Codeine is a short-acting narcotic prescribed by physicians for the treatment of pain. It can be highly addictive and provides the user with an overall sense of calm and feelings of pleasure. When codeine is used, it enters the brain and causes the release of neurotransmitters that stimulate the reward centre of the brain, leaving the user feeling intense well being and pleasure. But this kind of pleasure can lead to both psychological and physical dependence on the drug.
Although codeine is used for medical purposes through legitimate prescriptions, it has been turned put to recreational use and people have become addicted to it, using the drug as a means of obtaining creative inspiration and pleasure, among others. The consequences of codeine abuse to the individual and society are humongous and the abuse can cause significant damage to life. Some of these effects may include: acute pancreatitis, major depression, liver damage, kidney damage, financial problems, legal issues, domestic problems, job loss, heightened pain sensitivity, uncontrollable muscle twitches; muscle cramps and pain; loss of productivity at school or work, impaired social relationships, seizures, respiratory depression, and decreased muscle tone, among others. The social consequences are also numerous: cultism, violence, armed robbery, lawlessness, cultural disorientation, rape, assassinations, loss of productivity and all sorts of anti-social misbehaviour.
Currently, anecdotal data flying suggests that three million bottles of codeine syrup are consumed daily in Kano and Jigawa states alone and about six million bottles in the Northwest of Nigeria. Hence, the safety concerns over the use, misuse and abuse of codeine assuming a frightening dimension in Nigeria are not unfounded. The matter came to the fore when a foreign news medium aired an investigative documentary on how a particular cough syrup turned into street drug and became notoriously popular and expensive in the black market.
In reaction to the release of the investigative piece, the Minister of Health, Prof. Isaac Adewole, announced that the Nigerian government had banned the issuance of permits for the importation of codeine. In addition to the ban, the National Agency for Food and Drug Administration and Control (NAFDAC) shortly afterwards announced the shutdown of the three pharmaceutical companies indicted in the documentary.
As the war against the abuse of codeine rages in the Nigerian health sector, the actions of the Federal Ministry of Health and NAFDAC have stirred up debates on codeine crisis. While, for the government, the solution is an outright ban on the importation of the codeine-containing cough syrup, for thousands of those suffering from codeine addiction, the ban only means that codeine syrup is bound to become scarce and even more expensive.
Hence, the government’s ban should only be treated as a first step in addressing the problem because the ban will not deter those who have already developed codeine addiction and are ready to pay any price for it. A comprehensive prevention strategy is one that seeks to tackle this problem from various angles that will yield both short and long-term results. Essentially, effective codeine control requires evidence-based supply chain management, public enlightenment, engagement and monitoring of dispensing outlets and withdrawal management and rehabilitation of addicts.
Therefore, there is the need to understand the underlying reasons for people being drawn to codeine. As a result, it is important to have a baseline on the magnitude of Nigeria’s codeine problem, particularly the quantity and distribution. In addition, it is important to know the demographics and psychographics of codeine consumers; and outline the socio-economic impacts such as absenteeism in schools, wasteful spending and cost of hospital treatment.
So, a better understanding of the magnitude of the crisis, backed by credible data, must be put in place to stop codeine abuse. Therefore, rather than focus on debates, there is need for introspection on the deeper issues involved in order to find a solution to this growing crisis.
Also, beyond banning the importation, the government should improve the regulation and enforcement of existing regulations on sales of medications, especially in the open markets in Nigeria while experts need to carefully assess patients’ legitimate clinical needs for sedatives, opioids and stimulants, to ensure that these drugs do not get into the wrong hands.
Again, given the low risk perception of the dangers of codeine abuse, the Health Ministry and the National Drug Law Enforcement Agency (NDLEA) should work in collaboration with the United Nations Office on Drugs and Crime (UNODC) to design a good communications strategy focusing on the dangers of codeine abuse, and saturating the airwaves and public spaces with anti-codeine abuse messaging. At the family level, parents should create enough time to attend to the needs of their children and guide them properly to adulthood; while at the community level, religious leaders should sermonise on the ills of codeine abuse.
In addition, the lifestyles of Nigerians, especially with respect to self- medication based on ignorance, poverty, poor access to quality health care services, requires attention. Therefore, the Federal Ministry of Health, State Ministries of Health, NAFDAC, health-related non-governmental organisations (NGOs), the Pharmaceutical Society of Nigeria (PSN) should educate Nigerians on the dangers of codeine. Every pharmaceutical store should have resident pharmacists who should ask for prescription before dispensing drugs and educate patients about any drug.
Nigeria’s leaders must understand that the race to rid the nation of codeine abuse is a marathon, not a sprint, and should not expect one-stop answers to such an entrenched problem!