Care with codeine

Codeine is a commonly used painkiller in both developing and non developing countries. Often it is sold as a combination with acetaminophen / paracetamol in 'cocktail' drugs. It is cheap and usually readily available.  Research at the University of British Columbia (Stuart MacLeod and Noni MacDonald) indicates that it should be used with more caution than previously condsidered.

Codeine acts by being metabolized to morphine in the body, but the degree of metabolism depends on a person's genetic make-up. Thus the amount of morphine produced can be seriously unpredictable.This it may be that for some persons, the drug has almost no pain-killing effects

For infants, the problem can be particularly serious. The researchers have cited two children who died after being given codeine following a tonsillectomy, and two studies have shown toxicity in infants being breastfed by mothers taking codeine.

While for the vast majority, codeine remains a very useful  analgesic for pain control  its effects must neither be taken for granted by users/prescribers/health workers, nor assumed to always be benign for everyone.
This combined with the non-existent controls on the sale of of strong drugs in many developing countries is a cause for concern.