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We are mid “the coughing months” where as a provider I have patients with a cough that may benefit from a codeine cough syrup.  I am growing weary of prescribing promethazine with codeine as this can be doctored into a drink.  Codeine has been known as a good cough suppressant, and when combined with an antihistamine called promethazine, this results in an effective cough syrup that has been used for decades.

Cough medicine has gained notoriety for abuse in the past few years.  This codeine syrup is the main ingredient in a popular drink among teens known as the “Purple drank” or “sizzurp.” This drink has been posted on instagram, artists post tweets about it and even sing about it in their songs.  The mixture is promethazine with codeine, lemon-lime soda, and hard candies.  It is fizzy, colorful, and sweet.  Many teens add marijuana ingestion with this drink which can cause respiratory depression and potentially death.

Physicians need to use extreme caution, continue vigilance to identify frequent flyers and teens.  We should also prescribe only small amounts of this syrup to prevent leftovers from being kept around the house, leading to unsupervised use.

I will continue to dole out this medicine as it is warranted and will warn the parents to monitor its use.  As the mother of a teen, this is an issue dear to my heart: let’s keep our children safe.