Extent of Codeine Substance Abuse in Singapore

Mr Desmond Choo asked the Minister for Health (a) how widespread is the abuse of codeine in Singapore; (b) which are the most vulnerable groups; and (c) what are the measures taken to address such codeine abuse in Singapore.

Mr Gan Kim Yong: Codeine is used as a medicine for the relief of cough and pain. As codeine can be addictive, the supply of medicines containing codeine is monitored and controlled in a few ways.

First, the manufacture, import and supply of medicines, including codeine cough preparations, is regulated by the Health Sciences Authority (HSA). Under HSA's Health Products Act, doctors and pharmacists can only supply to an individual patient not more than 240 ml of codeine cough preparation on any one occasion. They cannot supply to the same patient within a period of four days.

Any person who violates the law can be fined up to $50,000 and/or jailed for up to two years under the Health Products Act.

Second, as the professional body which regulates the conduct of doctors, the Singapore Medical Council (SMC) acts on complaints of errant prescribing or dispensation of codeine cough preparations. The SMC Ethical Code and Ethical Guidelines also provide guidance for doctors to prescribe or dispense drugs with potential for dependence or addiction. Doctors who breach the MOH guidelines or the SMC Ethical Code and Ethical Guidelines may face disciplinary action and be liable for suspension of between three months and a year, fine and censure.

Third, HSA regulates the wholesale distribution of codeine cough preparations, and works closely with various enforcement agencies, such as the Central Narcotics Bureau (CNB) and the Singapore Police Force (SPF) to curb the illegal diversion of such preparations into the illegal market.

Finally, to help reduce the demand for such preparations by codeine abusers and addicts, HSA has stepped up public education on the harm caused by codeine abuse through public advisories and press releases.

From 2012 to 2016, HSA convicted 37 offenders and SMC disciplined 5 doctors for inappropriate prescribing of codeine cough preparations.