'It's like making your own alcohol at home' : factors influencing adolescent use of over-the- counter cough syrup

Background. Adolescents are increasingly experimenting with new 'craze drugs', including over-the-counter cough medicine (OTCCM). However, there is limited empirical evidence regarding South African (SA) adolescents' use of codeine-containing medicines, especially OTCCMs.Objective. To describe SA adolescents' views of OTCCM misuse, and the factors that may promote its use.Methods. The research adopted an exploratory qualitative design. Focus group discussions (N=24) were conducted with 144 learners between 14 and 17 years old in two township communities in SA. Data were analysed thematically supported by Atlas.ti.Results. Three core themes emerged from the analysis, namely knowledge of OTCCM use; factors that influence OTCCM use; and effects of OTCCM use. Participants reported that young people use OTCCM recreationally. Four main factors were noted to influence OTCCM misuse in their communities, namely accessibility, affordability, social influences and the clandestine appeal of cough medicine. Adolescents also said that OTCCM had similar euphoric effects to alcohol or marijuana, but could not readily describe any negative impact.Conclusion. This exploratory study with adolescent participants provides contextualised empirical evidence about OTCCM. The findings call for the South African Health Products Regulatory Authority (SAHPRA) to promptly consider pending regulations on OTC codeinecontaining medication and demands increased awareness of codeine misuse in communities.