The recent sealing off of three major pharmaceutical companies in Nigeria by the National Agency for Food and Drug Administration and Control, brings to the fore, the epidemic presently ravaging Nigerian youths (aged 18-35 years). This follows a BBC documentary, which brought codeine addiction to limelight. The former Director-General of the National Drug Law Enforcement Agency, Mr Otunba Ipinmisho, opined that 40 per cent of youths in Nigeria (the future leaders of our country) have taken drugs for non-medical purposes at least once. How on earth do we expect economic growth in such a sick nation?
A drug can be defined as any substance, which when ingested or otherwise introduced into the body, produces a physiologic effect. It is given to humans or animals to treat or prevent diseases. Drug abuse (substance abuse) is a patterned, illegal, non-medical use of a drug, which have properties of altering the mental state in ways that are considered by social norms and defined by statute to be inappropriate, undesirable, harmful, threatening, or, at minimum, culture-alien. Drug misuse on the other hand, is a term commonly used when prescription drugs with sedative (to produce calming or sleep inducing effect), anxiolytic (to reduce anxiety), analgesic (to relieve pain), or stimulant (to increase nervous activity), properties are used for mood alteration or intoxication. It sometimes involves drug diversion from the individual for whom it was prescribed. Drug overuse describes the long term use of a drug long after the illness has subsided.
Classes of drugs most often associated with these terms include: alcohol, caffeine, cannabis, inhalants, opioids, sedatives and stimulants. Depending on the actual compound, this may lead to health problems, social problems, criminal tendencies, physical dependence and psychological addiction. Before the 90s, the use of alcohol, morphine and heroin (diamorphine), was by the “bad boys”. With the turn of the 21st century, this trend changed dramatically. It used to be that you could predict who might have a drug problem; this has since changed. Today, ingenuity has been introduced into drug abuse with complex mixtures, experimentations and new discoveries as portrayed in the song “Science student” by Olamide. The abuse of conventional drugs such as inhalation of volatile solvents (gasoline, nail polish removal, kerosene and petrol), fumes from pit toilet/soakaways (biogas), “goskolo” (a concoction of unimaginable substances), (a substance resembling tea leaves) and pharmaceutical products (tramadol, rohypnol, methadone, hydrocodone, codeine) mixed with soft drinks is now rampant.
Tramadol, hydrocodone and codeine are opioids of the same family as morphine. In humans, they are used to treat moderate to severe pain. In veterinary medicine, tramadol may be used to treat post-operative, injury-related and chronic (e.g. cancer-related) pain in dogs and cats as well as many small mammals including rabbits, rats and guinea pigs. In addition, codeine is used as a cough medicine. Codeine works following its breakdown by the liver into morphine. Though codeine (the most commonly taken opioid) is on the World Health Organisation List of Essential Medicines, the most effective and safe medicines needed in a health system, its misuse could be very disastrous. Some patients are very effective converters of codeine to morphine, resulting in lethal blood levels. You hear cases of a person sleeping and not waking up. Also, as codeine is metabolised to morphine, morphine can be passed through breast milk in potentially lethal amounts, fatally depressing the respiration of a breastfed baby. The rate of prescription drug use is fast overtaking illegal drug use in Nigeria. Avenues of obtaining prescription drugs for misuse are varied: sharing between family and friends, illegally buying drugs at school or work, and often “doctor shopping” to find multiple physicians to prescribe the same medication, without knowledge of other prescribers.
The initiation into drug use is most likely to occur during adolescence, and some experimentation by older ones is common. People at risk include, street children (almajiris) in northern Nigeria, to dull the senses against the hardships of life on the street; artistes, to deal with the stress of performing by increasing alertness and cause feelings of euphoria; veterans to increase alertness and reduce the effects of long absence of their families and increasing number of students in secondary schools and tertiary institutions. Predisposing factors include academic-induced frustration, peer pressure, lack of self-esteem, and the impulsivity of being independent from their parents. Worldwide, the United Nations estimates there are more than 50 million regular drug users. The overall economic losses due to health-related costs, productivity losses and non-health direct expenditures cannot be overestimated. Nigeria losses a whopping $2bn monthly to India on medical tourism!
This emerging threat to the future leaders of tomorrow can only be addressed collectively. Unfortunately, drug abuse, misuse or overuse are usually not detected until the person (and the society at large) suffers from the consequences. Most governments have designed legislation to criminalise certain types of drug use. Even for simple possession, legal punishment can be quite severe (including the death penalty in some countries such as Philippines). Despite drug legislation (or perhaps because of it), large, organised drug cartels still operate in Nigeria. As a Yoruba proverb says, “Enikan ni nbi’mo, igba eniyan ni o to”, which literally translates into a couple gives birth to a child and the society raises up the child. Beyond referral for rehabilitation, guidance and counselling units should be revived in our institutions of learning. In addition, drug education, including drug refusal skills, should be incorporated into students’ orientation programmes. Parents/guardians should be more involved in the educational progress of their children/wards through effective collaboration with the school. Also, the activities of our children in terms of the kinds of friends they keep, their late night activities as well as their consumption of the internet should be monitored as much as humanly possible. Secondary and tertiary institutions of learning should establish a tripartite communication between parents, teachers/lecturers and students more for the overall welfare of the students, rather than for business interests.
Overprescribing of drugs is a major contributor to opioid crisis. Preparations containing codeine and other opioids should not be sold as Over-The-Counter drugs. In India, codeine preparations require a prescription. Physicians, pharmacists and veterinarians should educate themselves on how to identify medication-seeking behavior in their patients and clients and become familiar with “red flags” that would alert them to potential prescription drug abuse. It is very important to note that a healthy nation is indeed a wealthy nation!
- Dr. Adenubi is of the Department of Veterinary Physiology and Pharmacology, College of Veterinary Medicine, Federal University of Agriculture, Abeokuta, Ogun State