The National Chairman of Association of Community Pharmacists of Nigeria (ACPN), Dr. Albert Alkali was on point recently when he bemoaned the existence of open drug market in Nigeria. Speaking recently in Lagos at a press conference … … organised by ACPN in response to the May 1, 2018 British Broadcasting Corporation (BBC) documentary which revealed widespread codeine abuse in Nigeria, Alkali said that decades of neglect of the drug distribution system in the country has given room for charlatans, quacks and dubious individuals to carry out illicit trading in medicines that should ordinarily be dispensed under pharmacists’ supervision. In this cover story, PHARMATIMES examines the ills of the Open Drug Market and attempts to chart a way forward.
The drug industry has been seen by some individuals especially charlatans as a money making venture, forgetting the fact that the aim of medicines use is to save lives. Providing medicines to the sick is not about selling a medicine, it is all about ensuring that the sick person gets the right drug at the right dose to achieve a healthy outcome,” Alkali said.
He expressed concern that in a society where open drug market exists, drugs are sold to unsuspecting members of the public indiscriminately with far reaching implications including the attendant hazardous effects on public health.
The ACPN helmsman also said that his association has for long been at the vanguard of sensitising the public on the ills of drug abuse, adding that the theme of the forthcoming national conference of the association – “Medicine Abuse in Nigeria: a Call to Action for Community Pharmacists,” was carefully chosen to deepen the campaign against drug abuse in Nigeria. He however, called for the immediate closure of all open drug markets, and a restructuring of the drug distribution system in the country.
The BBC Africa news investigative unit ‘Africa Eye’ had on May 1, 2018 released a documentary video titled ‘Sweet sweet codeine’ which delivered a hard core evidence detailing widespread prevalence of drug and substance abuse in Nigeria. The video clip which jolted the nation, introduced young Nigerians including ladies, who have lost the power of self-control due to an addiction to codeine containing cough syrup.
The First lady, Mrs. Aisha Buhari, and President of the Senate, Dr. Bukola Saraki were among eminent personalities in the country that responded swiftly to the documentary with an appeal to Nigerians to join hands and halt the menace before it becomes a national catastrophe.
The Minister of Health, Prof. Isaac Adewole, on the same day announced the ban on the production, importation and distribution of codeine based preparations citing gross abuse of codeine containing syrups in the country as reason for the ban. On its part, the Pharmacists Council of Nigeria (PCN) in an advertorial signed by the Registrar, Mr. Elijah Mohammed acknowledged the role of open drug market in the drug abuse saga in the country.
“The existence of open drug markets in the country did not help matters. Earlier, the demand for these codeine-containing preparations was very conventional and there was no cause for alarm. However, within a period spanning over ten years there was gradual increase in the demand and use of these preparations despite no reported cases of cough epidemic in the country by the appropriate authority,” Mohammed said.
He also remarked that with open drug markets came sudden increase in the number of unregulated vendors which gave rise to unhindered access and unholy demand and abuse of drugs in the country. Stakeholders in the health sector had raised the alarm that the existence of open drug market is responsible for the proliferation of substandard, spurious, unwholesome and adulterated drugs across the country with its tragic implications on public health and the economy of the country.
President of the Pharmaceutical Society of Nigeria (PSN), Pharm. Ahmed Yakasai, had in condemning the existence of open drug market in the country at different fora, expressed the worry that operators of these open drug markets, store up drugs in places where they are exposed to temperatures higher than approved ranges.
The circulation of substandard drugs in the country has undoubtedly led to the loss of innocent lives. In fact, business in substandard medicine is regarded globally as a deadly phenomenon which undermines all aspects of medical and healthcare delivery as well as the economy of a nation.
Substandard medicine business according to late Prof. Dora Akunyili, former Director General of NAFDAC is the greatest evil against public health, as well as a source of economic sabotage. Experts say that fake drugs are so deadly that they could lead to treatment failures, organ dysfunction/ damage and worsening of chronic disease conditions. Most of the local pharmaceutical industries that are producing genuine drugs with high overheads are finding it difficult to break even because of unfair competition with drug fakers.
Again, due to the existence of open drug market, a study conducted in 1990 by the former WHO director, late Prof. Adeoye Lambo, revealed that about 54 per cent of drugs sold in pharmacies in Nigeria were substandard. The appointment of late Prof. Dora Akunyili as Director General of NAFDAC in 2001, however, marked a turning point in the upsurge of operations of drug fakers. Akunyili spent eight years trying to cripple the menace in the country. She blacklisted over 30 manufacturers and led raids against open-air drug markets across the country.
As a result of Akunyili’s determined effort to curb the menace, between 2001 and 2005, the proportion of fake drugs on sale went from 40% to 16.5%. Though ever since then, there have been considerable decline in the rate of circulation of substandard drugs in the country as successive administrations in NAFDAC continued tightening the noose on operators. Yet, every now and then promoters of substandard drugs seem to demonstrate ‘never say die’ attitude as officials of NAFDAC keep discovering a resurgence of their activities.
