THE PROBLEM OF DRUGS/SUBSTANCE ABUSE IN NIGERIA: A SYMPOSIUM
PROFESSOR MOJISOLA CHRISTIANAH ADEYEYE
DIRECTOR GENERAL, NATIONAL AGENCY FOR FOOD AND DRUG ADMINISTRATION AND CONTROL (NAFDAC)
THE UNIVERSITY OF BENIN, BENIN CITY
Distinguished Ladies and Gentlemen
It gives me great pleasure to be at the University of Benin to present a timely topic in the history of our nation – The Problem of Drug/Substance Abuse in Nigeria. The topic is extremely important because of the epidemic of drug abuse facing us today as a nation, especially among our youths. In December 2017, I joined the Senate Roundtable Conference on “Substance Abuse Epidemic In Nigeria”, in Kano. Since then, I have had opportunities to speak on the same issue in Kebbi (February 2018), a Conference organised by the Office of the National Security adviser (March 2018), etc. Then, on April 30, a BBC documentary was aired and this jolted the whole nation into an awareness that was not as heightened before that time. The exposure of abuse of codeine implicated many stakeholders including manufacturers, NAFDAC, Pharmacists Council of Nigeria and the Federal Ministry of Health.
The abuse of drugs in Nigeria is caused by many factors including love for money by peddlers, disobedience to the laws of the country, proliferation of the market with individuals who sell medicines, lack of control of prescription in the healthcare facilities and lack of control of dispensing among dispensers. Other reasons for abuse of drugs include smuggling substances of abuse through our porous seaports and land borders, corruption and compromises at the point of entries, diversion of legitimate exports to illicit use, weakness in inspections and weak penalties for the sellers and traffickers.
There are many social factors that have resulted in abuse of drugs. These include decline of family value systems, parents not playing their roles properly, children and youth therefore not receiving proper guidance, peer pressure, social media influence, poverty and unemployment.
The most commonly abused drugs in the country are tramadol and codeine. Tramadol is a synthetic opioid analgesic used to treat moderate to severe pain and is the most abused medicine among addicts. It has no effects on the respiratory system but overdose causes arrhythmias, cramps, coma and death. In Nigeria, it is regulated as the 50 and 100mg dosage strengths but very high dosage forms of 200 and 225mg have infiltrated the market. There is also noticeable increase in smuggling of Tramadol capsules. Tramadol use disorder is associated with physical withdrawal symptoms and compulsive behaviour.
Codeine can be obtained as an over-the-counter painkiller and cough medicines in Nigeria but consumers often become addicted. The risk of addiction is great, and in many countries including Nigeria, consumers are required to have prescriptions for all opioid-based medications. The misuse of codeine products contributes to severe health outcomes including liver damage, stomach ulceration, respiratory depression, coma and death. In Nigeria, despite the fact that all codeine-containing products are locally manufactured and are prescription-only-medicines (POM) since 2012, some products are smuggled into the country as unregistered products. The reclassification as POM did not stem the trend of abuse partly due to non-adherence to the provisions made for prescription.
The lack of due diligence to ensure the integrity of the distribution chain has led to unauthorised distributors distributing the products to illicit channels and to traders with little or no knowledge of the public health consequences of codeine-containing products. These unauthorised distributors also illegally import large volumes of codeine-containing cough syrup to satisfy the illegal. market.
This crisis led to tightening of NAFDAC’s regulatory controls in May and the temporary closure of three pharmaceutical companies and stringent inspections of all companies that manufacture codeine containing syrup.
Tramadol, a hitherto prescription-only-medicine was put under national control in 2013 after the 59th National Council on Health (NCH) meeting, based on national trends of abuse, harm to public health and social well-being. This was clearly an intervention to control supply and requires the manufacturer, importer, distributor and retailer to document all transactions including disposal of the drug. Sadly, national control measures can be circumvented at the international level hence the need to work in partnership through the United Nations to check the rising menace of pharmaceutical drug abuse among the risk groups.
