An issue formerly perceived as the problem of a select few, drug abuse is today becoming a problem of a sizeable proportion of the world population. The problem is so grave that it has extended beyond the usual characteristic profile of abusers being male, adult, and urban-based to now include females, youngsters and those who live in rural areas. In this Cover, PharmaTime’s CHIGBU NWAOBIA looks at the huge task before us and the possible new solutions.
The challenge posed by drug abuse in Nigeria points to a pressing need to sensitise Nigerians especially the youth on the negative effects of the syndrome which is progressively heading to a public health catastrophe. According to World Health Organisation (WHO), drug abuse refers to “a state of psychic or physical dependence or both on a drug following administration of the drug on a period or continuous basis.”
The 2018 British Broadcasting Corporation (BBC) report that detailed the widespread prevalence of drug and substance abuse brought the country under spotlight and also provided first-hand information of how drug addiction has gradually imperiled the nation’s future.
Aside the BBC documentary, the first ever large scale nation-wide survey conducted by National Bureau of Statistics (NBS) in collaboration with the Centre for Research and Information on Substance Abuse (CRISA) with technical support from the United Nations Office on Drugs and Crime to examine the extent and patterns of drug use in Nigeria provided a mind boggling statistical evidence of large scale prevalence of drug use in Nigeria.
According to the report, the number of drug users in Nigeria is estimated at 14.4 per cent or 14.3 million people aged between 15 and 64 years who had used a psychoactive substance in a year for non-medical purposes. The data suggests that the prevalence of 2017 drug use in Nigeria is more than twice the global average of 5.6 per cent.
The report further elucidates the true extent of prescription opioids use– mainly tramadol and cough syrups for non-medical purposes; with an estimated 4.6 million people using these drugs in one year in Nigeria thereby placing Nigeria among the countries with high estimates of non-medical opioid use globally.
Generally speaking, Nigeria currently has 21,213,000 people who abuse various substances. “This confirms the fact that drug abuse is a cankerworm eating really deep into the fibre of the Nigerian society,” Ahmed Yakasai, President of Safe Medicine Foundation (SMF) and immediate past president of Pharmaceutical Society of Nigeria (PSN), said recently in Kano. He added, “This also calls for innovative approach towards tackling the menace of drug abuse in Nigeria.”
The UNODC survey also revealed that out of 376,000 high risk users of drugs, 80,000 inject drugs. This simply means 1 in 5 high risk users of drugs inject drugs and even exchange needles doing so. Currently, Nigeria has high incident rate of HIV and Hepatitis B and C. Therefore, many high risk drug abusers are easily predisposed to HIV and Hepatitis B.
Consequences of Drug Abuse
The consequences of drug abuse in the country is everywhere in evidence. The conflagration of the menace into homes, engulfing young girls, married women and the elderly in addition to the greater involvement of an army of young men had raised the threat to pandemic levels. Expectedly, the impact on our social existence was immediate and devastating. Drugs and substance abuse have been linked to the persistence and brutality of the Boko Haram insurgency in the North Eastern states, and the peaking of criminality in forms of armed robbery, rape, assassination, and kidnapping across the country among other social vices.
All this is in addition to cattle rustling and the resulting tit-for-tat killings that follow across all the three geo-political zones which experts say are generously fuelled by drug induced ethnic hatred, bigotry and plain inhumanity.
Factors Facilitating Drug Abuse in Nigeria
The idle mind as the saying goes is the devil’s workshop. This perhaps better explains why the prevalence of drug abuse is widespread in the country. Youth attraction to drug usage according to experts is a consequence of high rate of unemployment and exposure to new technological tools such as use of smart phones in information gathering among other factors.
Pharm. Ahmed Yakasai had while delivering a paper titled, “Tackling the Menace of Drug Abuse in Nigeria: A disruptive Innovative Approach” during the 38th annual national scientific conference of the Association of Community Pharmacists of Nigeria held in Kano recently, enumerated factors contributing to the menace to include dysfunctional family systems in which parents make use of drugs, and do not pay attention to the activities of their children, as well a failure on the part of parents to reprimand their children during the initial phase of drug use.
He also identified Ignorance of the deleterious effects of substance abuse particularly in boosting physical activity, sexual gratification and recreational use. According to him Peer pressure and the desire to feel belonged, poverty and the desire to use drugs to achieve a sense of pleasure, poor awareness of the menace and dangers of drug abuse, poor control of prescription and dispensing at healthcare facilities, hence “the need for prescription policy in the country and indeed the urgent need for President Muhammadu Buhari to sign the Pharmacy Council of Nigeria Act as approved by the National Assembly.” There is also the issue of poor drug distribution system which allows the sale and peddling of controlled psychoactive drugs by unqualified persons.
