Let’s talk about abuse of cough mixture Broncleer ( BRONCO)
By Dr Chireka
I was pained when I saw on television recently our youth in Zimbabwe resorting to abusing drugs, especially the cough mixture called Broncleer but popularly known as “BRONCO”. We all know that young people normally look to a future with hope. If that hope is lost, they lose the will to live and may exhibit self-destructive behaviour as a manifestation of that despair. As a child, I used to say that when I grow up I would like to be a lawyer or a doctor. That was not a dream but a vision and, as they say, the rest is history. I became a doctor. The sad thing is that most children of today cannot say they have dreams or a vision as the reality of their day-to-day lives tells them that they will not realise such dreams. If we take away hope from children then we are promoting self-destruction behaviour in them .
Research has shown that a lot of factors play a role in addiction vulnerability such as a person’s environment which includes family, friends and socioeconomic status . Factors such as peer pressure , physical and sexual abuse , stress and parental involvement can greatly influence the course of drug abuse and addiction in a person’s life. Genetic and environmental factors interact with critical developmental stages in a person’s life to affect addiction vulnerability, and adolescents experience a double challenge of these. Although taking drugs at any age can lead to addiction, the earlier that drug use begins, the more likely it is to progress to more serious abuse. And, because adolescents’ brains are still developing in the areas that govern decision making, judgment, and self-control, they are especially prone to risk-taking behaviours, including experimenting with substances and indulging in unprotected sex.
There is a tendency to stereotype youth experimenting with drugs as coming only from poor families, single mothers , commercial sex workers, parents who are drug addicts themselves etc. Whilst some are from these backgrounds we have to also take note of the fact that the reality of substance abusers is that the majority are just like everyone else. They are parents, children, friends, workmates, sisters and brothers. They hold down jobs, have friends, go to social functions and enjoy their weekends. Some fail to manage their addiction and do become entrenched in a lifestyle that the stereotypes embody, but many do not. An addiction does not discriminate between rich and poor, young or old.
The saying goes that an idle mind is devil’s workshop and this true for both poor and rich young people. The rich young people have a lot of money such that they do not need to work. They stay at home and all the house chores are carried out by servants. They spend most of their time sleeping and also they have lots of time to do nothing. The same applies to the poor children, some of them have nothing to do except to roam in the streets without any purpose. These young people will find something to occupy their minds or while up their time and drugs will become attractive with the false happiness that comes with them.
There are a lot of articles written about the abuse of broncleer and I have tried to read most of them. Sadly, the majority of the article are just telling us what we already know: that our children are abusing this cough mixture . No detailed analysis is taken to look into the cause of the problem. Also there is little action that is being taken to address this problem before it becomes too late to prevent many of the worse possible consequences. I feel that many of the efforts being taken by various institutions are disjointed. These efforts only deal with the surface problems, and therefore only offer half-baked solutions in overall. I have heard of several calls to ban Broncleer and as I write, the cough mixture is now banned in Zimbabwe. I think the discussion needs to move to the next step from this development.
There is a lot of corruption taking place in our country and neighbouring countries . One wonders how a banned medicine such as broncleer is smuggled in huge cartons into our country and ends up being sold in our streets. One need a licence to import medicine and that medicine must be licensed in Zimbabwe. Broncleer is banned in Zimbabwe, so it should not find its way into the country. This culture, if not stopped, will result in hard core recreational drugs such as cocaine and heroin finding their way easily into Zimbabwe. We should be looking at the reasons why the current ban is not working and come up with well- thought solutions to the problem. Are the culprits difficult to arrests so as to save our children? Can one go to bed and sleep peacefully knowing that he/she is causing the death of these hopeless young men and women in our society?. We should bring to book all those that are promoting or facilitating this market of getting illegal drugs into our country. No one should be immune in these investigations as failure to act will destroy our future leaders.
I am a fan of raising awareness about the harmful effects of drug abuse, but I am also aware of the limitation of that approach. Recent research in the First World is showing that raising awareness is helping a lot in those that are affluent but it’s not achieving similar results among the least advantaged socioeconomic groups. As we raise awareness, we need to consider the socioeconomic status of our young people. I make no apologies that we have to sort our economic crisis and make sure that we create jobs and give hope to this young generation. We cannot fully blame them for resorting to drug abuse when we are not creating opportunities for them to take up.
Let us look more closely at the cough mixture called Broncleer (Bronco).
Broncleer is a cough mixture that is manufactured by Adcock Ingram Limited in South Africa and is exported to Botswana. In South Africa members, of the public can buy the cough mixture over the counter, i.e., without needing a doctor’s prescription. This cough mixture is banned in Zimbabwe so it is illegal to import it or sell it. It contains, among other ingredients Codeine Phosphate, Diphenhydramine hydrochloride, Ammonium Chloride, Sodium citrate and Nipastat (preservative).
Looking at the patient information leaflet that accompanies the cough mixture, there is the following warning: The use of this medicine may lead to drowsiness and impaired concentration, which may be aggravated by the simultaneous intake of alcohol or other central nervous system depressant agents. Patients should be warned against performing potentially hazardous tasks where loss of concentration may lead to accidents.
This is a warming that must not be ignored, yet this exactly what is happening. The cough mixture causes drowsiness and impair concentration and this is made worse by the intake of alcohol or other sedative drugs. This means that people will become easily drunk after taking a few pints of alcohol and this seems to be the pulling factor behind the recent and increasing popularity of Bronco.