Factors Facilitating Open Drug Market in Nigeria
Political will and the strong commitment of government are essential if there is to be concerted effort to improve drug control and discourage existence of open drug market in the country. However, the following factors must also be considered.
Absence of Drug Distribution Guideline
Stakeholders in the health sector have identified the absence of a drug distribution guideline as the single most important factor that continues to undermine quality pharmaceutical service delivery in Nigeria. They argued that the continuous shift in date for the full implementation of the National Drug Distribution Guidelines (NDDG) has encouraged spread and growth of open drug markets across the country.
To buttress their point they cited 1988, when the first drug law against faking and counterfeiting was promulgated in the country, the four thriving open drug markets according to them were located in Idumota in Lagos, Ariaria in Aba, head bridge market in Onitsha and Sabongeri in Kano. But currently, new drug markets have since become realities in Agege, Mushin, Ikotun Egbe, Ajangbadi, Balogun in Lagos, Agbeni in Ibadan, Oja Oba in Akure, Oja Oba in Shagamu, Ogbete in Enugu, Gamboru in Maiduguri and virtually every state capital in Nigeria.
Weak Regulatory Framework
Inadequate and ineffective legislation as well as slow nature of the judicial system were also identified by stakeholders as major impediments to curb proliferation of open drug markets in the country.
Again, Mr. Elijah Mohammed, Registrar of PCN, who threw some light on the matter in an advertorial recently, recalled how court orders and injunctions frustrated the agency from carrying out its statutory functions and responsibilities towards ensuring standardisation of pharmacy practice in Nigeria for many years.
“Orders of interim injunction restraining the Council from regulating the activities of patent and proprietary medicine vendors (PPMVs) over a period spanning ten years,” hindered PCN from performing its functions effectively according to the PCN boss.
“Within this period under review their number grew astronomically to an estimated 750,000 from a figure of 50,000 in PCN database before the court cases. The implication of the order of injunction made against the council is that so long as it subsists, the council cannot enforce the law thereby giving unfettered opportunity to all manner of persons to sell all kinds of drugs unrestrained.”
A major enabler of the thriving open drug market in the country is our porous borders; it accounts for the greater percentage of illicit business in drugs across the country because those who indulge in importing pharmaceutical products through the borders are mostly those who deal on substandard drugs.
The Way Forward
The implementation of the National Drug Distribution Guidelines (NDDG) by 1st January, 2019 as announced by the federal government remains the major step forward in reversing the ugly chaotic drug distribution system currently in operation. If implemented, the NDDG as articulated by the Federal Government will facilitate the sanitisation of drug distribution channels and bring them in line with international best practice and standards as encapsulated in the International Pharmaceutical Federation guidelines on Good Pharmaceutical Practice declarations.
It will also invigorate confidence of the public in the nation’s healthcare system, healthcare professionals including pharmacists and other authorised dealers of pharmaceutical products. It will undoubtedly strengthen the activities of regulatory agencies – PCN and NAFDAC in carrying out their mandatory responsibilities especially in the area of effective monitoring of drug distribution from manufacturing to end users among other benefits.
Therefore, government must ensure that the 31st December, 2018 deadline for closure of all open drug markets operating in the country is sacrosanct. Pharmacists on their part need to sustain sensitisation of the public on the ills of patronising unauthorised dealers of medicines in Nigeria. The ACPN members have an important role to play in this regard. As professionals closest to end users of pharmaceutical preparations, it is incumbent on every member to adopt standard practice in dealing with customers in other to militate against any compelling desire to patronise quacks.
There is also the need for the national assemble to expedite action in the review of all laws relating to the manufacture, importation and distribution of drugs in the country in such a way that regulatory authorities would be adequately empowered to effectively enforce them. The inability of regulatory agencies to convict many indicted criminals in the illicit drug business and the current widespread of drug abuse in the country, are clear attestations of how weak legislation could aid culprits of illegal drug dealings in the country to escape prosecution.
Due to high rate of smuggling of drug products through the nation’s porous borders, it has become necessary for inter-agency co-operations in this regard. The Nigeria Customs Service officials should be trained on how to detect counterfeit drug products at the borders. This would help to discourage promoters of illegal drugs in the country. Government should partner with PSN and ACPN at all times to get professional advice on all issues regarding pharmacy practice and operations in the country so that proactive measures could be taken.
The ban on codeine containing cough syrups in the country received condemnations by a section of healthcare professionals who saw the action of government on the saga as a fire-brigade approach requiring more holistic considerations. Though the issue of NNDG has long been touted by government without execution, the January 1, 2019 date for full implementation of the new system will determine whether or not government is actually serious with the health of the Nigerian public.