Other factors identified by Yakasai include, social media influence, which exposes youths to newer trends of substance abuse, promotion of drug abuse, thus inspiring curiosity to try using drugs. Traditional beliefs about substance use especially alcohol and cigarette which promotes early use of psychoactive substances hence breeding more difficult cases of addiction, lack of sufficient rehabilitation facilities to help treat victims of substance use disorders who can serve as counselors with first hand experiences to influence young people to stay away from substances of abuse. Porous country borders allowing uncontrolled trafficking of psychoactive substances, weak implementation of drug policies and laws leading to poor regulation of handling and trafficking of psychoactive substances, diversion of legitimate exports to illicit use, and corruption and compromises at ports of entries are also factors he identified.
Efforts Made in Curbing Drug Abuse in Nigeria
There have been a number of efforts geared towards tackling the menace of drug abuse in the country but the deep rooted nature of the menace appear to be slowing progress.
President Muhammadu Buhari, in response to the public outcry on drug abuse in the country inaugurated the two-tier Presidential Intervention Structure on the Elimination of Drug and Substance Abuse in November 2018 with a call for collective action to help those enslaved by drugs to build new lives.
“This is a situation of emergency and we must face and address it as such,” the president said. According to him, the use and abuse of drugs by adolescents have become one of the most disturbing health related phenomena in Nigeria and other parts of the world. The president revealed that State Implementation Committee (SIC) would be established in all states of the federation to complement Federal Government’s efforts nationwide.
Subsequently, a High-Level Ministerial Steering Committee was set up and chaired by the Secretary to the Government of the Federation while the Presidential Advisory Committee on the Elimination of Drug Abuse is chaired by retired Brig.Gen. Buba Marwa. Members of the Presidential Advisory Committee include Wives of the President and the Vice-President, representatives of Governors’ Wives Forum (North and South), Nigeria Customs Service, NAFDAC, NDLEA, Police and others.
However, some commentators believe that innovative ideas are required to deepen the campaign and achieve more effective strategy to significantly curtail the menace before it gets out of hand.
Drug abuse is a global public health burden and a number of countries have continued to explore innovative ways to stem the menace. There is indeed the need for authorities in the health sector to adopt evidenced based models that have worked elsewhere and find ways to domesticate workable experiences.
Catch them Young model in Iceland
The Boston-based The Atlantic monthly publication in the United States, reported in a recent edition of how a survey carried out by two psychologists has changed the narrative of Iceland that was plagued by social ills as a result drug abuse among its youth.
According to the publication, Iceland teens were among the heaviest-drinking youths in Europe. Today, Iceland tops the European table for the cleanest-living teens. The percentage of 15- and 16-year-olds who had been drunk in the previous month plummeted from 42 per cent in 1998 to 5 per cent in 2016. The percentage that has ever used cannabis is down from 17 per cent to 7 per cent. Those that smoked cigarettes daily fell from 23 per cent to just 3 per cent. The way the country has achieved that turnaround has been both radical and evidence-based, but it has relied a lot on what might be termed enforced common sense, the publication reports.
Home and School, the national umbrella body for parental organizations, introduced agreements for parents to sign. These agreements educate parents but also help to strengthen their authority in the home. State funding was increased for organised sport, music, art, dance and other clubs, to give kids alternative ways to feel part of a group, and to feel good, rather than through using alcohol and drugs, and kids from low-income families received help to take part.
Impact of Disruptive Innovations
In proffering solutions on the menace of drug abuse in Nigeria using disruptive innovations, Pharm Yakasai, said in his paper at the ACPN event in Kano that there are a numbers of innovative solutions to drug abuse that are being tested and adopted across the world to increase the effectiveness of treatment and rehabilitation against drug abuse, and they include: Anti Cocaine vaccine, Buprenorphine maintenance, Heroin maintenance, and Methadone in a physician’s office. Others include Contingency Management, Treatment in prison, and Family therapy.
RECOMMENDATIONS TO CURBING DRUG ABUSE IN NIGERIA
The UNODC aptly captures what needs to be done for Nigeria to significantly change her narrative on the drug abuse challenge in a memo it sent to the national assembly on March 31, 2018.
According to UNODC the Nigerian government should gather data on drug-use disorders’ prevalence and the accessibility and utilisation of treatment; invest in ensuring treatment and rehabilitation are evidence-based; and allocate sufficient resources to treatment and rehabilitation, the two crucial components of demand reduction. It equally recommended that the government should pay particular attention to special population groups, share nationally and internationally best practices and build capacity as well as stimulate research into new interventions.
The UNODC also recommended that the Nigerian government should use the results of the National Drug Use Survey, as evidence to drive its policymaking; make available adequate resources to the drug regulatory authorities, provide adequate legislative oversight over drug regulatory authorities and encourage the drug regulatory authorities to make regulations requiring all manufacturers and marketers of pharmaceutical narcotics to print labels warning users of the addictive nature and other medical side effects of the drugs. “These messages should be field-tested to ensure that they effectively communicate the required message,” said UNODC.
The Nigerian government is equally encouraged to promote a nationwide campaign to sensitise the general public and vulnerable segment to the effect of non-medical use of pharmaceutical narcotics, including the possible inclusion of this in school health science curricula. It suggested that the sensitisation messages must be developed using tested messages specifically targeted at parents, teachers and healthcare professionals who serve as role models.