Offenders found guilty of engaging in the unlawful trade of codeine-based cough mixtures can now be fined up to S$50,000 and/or jailed for up to two years, according to the Health Sciences Authority (HSA).

The revised sentence has been transferred to the Health Products Act, from the Medicines Act and Poisons Act, as a regulatory control of pharmaceutical products.

"With the higher penalties... we hope that a strong deterrent message is sent to those who are thinking of profiting from the illegal sale or supply of such products,” said Dr Dorothy Toh, the acting group director of the health products regulation group under HSA.

Penalties revised to target illegal trade of codeine

The stricter penalties have been in effect since November 2016, and are the first time that the sentence for codeine-related offences has been revised since 1987.

The revised penalties come as a regulatory control of pharmaceutical products, and are part of an effort to streamline regulations for health products, including medical devices and cosmetics, under a single Act.

Previously, under the Poisons Act, the prescribed sentence for illegal sale or import of such codeine cough mixtures could lead to a fine of up to S$10,000 – five times less than the current penalty – and/or a prison sentence for up to two years.

Since its enforcement in November, no offenders have been charged under the new penalties.

Codeine addiction in Singapore – a persistent problem

The development of stiffer penalties is in line with the longstanding issue of illegal trade and addiction with codeine in the country.

According to an addictions specialist and psychiatrist Dr Munidasa Winslow, two cases related to codeine addiction show up in his clinic every month.

"Most (patients) have some experience with illicit drugs and are introduced to codeine through friends or peers," he said. "Rarely do people discover codeine via doctors."

In November, a woman was charged with 21 counts of masquerading as different individuals to trick 18 doctors from polyclinics in Jurong and Bukit Batok to prescribe roughly $500 worth of codeine cough syrup to her.

Later in December, a 58-year-old pharmacist was sentenced to eight months and three weeks in prison for the unlawful sale of 20,440 bottles of codeine cough medication between May 2013 and April 2015.

Supply of codeine cough syrups in black market driven by demand

In Singapore, codeine-based cough mixtures can only be supplied by qualified doctors and registered pharmacists. Strict rules also enforce that an individual can only be prescribed a maximum amount of 240ml of codeine cough syrup at any one time, and the syrup cannot be dispensed to the same person within a four-day period.

A 90ml bottle of cough mixture may cost up to $10 at a clinic, and many addicts have resorted to “doctor-hopping” in order to stock up.

“We are cautious with patients who insist on having only codeine-type cough syrups, and who appear clinically well when they come for a repeat visit,” said Dr Winston Ho, the medical director of Parkway Shenton.

However, due to strict rules that govern the sale of codeine cough syrups, addicts turn to the black market, where a same amount can cost roughly $35.

“If you buy 10, you get one free,” said a patient of Winslow’s, who was consuming 11 bottles of codeine syrup daily.

According to Toh, the HSA works with the Central Narcotics Bureau, Immigration and Checkpoints Authority and Singapore Police Force to clamp down the illegal supply of codeine mixtures. Between 2011 and 2015, authorities seized approximately 3,800 litres of codeine cough syrups with a street value of $1.3million, with forty individuals prosecuted for its illegal trade.

Despite strict regulations and targeted operations by authorities, the black market has persisted due to high demands.

“As long as there is demand for such products, there will be unscrupulous persons looking to make a quick profit,” said a spokesman from HSA. MIMS

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