While the impacts of drugs and crime is well documented in the world, the rising addiction to opioid, a prescription painkiller is taking a deepening crisis the world over. Opioid abuse is arguably one of the major challenges facing humanity at least for now. Indeed, opioid abuse and addiction transcends culture, gender, and socio-economic class.
According to the United Nations Office on Drugs and Crime (UNODC) report, about a quarter of a billion people use drugs. Of these, around 29.5 million people or 0.6 per cent of the global adult population were engaged in problematic use, and suffer from drug use disorders including dependence. Opioids were the most harmful drug type and accounted for 70 per cent of the negative health impact associated with drug use disorders worldwide.
In a report, the UN has warned of a rise in trafficking of the synthetic opioid – tramadol. Tramadol is an opioid analgesic used for the treatment of moderate to severe pain. The non-medical use of tramadol has been reported by many countries, including Egypt, Jordan, Lebanon, Libya, Mauritius, Saudi Arabia and Togo, and many have put tramadol under national control in recent years. The drug was initially under the radar but continued press exposure of its abuse brought it to the attention of the World Health Organisation, but this only looks to have driven up the demand and use of the drug.
In the United States, it is estimated that 115 Americans die every day from opioid overdose. This has been recognised as a national crisis that affects the public health as well as the social and economic welfare. The estimated economic burden in United States is $78.5 Billion a year. In response to all of this, the government has put in place checks that have limited how many opioids doctors can prescribe. Some opioids are on a stricter regulatory schedule. Also, law enforcement has threatened doctors with incarceration and the loss of their medical licenses if they prescribe opioids unscrupulously.
In the case of Nigeria, opioid is known to be popular with the Islamist militants, Boko Haram. The pills which can be legally prescribed as painkillers are thought to be used to calm the would-be attackers. A call for effective action towards truly curbing the opioids epidemics in the country has been made by experts. Commenting on this, Pharm. Nkere Ebube, former President Nigerian Association of Pharmacists and Pharmaceutical Scientists in the Americas (NAPPSA), who spoke to PharmaTimes, said that in recent times, opioid abuse and addiction in Nigeria has seemingly attained a national crisis. He added that it is on the verge of imploding into a pandemic of unprecedented proportion with some severe but crippling consequences if drastic measures to check this epidemic are not taken.
“A fundamental step towards truly curbing the opioids epidemics in Nigeria is to first recognise that this is a national crisis. More than anything that we have ever faced in the past the threat is real and our future and survival as a country is at stake. The government and policy makers need to give the opioid epidemic adequate attention by providing necessary resources, framework and infrastructures to tackle this problem before it becomes a pandemic,” Ebube said.
To underscore the need to avert the crisis, Ebube disclosed that the opioid epidemic presents a unique opportunity for Pharmacists and Doctors, both in Nigeria and the diaspora, to work closely together and with the rest of the medical community, legislatures, religious leaders, other key stakeholders, and the government to control the devastating menace and spread of this evil in Nigeria.
Speaking on how the government can curb the abuse of opioids such as tramadol which is on the rise in West African sub-region, he said: “I believe that the Nigerian government can work with other West African countries to enact strict drug laws with stiff penalties, as well as create a mechanism to share intelligence information related to drug trafficking. West African countries can pull together to create a drug trafficking & control patrol unit with a mandate to minimise drug trafficking and abuse across the entire sub-Saharan region. Nigeria can play a lead role with a centre in Abuja; this unit will monitor and track all opioids getting into the sub-continent by working very closely with appropriate local/ primary regulatory and drug enforcement agencies.”
Furthermore, Ebube recommended a necessary and far reaching short and long approach to addressing the problems of opioid abuse and addiction as follows:
Overhaul the drug laws – no one can get a pain medication with potential for abuse without a prescription.
Pharmacists must keep records of all opioid drugs procured/ dispensed – records must be submitted to drug enforcement agency quarterly/ reviewed annually. Pharmacies must be equipped with a functional surveillance camera, and must apply for annual quota based on projected sales volume.
Mandatory drug screening at the work place – coordinate unannounced screening with stiff penalty for abusers including termination.
NAFDAC must increase surveillance at the point of entry as well as track/ have records of drug distribution pathway. For drugs manufactured locally, the manufacturer must keep record of the API procurement and finished product distribution channels. Opioids cannot get to the hands of street drug peddlers.
Empower the criminal justice system – stiff penalty for drug abusers and peddlers. Medical professionals indicted for aiding drug abusers will be penalised including loss of license to practice.
Health education programmes – targeting churches, mosques, schools, etc. must be encouraged with opportunity to establish drug recovery outposts.
Create jobs and alternative recreational activities for the youth – sports centres, computer centres, vocational centres, after-school programmes, etc.
Drug Enforcement Agency must be under NAFDAC to streamline drug regulation, closely monitor and control drug procurement, manufacturing and distribution.
Establish multiple centres for drug abuse treatments, counseling and rehabilitation – this must be mandatory for each State/ Local Government.
Create a mechanism to reward States with the least incidence of drug abuse through incentives programmes.
NAFDAC will partner with Pharmaceutical Companies/ Manufacturers to develop drugs with abuse resistance properties without compromising on the therapeutic benefits of the drugs. Opiates with proven abuse and alcohol resistant properties will receive accelerated approval/ release as an incentive to the manufacturer/ vendor.
Note: Opioids are drugs that act on the nervous system to relieve pain. Opioids include the illegal drug heroin, synthetic opioids such as fentanyl, and pain relievers available legally by prescription. Other class of opioid include oxycodone (OxyContin), hydrocodone (Vicodin), codeine, morphine, and many others. Regular use even as prescribed by a doctor can lead to dependence and, when misused, opioid pain relievers can lead to overdose incidents and deaths.