responsible.

The vast majority of alcohol users are responsible drinkers. I have the occasional beer myself. Unfortunately, there are a comparative few who aren’t, and their actions can bring tremendous grief to many others. So we have tougher laws all around that we all have to follow.

I agree with Walgreens actions on this, but still find myself wondering how much of a difference it will make.

Probably not as much as I hope.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Recommended Reading

Ruminations on health care spending
MDedge Neurology
The marked contrast in pandemic outcomes between Japan and the United States
MDedge Neurology
Loan forgiveness and med school debt: What about me?
MDedge Neurology
Starting a blog
MDedge Neurology
‘Not in our lane’: Physicians rebel at idea they should discuss gun safety with patients
MDedge Neurology