SINGAPORE - Amy (not her real name) has been fighting a losing battle to get her husband to stop abusing prescription medication.

Amy, who is in her mid-twenties, said her husband fell in with the wrong crowd and started abusing painkillers in 2019.

His drug habit was so bad he stopped working. In 2021, she had an abortion after finding out she was pregnant.

“I had the abortion because he said he could not take responsibility for the child. Even then, he refused to accompany me to the clinic,” she said.

“In fact, he was taking pills and cough syrup when I was on the way to the clinic.”

He has not been able to quit, even now.

“He has been in and out of the police station and the Institute of Mental Health multiple times, and has also overdosed on the pills,” she said.

Amy said her husband relies on sellers on Telegram to provide him with his supply of cough syrups, painkillers such as tramadol and Lyrica, and sedatives including Valium and midazolam, commonly referred to as “pink lady”.

He sometimes visits the red-light district in Geylang to buy prescription medication as well.

On April 18, The Straits Times spotted two men openly selling slabs of prescription drugs in Lorong 22 Geylang.

Amy showed ST screenshots of conversations her husband has had with sellers on Telegram.

After placing orders with them, the prescription drugs are delivered without labels.

She agreed to speak to ST to raise awareness about the issue of prescription drug abuse in Singapore.

“I’ve tried calling for help, but he is too numbed by the pills. He has been jobless since he was introduced to the drugs. He can’t quit,” she said.

She added that he used to work in the food and beverage industry before his addiction to the drugs.

“I’ve not given up on him, but I am also a victim of drug abuse.”

Online sellers

Checks by ST showed that there were at least six groups of self-proclaimed pharmacists on messaging app Telegram, some boasting thousands of members.

Cough syrups were advertised for sale at between $18 and $35 a bottle. Neurostimulants like armodafinil; painkillers such as tramadol and Lyrica; and benzodiazepines – a class of depressants – like midazolam cost between $15 a pill and up to $50 for a slab.

Mr Narasimman Tivasiha Mani, executive director at youth mental health charity Impart, said that he has noticed an increase in young people abusing prescription medication since the pandemic.

The 40-year-old, who works with youth and people facing adversities, said more individuals have come to him to seek assistance to combat their prescription medication habits.

“The rise in prescription drug abuse among youth seems to correlate with the increased accessibility of these medications through online channels,” he said.

“Platforms like Telegram provide a convenient and seemingly discreet way for individuals to obtain prescription drugs without a prescription, contributing to the growing trend.”

He added that abusers are also producing their own cocktails, to enhance or mimic the highs associated with illegal drugs.

Mr Gopal Mahey, senior counsellor at the Centre for Psychotherapy, said younger people are drawn to the idea that prescription drugs are safer than illegal ones because they are legal and come from medical sources.

“Social media and chat channels have also made these (drugs) simply accessible,” he said.

Drug cocktails

Dave (not his real name) said he first heard about such drug cocktails for sale from his friends.

The 35-year-old, who works in his family-owned business, said: “A few people in my group had heard about it and told me to try a popcorn-flavoured cough syrup.”

He then started abusing drugs such as Xanax, Ritalin and nitrazepam, commonly known as Epam. The drugs are used to treat conditions including attention-deficit hyperactivity disorder (ADHD), anxiety and insomnia.

The ease of choosing what he wanted, ordering everything online and having them delivered made it harder for him to stop, he said.

“I used Telegram more than a few times, and it was very efficient. They usually deliver at night, but it was so convenient because they delivered it to my home,” said Dave.

He spent between $300 and $400 on the drugs every month at the time.

In 2023, he was caught while on his way to collect marijuana.

Said Dave: “I don’t recall much of what happened. I know that I went to collect weed, and then I was in a police car.”

Dave was charged with possession and consumption of cannabis. He is currently out on bail.

Tony (not his real name) said he was around 14 when he started experimenting with drugs. He said he was initially influenced by movies and music he liked.

“I would steal my dad’s medication when I was younger, and I ended up having sort of an addiction to those drugs for a long time,” said the 25-year-old.

He then abused cough syrup, antidepressants and anti-anxiety medication such as Epam, Xanax and Valium.

“I guess I was looking for a rush of euphoria, or numbness. Any stress or anxiety I had would go straight out of the window. But I always regretted it even then, because the lows were severe when the drugs wore off,” he said.

