Codeine Cough Syrup Abuse Bihar Alcohol Ban

As Bihar approaches a decade of alcohol prohibition, codeine cough syrups have surged as a cheap substitute, with seizures and addiction cases rising, especially among youngsters and in rural areas.

The Directorate of Revenue Intelligence (DRI) this week seized 7,500 bottles of codeine-based cough syrup from outside the Rajendranagar Terminal Railway Station in Patna.

The alcohol ban reduced overt alcohol harm but fuelled an underground market for opioid alternatives, straining police, hospitals, and de-addiction centres.

Codeine is a naturally occurring opioid derived from morphine, a compound found in the opium poppy. Used primarily as a cough suppressant, it is found in various medicines, particularly cough syrups, where it works by suppressing the brain’s cough centre. It is commonly prescribed for upper respiratory infections or chronic conditions like bronchitis, which cause persistent dry coughs. However, it is not the first-line treatment for the common cold.

In therapeutic doses, codeine helps manage severe, persistent coughs that don’t respond to common treatments like antihistamines. The recommended dosage for adults is typically from 10–20 mg every 4–6 hours, up to a maximum of 120 mg daily. Children under the age of 12 are generally advised to avoid it, as it can be rapidly converted into morphine in their bodies, causing potentially dangerous respiratory complications.

Even within the prescribed limits, codeine can cause side effects including drowsiness, constipation, nausea, and dizziness. Misuse can lead to respiratory depression — where breathing becomes dangerously slow — as well as tolerance, addiction, and withdrawal symptoms such as anxiety, sweating, and irritability.

Codeine can also be intoxicating, especially when combined with depressants like alcohol. Overuse can damage the liver, kidneys, and mental health, leading to psychiatric disorders. Hospitals in Bihar are reporting more young people suffering these long-term effects.

Since Bihar enforced alcohol prohibition in 2016, codeine cough syrups have emerged as an increasingly popular alternative to alcoholic beverages. The ban, intended to reduce violence, road accidents, and social harm, has not eradicated substance abuse but has instead fostered new forms of addiction.

Following the ban, many former alcohol users have turned to other, easily accessible substances like cannabis, heroin, and most notably, codeine syrups. In Patna and across rural Bihar, users can often obtain these syrups through the black market or from pharmacies with inadequate oversight.

Codeine syrups are particularly attractive due to their affordability and powerful sedative effects. Their easy availability and relatively low cost — typically INR 100-200 per bottle — have contributed to their increasing popularity as an alcohol substitute. This issue is particularly alarming in Bihar, where the substance abuse crisis has shifted from alcohol to opioids, creating new challenges for law enforcement and public health authorities.

Scale of misuse and the impact on law enforcement

The rise of codeine syrup misuse is not isolated. Data shows an increase in cases involving the sale and possession of narcotic substances, including codeine syrups, since the alcohol ban. Seizures of illegal syrups have skyrocketed, from just under 30,000 bottles in 2016 to over 1.17 lakh bottles in 2024. Authorities have also seized increasing quantities of other narcotics, including doda and smack, highlighting a broader rise in drug abuse in the state.

Despite stringent laws and penalties, including life sentences for alcohol-related offences, the black market for codeine syrup thrives. Recent raids by the Anti-Narcotics Task Force (ANTF) uncovered large illicit stocks, including syrup worth crores of rupees stored in Patna godowns, often controlled by interstate trafficking networks.

Bihar Police is stretched thin, devoting significant resources to tackling the illegal liquor trade, which continues alongside rising codeine syrup trafficking. Since 2016, police have seized an average of about 10,000 litres of liquor daily, totalling nearly three crore litres. Annual seizures peaked at 45.37 lakh litres in 2021, and stood at 36.39 lakh in 2025 over 34.61 lakh in 2024. These figures underline the continuing challenge of enforcing prohibition in the state.

In response to the rising misuse, Bihar tightened the regulation of codeine syrups by designating them as “intoxicants” under the Bihar Prohibition and Excise Act in 2016. This designation restricts sale and possession without a permit, with penalties including fines, confiscation of goods, and imprisonment.

Follow our daily newsletter so you never miss anything important. On Wednesday, we answer readers' questions.

Despite these measures, enforcement remains difficult. Weak regulation of pharmacies and the relative ease of selling syrups as medicines have allowed codeine to flow freely through the black market. The Patna High Court has upheld Bihar’s right to regulate substances under its own laws, even where provisions of the Narcotic Drugs and Psychotropic Substances (NDPS) Act may overlap.

Authorities are considering stricter measures, including a total ban on codeine syrups, mandatory e-prescriptions, and more rigorous pharmacy audits. However, experts argue that addressing the root causes of substance abuse like unemployment, poverty, and lack of education could go a long way toward mitigating the issue in the long term.

Meanwhile, critics warn that restricting access to codeine syrups could limit access for legitimate patients suffering from severe coughs, creating a dilemma between public health and individual patient needs.

Himanshu Harsh is a Correspondent with The Indian Express, currently leading on-the-ground coverage in Bihar. With a reporting career rooted in the complexities of the National Capital Region (NCR), Himanshu specializes in the critical intersection of law, crime, and civic governance. Professional Expertise & Credentials An alumnus of the prestigious Indian Institute of Mass Communication (IIMC), Delhi, Himanshu brings a rigorous academic foundation to his investigative work. His expertise is characterized by a "ground-up" reporting style, most notably demonstrated during his extensive coverage of the 2024 Lok Sabha elections, where he analyzed shifting political landscapes and grassroots sentiment. Specialized Beats Himanshu’s portfolio reflects versatility, allowing him to navigate diverse industries and social issues: Civic & Legal Affairs: Extensive experience covering the Delhi reporting beat, focusing on policy implementation and judicial impact. Automotive Industry: A technical background in reporting on India’s evolving transport and automotive sectors. Social Fabric & Human Interest: Beyond hard news, he is known for exploring the changing social dynamics of India’s urban and rural heartlands, bringing a human-centric lens to systemic issues. Personal Interests & Digital Literacy Outside the newsroom, Himanshu’s deep engagement with technology and gaming informs his understanding of digital trends and the modern information economy. A trained DJ with a passion for music, his diverse personal interests contribute to a well-rounded perspective that resonates across both traditional and digital media platforms. ... Read More