Pharm. Abiola Paul-Ozieh FPCPharm is the immediate past Chairman of the Association of Community Pharmacists (ACPN), Lagos State Chapter. In this interview with PharmaTimes Waire Emonefe, she shares her thoughts on the menace of drug abuse, the challenges faced by community pharmacists and the need for regulatory bodies to step up in the fight against drug abuse
What distinguishes the community pharmacist from other pharmacists?
Community pharmacists are based in communities, various neighbourhoods; sometimes we are in commercial nerve centres. We are in the nooks and crannies of the society where we offer pharmaceutical services. I believe that our location as the last leg of the distribution value chain in the pharmaceutical service sector, the community pharmacist is the one you see almost 24/7. In fact, today in Nigeria some community pharmacists run 24/7. The community pharmacist is the closest pharmacist to the average citizen. All over the world it is known that pharmacists are the most accessible health care providers, it is actually the community pharmacist that is being referred to, and even in Nigeria that is the case.
In Nigeria, most people go to the pharmacies in their communities, seeking not just drugs but diagnoses. Is this standard practice? Can the community pharmacist stand in as a doctor?
The healthcare system is such that attracts different disciplines and professionals. It is a multi-disciplinary sector, where different professionals come into play. As regards your question, in terms of training, I won’t say that the pharmacist has been trained to diagnose, that’s the work of the physician (doctor). However, when it comes to rendering care at the community level, it’s no news that the community pharmacist is often the first contact with the patient. It has even been documented that before most people go to the hospital, they would have seen their community pharmacist at one time or the other. This only shows that the community pharmacist has a wealth of knowledge that attracts people and makes them feel that this person, as a health care professional can give solutions to my problems.
The community pharmacist is equipped with knowledge on the signs and symptoms of various conditions that would suggest that this person needs health care attention or the attention of a professional. As community pharmacists we act as a sieve. When we interface with our patients or clients it’s our duty to be able to suspect serious cases that would require people to go to the hospital and those that we can handle. For example, if someone has a stomach ache, we can’t just tell the person to go to a hospital when we know that probably an antacid will solve the issue.
If we send every health issue off to the hospital, those at the hospital will be overwhelmed. This is why pharmacists are equipped to carry out these simple health interventions at that stage. Besides, there are some aspects of healthcare that has been worked out so well that the pharmacist can handle. A good example is the syndromic approach to Sexually Transmitted Infections; it is known worldwide that there is an algorithm that depicts the symptoms and what should be done. Also, for conditions that are not life threatening, it is well known and practiced all over the world – that pharmacists can intervene based on the laid down procedure.
Some of the major challenges we have in the health sector are the availability and accessibility of drugs. What can be done to improve this situation?
In order to deal with availability, the government still has a lot to do. We are in a system where we import virtually everything. The local manufacturers are not yet at a level where they can produce a majority of what we need for our medical consumption. This is due to the fact that we import most of our raw materials. This puts a heavy burden on the manufacturer, especially during the recession, where importation became costly, their capital gradually became eroded. To solve this, the government has to come to play, because the places where we buy these raw materials from also put policies in place and they implemented these policies. The national drug policy was put in place with the intention that we would be self- sufficient in terms of local production of drugs that we need in Nigeria and we are far away from realising that goal.
One of the things that we need to put in place will be the petrochemical industry so that the raw materials can be made available here in Nigeria. Once the raw materials are made locally then our manufacturers can get these materials at a reasonable rate. There should also be a partnership between the academia and the manufacturers, so that the academia will not just research and leave their theories lying in the libraries and not translate this knowledge into practice. I believe that presently, the National Association of Industrial Pharmacists (NAIP) and the pharmacists in Academia are working together on a partnership to translate this research into practical products that are made available.
Government should also think about giving incentives to community pharmacists, so that they can move into the rural community. Many people are in the rural areas, but the roads leading to these places are deplorable, access go these people becomes difficult. They should also note that community pharmacy is not just a practice, it’s also a business, and power is needed to run that business. In terms of accessibility, when we talk about universal health coverage, we can’t do much without the National Health Insurance Scheme. This moribund NHIS that we are running cannot deliver universal health coverage. This is why the whole NHIS must be re-engineered and repositioned to deliver what they have been carved out to do.
What roles can the community pharmacist play in the fight against drug abuse, especially with drugs like Tramadol and Codeine having medical uses?
I want to say categorically that community pharmacists both at national, state and zonal levels have been working and campaigning against drug abuse and misuse in the past, and we will continue to do so. However, the distribution system which is a chaotic system makes it very difficult for us to tame this monster of drug abuse and misuse. The open drug market must go. If there is restriction and limitations of drugs then drug abuse will be managed by half. Also, the regulatory bodies need to step up in this fight against drug abuse. The Pharmaceutical Council of Nigeria (PCN) should be able to do an auditory on manufacturers. They should be able to look down the distribution chain of every manufacturer. When they do this, they would be able to trace where every bottle of codeine containing cough medicine, or tramadol has gone to.
The National Agency for Food and Drug Administration and Control (NAFDAC) should also step up. We can’t keep shouting about drug abuse and NAFDAC is seen registering these same products, if we have so many brands of codeine containing cough syrup, and tramadol in the market and at the point of registration, NAFDAC is not saying “no more”, then we have a problem. These drugs should be on an exclusive list, so that government can legislate on it. Everyone should also realise that we all have roles to play. Parents should also monitor their kids. Even the media has a role to play – to make sure we curb this menace of drug abuse in our society.
The National ACPN conference “EDO 2018” is coming up soon. What should community pharmacists expect?
This year’s conference has been tagged “Conference with a Difference” and I believe that the members of the conference planning committee are up to the task to deliver to the teeming population of community pharmacists in Nigeria. So, community pharmacists should be prepared to have a very exciting time when they get to “Edo 2018” in June.
As your tenure draws to a close, what legacies would you say you are leaving behind?
I can boldly say that by the grace of God, we have raised the bar especially when it comes to leadership matters. My team and I in these past 3 years have worked assiduously to ensure that community pharmacists retain that pivotal role amongst the various technical groups of the pharmaceutical industry. We have done a lot on capacity building too. We’ve held our continuing education conferences every year with choice speakers that have been able to influence our lives. We’ve also had a lot of business seminars. We have also cooperated with implementing partners that have come to lecture and build the capacity of community pharmacists. We have encouraged members to take advantage of these best practices and many of our members are now into many programmes that are improving their capabilities as pharmacists. Also, more people are now showing interest in leadership. All in all, I believe that we have done well.