Are our drug abuse control strategies sufficient?

I arrived in the UK in winter, my first experience of a chilling cold outside the conventional dry harmattan of my place of residence – Kano. Then, I caught a bad flu! As a pharmacist, I walked into a nearby pharmacy to purchase common flu medications – Paracetamol, vitamin C, piriton, and septrin. I was dispensed the first three items and declined the fourth, which required a prescription (a medication order written by a doctor to give medicine to a patient). I was dumbfounded; prescription for ordinary septrin? The same septrin that my 80-year-old grandma in the village can purchase effortlessly in any pharmacy or patent medicine store (chemist) in Nigeria. How naive and foolish I was! Then a thought crept into my mind; I am in a different world.

Septrin is an antibiotic used in treating upper respiratory tract infections accompanying flu. Consequently, it is classified as a prescription medicine in most official pharmacy books and as such is subject to stringent prescription and dispensing regulations. Although it is supposed to have prescription status in most  countries that seek to provide good antibiotic husbandry, alas this is not so in Nigeria. The indiscriminate use of antibiotics is a classic case of poor practice, a ticking time bomb that will, in the near future, render many of our available antibiotics ineffective.

Even more disappointingly, people have unfettered access to substances of abuse which can be found in groceries and wares in our markets. Strangely, you can send a five-year-old to a nearby pharmacy store/chemist for a strip of tramadol or any other drug of misuse with little or no challenge. Suffice it to say that drug abuse is a public health concern bedevilling Nigeria with northern Nigeria being the worst hit as will be illustrated shortly in this piece. This experience explains the weakness of drug regulation and distribution system  in Nigeria.

If there is any social problem causing so many physical and mental health problems for Nigerian youths, it is the drug abuse scourge. The United Nation Office for Drug and Crime (UNODC) reports that the states of Gombe (21.8%), Yobe (18%), Adamawa (17%) and Kano (16%) are the most involved in drug abuse. Put differently, 1 in every 5 people in Gombe State abuses drugs. This is an unnerving and shocking statistic of public health interest with far-reaching and rippling effects in all strata of our social lives, particularly security, which has temporarily been our albatross as a nation. We can easily see a correlation between these numbers and growing insurgency, banditry, and youth restlessness in these states. On the other hand, we have seen the manifestation of weak drug control measures in the number of Nigerians being arrested and convicted for drug-related offences especially in Asian countries. There is a need to repeal the existing drug laws and legislate new ones which will be realistic, workable, and commensurate with the magnitude of the offence.  

The media is always awash with news of arrests, raids, and convictions of drug offenders by enforcement agencies. Yet, there is still a big vacuum to be filled in order to rid Nigeria of the drug abuse epidemic. In my opinion, this is more of a symptomatic approach, only scratching the surface. To address this scourge, a preventative approach should be driving this fight.

At the epicentre of the drug abuse challenge lies the chaotic drug distribution and the combat-driven tactics employed by enforcement agencies which in my opinion are archaic, untenable and have outlived their usefulness in a technological age like ours. There is a clear lack of strategy and coordination in rooting out the drug abuse challenge by the authorities concerned. The narrative I painted earlier clearly underscores the easy access to drugs in our country. Synergy among enforcement agencies needs improvement. In the same vein, there is a need to put up a holistic plan to control the distribution channels of these agents through tracking and surveillance mechanisms. This should, among others, take control at the whole chain of the drug process in contrast to the current model that just targets retail or distribution check points.

Another angle to look at, is the perceived lucrative nature of the pharmaceutical business. To everyone, the pharma business is a cash cow and in the recent past, it has attracted non-professional actors who are now investing hugely to get their slice of the cake. However, the code of conduct in the pharma business is on a higher pedestal entirely because lives are involved, and non-professionals venturing into this area need not only to appreciate this but rather imbibe and live with the spirit.

Similarly, a cursory look at the states with higher drug abuse in the country suggests lower pharmacist/population ratios in these states. The implication is that drug abuse in these states is fuelled primarily through the chemist retail channel where many individuals are in the business to garner profits rather than to provide a public health service. Could we have a situation whereby patent medicine stores are gradually upgraded to satellite franchises of a pharmacy which adheres strictly to professional codes of conduct and governance? Alternatively, in rural areas where not enough health centres are present, medicines with strong abuse potential are domiciled and dispensed at designated public health facilities which could be properly automated and audited for public safety.

From the foregoing, the current strategies employed to tackle drug abuse are in dire need of improvement. There is need for a positive disruptive intervention, with restrictions to access to these substances of abuse and severe punitive measures for violations of professional codes of conduct.

Dr Garba is a Research Fellow in Retinal Gene Therapy, Department of Clinical and Experimental Sciences, University of Southampton, United Kingdom. [email protected]