The problem is that this cough mixture does have undesired effects (side effects) and these get worse when taken in overdose, which is often the case. Those who abuse this cough mixture do not follow the recommended dosage at all, but experiment to get “high” on the mixture.
As stated above, this cough mixture contains codeine, which can cause vomiting , constipation , drowsiness ,dry mouth and confusion. Large doses, which are taken by people who abuse this cough mixture, can cause breathing problems, low blood pressure result in circulatory failure and coma. Death can also occur if large doses are taken, especially with other medication that affect the brain. If doses are not high enough to cause death , Users will become dependant on these medication and can do anything to get more drugs. Users will be prepared to go to any length to get this cough mixture, even if it means stealing to get money to buy the drugs. So, the effects of substance use begin to impact on the lives of people other than the user.
Special warnings and precautions for use of codeine.
Codeine is broken down to morphine ( which with either stop the pain or cough) in the liver and the process is catalyzed by the cytochrome P450 enzyme CYP2D6. There are people who lack this enzyme so they will struggle to get any benefit from the codeine. There are some who have a hyperactive enzyme CYP2D6, resulting in higher than expected morphine levels in blood. This can be fatal if the person abusing the cough mixture has a hyperactive enzyme CYP2D6 and takes Broncleer mixture even in normal doses. Sadly research has shown that about 29% of Africans especially Ethiopians, 5% of African Americans and 5% of Caucasians have this hyperactive enzyme. I am not sure about the statistics in Zimbabwe, but the messages is that anyone taking codeine for the first time must start at a very low dose to avoid serious side effects or even death.
I see a lot of codeine abuse in the UK, and people go to the extent of coming up with pathetic lies to get a prescription from a doctor. I get told that either the medication has been stolen or has been left somewhere very far. The classic one was when I was told that the dog had eaten the prescription that I had issued. On further enquiry, it turned out that the person had cashed the medication and was trying to get extra tablets. This is a sad scenario and I see it as a cry for help . I am glad that we do have services in the UK that cater for people that abuse these medications. I have several success stories of people that have managed to gradually stop abusing codeine. It is a challenge and needs support from the health professionals, support groups , family and friends and also the will power of the person to fight the addiction. Society must not look down upon people who abuse medication, but must give them support so as to stop. Drug addiction is like any disease and is no respecter of people but it can be treated. I am optimistic that we will have success stories in Zimbabwe if we change the way we are operating now in our efforts to combat substance abuse.
Another component of the cough mixture is Diphenhydramine Hydrochloride which may cause sedation and worsen the effect of alcohol on an individual. It can cause drowsiness , blurred vision and problems in passing water to just name a few side effects. In large doses it can cause fits in epileptic people .
Ammonium Chloride which is found in mixture can causes vomiting headache and hyperventilating in large doses and can results in drowsiness and severe chemical imbalance (acidosis and hypokalaemia) in the body which can be life-threatening.
Another chemical in the cough mixture is Sodium citrate and may cause restlessness , decreased urine flow , low blood pressure , confusion and stopping of breathing resulting in death. There is high risk of side effects in people that have heart failure , kidney failure , chest problems or high blood pressure.
Here are my 2 cents thoughts;
Drug addiction is a preventable disease and the prevention programmes must involve all stakeholders such as the government , pharmaceutical companies , health professionals ,families, schools , communities , media, especially the social media which is very popular with the young generation. I call upon all stakeholders to work together to address this problem of addiction. Addiction is not something that you can wake up one day and shake it off. Even if the economy improves and jobs creation rises, we will still have a huge problem of people that are already addicted to certain drugs.
The health system must come up with a “turning point” programme that help those that are already abusing drugs. The programme must be easily accessible, non- judgemental and must be fit for purpose. It must be delivered at the right time to the right people by the right professionals.
A dedicated and committed political leadership must revisit the economic situation and revive it so that new jobs start to be created which will be able to bring hope to our youth.
The culture of corruption must the stopped and the culprits who facilitate the illicit traffic in a banned cough mixture must made to account for their evil deeds. No one should benefit by making our youth drug addicts and hopeless young people.
Adcock Ingram Limited in South Africa has a moral duty to make sure that its product is not abused. The company must make sure that it’s does not sell the medication to Zimbabwe as it is banned and also it must limit the quantities sold to each individual at a time. The company must invest part of its profits into raising health awareness about the dangers of abusing Broncleer cough mixture.
Medicine Management Authority of South African must explore further to look at what it can do to stop the abuse of this cough mixture. We know that the problem is not only in Zimbabwe but it’s also in South Africa.
Churches and charitable organisations need to start programmes that engage our youth such as interact clubs , scouts , girl guides, sporting activities , drama clubs. I also call upon our business community to start changing the way they invest. There is need to start investing in areas that bring high social impact.
Health awareness about the dangers of drug abuse is needed . We know that, although many factors affect drug abuse trends , research has shown that when youth perceive drug abuse as harmful , they reduce their drug taking. It is necessary, therefore, to help youth and the general public to understand the risks of drug abuse and for teachers , parents and health care professional to keep sending the message that drug addictions can be prevented and help is available. I have done my part and may you do yours by sharing this article.
This article was compiled by Dr. Brighton Chireka who is a GP and a Patient Engagement Advocate (PEA) in Folkestone Kent, UK. You can contact him at: firstname.lastname@example.org or read more articles on his blog DR CHIREKA’S BLOG
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions.