This article was first published in The Sunday Times on Feb 1, 2015
Six doctors were among 10 people in the medical line caught selling cough syrup to drug syndicates and addicts, raking in big money from the rising black market price of cough mixtures containing codeine.
Codeine is the active ingredient in the cough medicine sold by these doctors, and addicts use it as a substitute for other drugs to get high.
Since 2012, one doctor has been jailed, two have been fined, another two have been charged in court and investigations are ongoing against the sixth.
In the worst case so far, a 41-year-old general practitioner (GP) raked in more than $500,000 in profit in just four months by supplying 3,500 litres of cough syrup to three patients.
The buyers repackaged the mixture in small bottles to sell to addicts. The doctor continued his illicit trade even after the Health Sciences Authority (HSA) raided his clinic.
When he was arrested, he had about $80,000 in cash at home, which was seized by the authorities. He was jailed for 71/2 months in 2012 and fined $60,000.
In another case, an 80-year-old GP sold 500 litres of cough mixture to Malaysian gangsters, and made a profit of more than $30,000 in three months before he was caught. He was fined $35,000 last year.
The HSA declined to name the doctors involved.
Its deputy group director of health products regulation, Associate Professor Chan Cheng Leng, said: "These doctors got involved out of greed as it's a fast way of making money. This is a reprehensible crime."
She said the black market price of cough syrup containing codeine has nearly doubled in recent years.
Doctors pay $40 to $50 for a 3.8-litre canister from pharmaceutical companies, but can sell it for up to $1,100 on the black market now.
In 2009, the same canister fetched only $650.
For addicts, it means that a 90ml bottle of cough syrup now costs $35, up from $20 in 2009.
Prof Chan said of the doctors involved: "They are the black sheep in the medical community. Doctors caught selling cough syrup containing codeine are not common."
Drug counsellors say addicts take cough medicine as it is not illegal, and they feel they need not worry about being jailed for getting high on cough syrup.
But a Central Narcotics Bureau spokesman told The Sunday Times that enforcement action will be taken against those suspected of abusing codeine.
Mr Don Wong, founder of New Charis Mission that runs a halfway house for addicts, said more abusers turned to cough syrup after the authorities banned another substance, Subutex.
That was a drug used to wean heroin abusers off their habit, but it became widely abused by addicts. In 2006, it became illegal to consume, possess or sell Subutex.
Only doctors and licensed pharmacists can sell cough medicine containing codeine. They cannot give a patient more than 240ml per visit, among other guidelines to prevent abuse by addicts. Codeine can be addictive and an overdose can be fatal, Prof Chan said.
Besides doctors, some others in the health-care industry have been caught selling cough syrup.
A former drug offender, 45, set up a clinic and hired a doctor to run it. Although the doctor quit soon after and the clinic did not receive patients, he kept the clinic going and continued ordering cough medicine containing codeine from pharmaceutical firms. He even forged orders from three other clinics to buy the drug.
He sold 3,800 litres of cough syrup on the black market and made a profit of $650,000 in less than six months.
When he was arrested, he had more than $100,000 in cash in a Louis Vuitton bag.
He was jailed for one year and 10 months in 2011.
Two clinic assistants have also been jailed for stealing cough syrup from their employers.
Last December, a 40-year-old woman was jailed for four months for stealing almost 500 litres of cough syrup containing codeine.
She sold it to her former husband for more than $70,000 and he intended to sell it on the black market.
Since 2009, 47 people have been prosecuted for the illegal sale of cough mixture containing codeine. The HSA seized almost 12,000 litres of such products with a street value of $2.5 million between 2009 and 2013.
Offenders face a jail term of up to two years or a fine of up to $10,000, or both jail and a fine, for importing or selling cough mixture containing codeine without a licence.
Prof Chan said: "We have stepped up our surveillance and enforcement efforts against those selling cough preparations containing codeine. We will not hesitate to take action against them."
HOOKED ON CODEINE AT 18
Former codeine addict Brian, 31, started taking cough syrup when he was 18. His friends said he could get high from codeine without the risk of being sent to jail, unlike for other illegal drugs like heroin or ecstasy.
He was soon hooked, taking up to 360ml a day.
If he did not do so, he would suffer from withdrawal symptoms such as severe diarrhoea and a runny nose.
He visited several doctors, as each would give him a maximum of two bottles per visit. When he could not get enough from them, he would buy cough syrup from the black market.
He did not like the black market cough syrup because some syndicates added paint thinner and turpentine or diluted it with water.
He started taking more drugs, including ecstasy, and sleeping pills.
To feed his drug habit, which cost a few thousand dollars a month, he worked for loan sharks and peddled drugs.
He only stopped after his parents caught him sniffing glue and reported him to the police. Since then, he has been living in a halfway house and has stayed off drugs for the past five years.
Now a chef, he recalled: "I was stressed by fights with my girlfriend and not having enough money, so I took codeine to relieve stress. I thought I wouldn't be hooked."