On the 30th of April 2018, a dwindling conversation in Nigeria was jerked back to life. The BBC investigative documentary on Codeine and its debilitating effect brought to the fore what has been a rising concern hitherto treated with dragging feet by the Nigerian government.
Perhaps, it would have been just like any other documentary, highly insightful but not really prickling to the conscience if it had just spotlighted the use of codeine containing cough syrup. Well, good for us that it didn’t stop there but went on to ask salient questions that has galvanised the Federal Ministry of Health and other regulatory bodies into action.
In the aftermath of that documentary, a couple of big steps have been taken. These steps include the ban on the importation and use of codeine in the production of cough syrup; in its stead the Federal Ministry of Health endorsed the alternative of dextromethorphan. The ministry also directed the Pharmaceutical Council of Nigeria (PCN) and The National Agency for Food and Drug Administration and Control (NAFDAC) to supervise the recall for labelling and audit trailing of all codeine containing cough syrups in the country, while banning the sales of codeine containing cough syrups without prescription in the country. NAFDAC has also placed an embargo on all new applications for the registration of codeine containing cough syrup and applications for renewals have been abolished and many other plans have been outlined.
In the days following the release of the documentary, NAFDAC has proceeded to shut down the three (3) pharmaceutical companies implicated in the documentary; Emzor Pharmaceuticals Ind. Ltd., Peace Standard pharmaceutical Limited and Bioraj Pharmaceutical Limited. These pharmaceutical companies were later reopened for business and were given administrative fines to pay.
While all these steps are fine and good, some concerns have arisen as to whether they are the best steps to be taken and if they will be effective at all.
The first question that popped into the mind of many Nigerians was “why did it take so long for the government to act?” It could not be because they were unaware. In fact, sometime in October, Senator Bashir Garbai from Borno State moved a motion on the floor of the Senate demanding the Upper Chamber to investigate the massive influx of codeine containing cough syrup into the Northern States especially. The Senate adopted the motion, yet it was a long silence until the NDLEA seized 24,000 bottles of codeine containing cough syrup in Katsina State. Then came the committee and group forming stage; a working group which comprised of experts from various ministries and agencies of government including regulatory agencies, development partners and associations was formed and named Codeine Control and Other Related Matters Working Group (CCRWG). Suffice it to say that, no tangible move was made to curb this menace until the BBC documentary surfaced.
Professionals in the pharmaceutical sector have also shown concern over the ban on codeine containing cough syrup. The National Chairman of the Association of Community Pharmacists, Dr. Albert Kelong Alkali in a press briefing said that banning codeine containing cough syrup was not an outright solution to the problem as there are other controlled medicines that drug addicts can turn to in order to achieve their nefarious aims. He advised the Federal government to channel all efforts into implementing the National Drug Distribution Guidelines, which has been in the works for close to 5 years now.
He is not the only expert in the field that feels this way as Pharm. Biola Paul-Ozieh, the immediate past chairman of ACPN Lagos State Chapter has in times past lamented over the chaotic drug distribution system in the country – stating that “The open drug market must go”. She went on to explain that if there is restrictions and limitations of drugs then the issue of drug abuse will be managed by half. Although, the Minister of Health, Professor Isaac Adewole said in the statement released after the documentary came out, that the Federal Government is committed to ensuring the full implementation of the National Drug Distribution Guideline (NDDG) come January 1st, 2019 and many Nigerians hope that the political will to achieve it is existent.
The implementation of the National Drug Distribution Guideline cannot be overemphasised as drugs must be monitored. Dr. Alkali expressed concern over the alternative suggested by the Federal Ministry of Health – Dextromethorphan. He stated that it is also addictive albeit less addictive than codeine, but if consumed in large quantities it could lead to the same menace we have on ground now. Hence, he encouraged that all hands should be on deck to make sure that only people with prescriptions can get these drugs.
The leadership of the Lagos State Chapter of the ACPN also decried the ban on the syrup. Pharm. Obideyi Olabanji, the chairman of ACPN, Lagos State branch stated that banning codeine containing cough syrup is tantamount to cutting off branches of a tree, while hoping to eliminate the tree. He went further to state that the decision was hasty and there were better ways to handle the situation instead of the knee jerk reaction that the Federal government displayed.
Dr. Lolu Ojo, former chairman of the Association of Industrial Pharmacists, Lagos State, and the present chairman of the National Drug Distribution Committee PSN in an interview with Core Health, stated that the ban on codeine will only give us short term relief because government is only banning those coming through legal means. What happens to those that are being smuggled into the country? What happens to those being produced illegally? Does the government have the wherewithal and political will to combat these ones?” These were some questions that he raised in that interview.
We could be looking at more serious consequences in the future from the menace of drug abuse. With the ban on codeine containing cough syrup, it will become a black market drug and the price will be hiked. This alone could lead to increase in armed robbery, fraud and all manner of illegal activities as addicts will only get desperate to get their “fix”.
While it’s all well and good to fight to stop these drugs from getting into the hands of wrong individuals, it’s important also that we think about those that have been affected. Those young boys and girls that were shown in the documentary in an ill equipped rehabilitation centre posed a sorry tale. The question is: will funds be set aside for those battling with this addiction? Or will they be abandoned to wallow in their addiction and helplessness; what hope is there for them?
It is said that it is better late than never; at least the Federal Government and regulatory bodies have taken a step, however inadequate they may seem. But there is more to be done, not just on the part of the government, but also on the part of professional bodies, civil societies, NGOs, and every individual.