Codeine cough syrup and 'lean' in Barbados: off the shelf, under scrutiny

Codeine on the shelf next to the snacks

In Barbados, a bottle of codeine cough syrup is not hard to find. "You can go to any petrol station, service station in Barbados, any supermarket and buy a bottle off the shelf," Troy Wickham, deputy manager of the National Council on Substance Abuse (NCSA), said in August 2026 at the closing of a Regional Security System training course on drugs, gangs and transnational organised crime³. He described codeine linctus as a precursor for methamphetamine that is controlled in North America, and said criminal enterprises continue to ship precursor drugs out of Barbados, a threat to national security; he added that he had spoken with the Barbados Drug Service, which had taken steps to remove the substance from shelves³. "Precursor chemicals are posing serious challenges for the hemisphere," he said³.

"Lean" reaches the treatment centres

The local market is young. In March 2026, NCSA Research and Information Officer Laura Foster told members of the Barbados Union of Teachers that people are entering treatment for "non-traditional substances", including ecstasy, ketamine, crystal methamphetamine, prescription benzodiazepines and lean, which she described as codeine cough syrup mixed with a lemon-flavoured soft drink and hard candy, with the syrup as the active ingredient¹. In October 2026 she told doctors, nurses and allied health professionals that field reports, media monitoring and testing by the Forensic Sciences Centre had confirmed liquid "lean" in Barbados, alongside synthetic cannabinoids, ketamine and prescription sedatives, that synthetic compounds "frequently evade standard hospital drug tests", and that clinicians should report suspected new substances to the NCSA⁴.

The warning signs are not new. After its 2020 national primary school survey, of children with an average age of 10, the NCSA recommended that drug prevention efforts include energy drinks, e-cigarettes and lean⁵. During the June 2026 House debate on the Barbados Medical Products Bill, Minister Adrian Forde described young people buying cough syrups containing "codeine phosphate" off the shelf, "mixing them with Sprite and what's not, Jolly Ranchers and calling it 'lean'", and said: "They go to a lot of non-pharmacies. They ain't getting advice from the pharmacist"².

Who polices the sellers?

Pharmacists have long said enforcement is thin. In April 2022, then Barbados Pharmaceutical Society president Yolan Pantin said there were not enough drug inspectors at the Barbados Drug Service to police unlicensed outlets, that generic sildenafil was being sold by unlicensed sellers and pharmaceutical-grade steroid creams in beauty supply stores, and that the Society was setting up a monitoring unit: "We have a lot of people posting these things on Facebook, getting them in and selling them"⁶. On codeine specifically, the only official step reported so far is the one the NCSA described in August 2026: the Barbados Drug Service taking steps to remove codeine linctus from shelves³.

What other countries did with codeine linctus

• United Kingdom (2024). On 20 February 2024 the Medicines and Healthcare products Regulatory Agency reclassified codeine linctus from a pharmacy medicine to prescription-only, citing "the risk of abuse, dependency and overdose" and Yellow Card reports of misuse, including in the recreational drink "Purple Drank"⁷. Its advice to clinicians: codeine linctus "is only considered to be effective in the treatment of chronic cough lasting over 8 weeks"⁸.
• France (2017). Opioid cough suppressants became prescription-only on 12 July 2017. In the national database of suspicious prescriptions, codeine mentions rose from 0.3% to 0.7% before the change to 10.1% in 2017, 16.1% in 2018 and 19.8% in 2019, and the typical user became younger (23 vs. 40 years) and more often male⁹.
• Australia (2018). After codeine became prescription-only in February 2018, pharmacy sales of paracetamol, ibuprofen and their combinations rose, while sales of non-codeine prescription analgesics did not¹⁰.

What physicians in Barbados should know

Codeine's mild image is misleading. A 2025 review from Geneva University Hospitals warns that the easy availability of codeine-based combinations in pharmacies "masks a very real addictive potential" and that recreational mixtures such as Purple Drank illustrate the dangers of dihydrocodeine¹¹. Response to codeine also varies by genotype: a 2009 report in the New England Journal of Medicine linked an ultrarapid-metabolism genotype to a postoperative death after codeine¹². In practice, that means asking adolescents and young adults about cough syrup use, considering lean in patients with unexplained sedation or respiratory depression, and remembering that standard hospital drug screens may not detect what they took⁴.