Expectedly, at the 57th Session of the Commission on Narcotic Drugs (CND) in 2014, concerns were raised on the increase in the abuse of New Psychoactive Substances, such as tramadol not controlled under the International Drugs Control Conventions. Nigeria supported the call for scheduling of tramadol in order to bring it under the Import/Export Authorisation System of the International Narcotics Control Board (INCB) to effectively control international trade in Tramadol.
Due to lack of data on widespread use of tramadol, in 2017 the Expert Committee on Drug Dependence of the World Health Organisation requested for information on the extent of problems associated with Tramadol misuse to enable critical review of the dangers associated with the abuse of Tramadol worldwide. Available information has shown Nigeria as one of the countries in the world with highest use of Tramadol relative to our population.
In Nigeria as in many African and Middle East countries there are signs of expansion of the market for Tramadol. From the January and June 2018 data, provided by NAFDAC’s Ports Inspection Directorate, 9 X 40’ containers were intercepted at the Apapa Port all containing unregulated 200/225mg Tramadol capsules. At the Onne Port 9 X40’ containers containing similar formulations were also intercepted and handed over to NAFDAC by the Nigeria Customs Service. In another development in May 2018, the Nigeria Customs Service at the SAHCOL Shed of the Murtala Mohammed Airport, Lagos, intercepted 180 cartons of Tramadol 225mg. The consignment has since been handed over to NDLEA.
Despite the fact that the Onne Port, Tincan Island Port and all the land borders are not approved as entry points for pharmaceuticals into the country there have been reports of clearance of drugs through these unapproved entry points. The concealment and importation of illicit pharmaceuticals into the country remain complicated and poses a serious challenge for effective control at the national, regional and international levels. NAFDAC has been able to seize large amounts of tramadol destined for illicit markets from the Onne port. This is as a result of improved cooperation, collaboration, coordination and information sharing between and amongst regulatory and enforcement agencies in real time to detect and prevent diversion of controlled medicines to illicit markets and abuse.
In order to address the public health, and social problems resulting from abuse of drugs, the three arms of government – the executive, the legislature and the judiciary, Ministries, Departments and Agencies (MDAs) of Health, health, educational and religious institutions, parents must address the issues with vigour and holistically through these approaches:
- Collaboration among strategic agencies (Nigeria Custom Services, National Drug Law Enforcement Agency and NAFDAC) responsible for importation and regulation of controlled medicines and/or prevent the importation, distribution and use of illicit drugs .
- Heightened regulatory alertness, diligence and control of importation of drugs and food, now that NAFDAC has been returned back to our ports and borders
- The Federal Ministry of Health should develop National Prescription Policy
- Enforcement of the prescription policy by the Federal Ministry of Health
- Advocacy, and public awareness campaign through the print, social and electronic media should be carried out. Ministry of information and agencies directly responsible for the end users and consumers such as the Pharmacists Council of Nigeria (PCN), Pharmaceutical Society of Nigeria (PSN), NAFDAC, Medical and Dental Council of Nigeria (MDCN), etc should play active role in these. Additional funding of these should be provided by the government
- Stricter issuance of permits and registration of controlled medicines by NAFDAC
- Greater collaboration through use of task forces among regulatory bodies responsible for drugs and controlled substances – NDLEA,NAFDAC and PCN
- Extra-territorial enforcement to identify, disrupt and dismantle organised criminal groups operating across borders.
- Review of the drug laws to enable the judiciary apply penalties that are commensurate to the offences.
- Provision of more rehabiliation centers and workers to assist those that are addicted to controlled drugs
- Provision of educational and employment opportunities to the youth
- Greater inolvement of parents in the guidance of their children and strengthening of the marriage institutions for effective upbringing of children.
Greater involvement of educational institutions through emphasis in the curriculum about dangers of drug abuse, and of religious institutions in laying more emphasis on the protection of the body from substances that can damage and destroy it.
As a result of this crisis, the government is actively and currently working with various MDAs to mitigate the abuse of drugs in the country. If all the stated approaches are implemented, the nation and its youth can be spared from the current nightmare.
Prof Mojisola Christianah Adeyeye, PhD, FAS
Director General, NAFDAC