“There were times when I found myself taking five pills, and my friend was only taking one. That was when I knew there might be a problem.”

At 18, he was convicted for consumption of marijuana.

Dangerous habit

Dr Thomas Lee, medical director and consultant psychiatrist at Resilienz Clinic, said he has noticed more patients going online to purchase medication illegally.

Dr Lee, 50, said: “I had a patient who was addicted to codeine, and he knows he can only get so much of it from the clinic, so he started visiting different clinics just to get more. But now, he can just order them online.”

He said most prescription drugs like cough mixtures are safe if taken as prescribed. The danger comes when people start to increase their intake or abuse them, amplifying the effects.

“Codeine itself mimics endorphins; it’s a very mild version of heroin or opium. But too much of it can potentially shut down your breathing centre,” Dr Lee said, adding that codeine is a gateway drug to future use of a strong opioid.

He pointed out that he has seen people abuse medication for ADHD, such as Ritalin and Adderall.

Dr Choo Chuan Gee, a specialist in respiratory medicine at Raffles Internal Medicine Centre, said people become addicted because of the effects of the medication, an increased tolerance after prolonged use and the withdrawal symptoms that follow.

Dr Choo said an excessive use of cough syrup could impair a person’s daily functional ability, adding: “More seriously, it may lead to substance addiction and abuse disorder.”

Dr Tan Ming Wei, senior medical director at telehealth provider WhiteCoat, said controlled drugs are generally not prescribed over a telemedicine consultation, where conditions are usually stricter than in a clinic.

“For the high-risk prescription drugs, we do not allow them to be prescribed over a video call at all,” Dr Tan said, referring to controlled drugs, like benzodiazepines, and other hypnotics.

Dr Andrew Fang, director of medical affairs at telehealth provider Doctor Anywhere, said current guidelines in Singapore also prevent drugs like codeine to be prescribed online, without a prior physical examination.

“This ensures that such powerful medications are prescribed responsibly and only when truly necessary, safeguarding against potential abuse,” Dr Fang added.

Despite that, some people have tried to abuse the telemedicine system to receive prescription drugs.

Dr Fang, 38, said the issue is being taken seriously, with the telemedicine firms implementing stricter controls and training for employees to safeguard the well-being of patients.

Both WhiteCoat and Doctor Anywhere said their clinics contribute data to the National Electronic Health Records system, which allows participating clinics and hospitals to access the patient’s details such as consulting history and medical records.

Jail sentence

The Health Sciences Authority (HSA) said prescription medication including codeine-containing cough medicine, sedatives, opioid painkillers, modafinil and armodafinil can be supplied only by a doctor or a pharmacist.

This is because they contain potent ingredients.

“Taking these medicine inappropriately for non-medical uses or without medical supervision can be dangerous, as they can cause serious adverse effects,” said HSA.

It added that it is prohibited to import, sell or supply prescription medicine without a licence, with offenders risking fines of up to $50,000 and a jail sentence of up to two years.

The authority said that prescription medicine available online are likely from dubious sources and not registered by HSA, adding that they may be adulterated, fake or substandard.

“There is no knowing where these products were manufactured, and how they were made and stored,” HSA said, adding that they can also cause serious side effects.

For instance, the adverse effects for codeine-containing cough medicine, sedatives and opioid painkillers can include drowsiness, confusion, respiratory depression, hallucinations, as well as development of physical and psychological dependence.

HSA said it works closely with the administrators of local e-commerce and social media platforms to regularly monitor, detect and remove sale listings of prescription medicine.

On average, it has removed about 10 listings of codeine-containing cough medicine, sedatives, opioid painkillers and modafinil/armodafinil per year over the past five years.

It also monitors the illegal sale of prescription medicine on instant messaging apps such as Telegram, and has taken enforcement actions including raids, seizure of illegal medicine, and prosecution against those involved in the illegal sales. 

From 2019 to 2023, HSA seized about 1,038,000 units of codeine-containing cough medicine, sedatives, opioid painkillers and modafinil/armodafinil being sold illegally, which amounted to an estimated street value of $685,000. 

The authority also prosecuted 47 people for selling or importing these prescription medicine illegally. These individuals were sentenced to between two and 42 weeks’ jail.

Editor’s note: This story has been edited for clarity.