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How to reduce drug abuse, misuse in Nigeria, by ACPN

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Codeine Syrup abuse

Mr. Albert Kelong Alkali is a consultant pharmacist and outgoing Chairman of the Association of Community Pharmacists of Nigeria (ACPN). Alkali, a fellow of the West African Post-graduate College of Pharmacists (WAPCP) and former Chairman of the ACPN Federal Capital Territory (FCT), in a chat with journalists proffered solutions on how reduce the menace of drug abuse and misuse as well as frequent strike action by health workers. CHUKWUMA MUANYA was there. Excerpts:

In recent times, the country has been awash with several cases of drug abuse and misuse as well as mental health issues especially suicide. How best can the government address this menace?

We must commend the Senate for showing sensitivity and sensibility in this obvious menace.

The Senate is working on two draft bills, a nation drug control bill and a mental health bill to deal decisively with the menace of drug abuse and misuse.

You will recall that the Pharmaceutical Society of Nigeria (PSN) and its technical group especially the ACPN blazed the trial of consultations which signposted these development you talked about.

The initial visit to the Senate was followed up with roundtable discussion in Kano particularly because this menace appears to be malignant in the Northern region of the country where youths and women are substantially afflicted.

This challenge is directly traceable to the many defects associated with our drug distribution channels which encourage unlimited and easy access to all categories of drugs including Pharmacists initiated Medicines (PIMS) and Prescription Only Medicines (POMs).

Ordinarily therefore the pragmatic and best feasible option is to appropriately regulate and control the various pharmaceutical premises, deal decisive blows on the plethora of unregistered pharmaceutical premises which are well over two million compared to the less than 6,000 pharmaceutical premises and 20,000 patent medicine vendor duly licensed by the PCN to legitimately handle what should normally be a professional endeavour.

Government must also strengthen regulatory procedures modulating the endeavours of National Agency for Food Drug Administration and Control (NAFDAC) and the National Drug Law Enforcement Agency (NDLEA).

The NAFDAC mandate dictates it must ensure circulation of safe drugs, water and other regulated products.

How do NAFDAF, NDLEA and Pharmacists’ Council of Nigeria (PCN) cope with their respective mandates which normally should be restricted to less than 6,000 pharmaceutical premises and 20,000 Medicine vendors it field experiences confirm that almost two million unregistered premises exist today in our country?

In effect if we legislate on this menace without redressing the fundamental dysfunctions in the distribution channels, it might just be another waste of time, resources and specialized personnel.

So what is the solution to this menace?

The ACPN posits albeit very strongly that the way forward remains: Diligent implementation of the National Drug distribution Guidelines (NDDG) with particular emphasis on the closing of existing drug markets on June 1, 2019 to pave way for the emergence of the Coordinated Wholesale Centres (CWCs) in Lagos, Onitsha, Aba and Kano.

The CWCs, which would have PCN, NAFDAC, and the Police within have prospects of better regulation and control; which has always been impossible in the existing market structure.

Government must breath down heavily on the operators in the markets as it is apparent some are still not ready for a paradigm shift.

While the CWC structure is taking shape in Lagos and to a lesser extent in Onitsha, same cannot be vouched for in Aba where operators appear dodgy and non-committal.

Even the training schedule for operators has not been possible in Aba despite a January 1st, 2019 deadline.

The CWC structure in Kano also appears to be slower than others, but there are assurances that the operators would respond to the ace of regulators.

There is obvious paucity of funds associated with funding the regulatory activities of PCN, NAFDAC and NDLEA.

Rather than spread lean and ineffective budgets on new bureaucracies, it might make a lot more sense to appropriate meaningful budgets to the existing regulatory agencies listed.

The Federal Government and State Government must approve of special funding for the Federal and State task forces on fake and counterfeit drugs which remains the statutory and regulatory instrument to remove outrightly all structures and places where drug sales are prohibited in Nigeria.

Government must also adequately enhance professionalism in the Health Sector through discouraging open ended access to all cadres of drugs including potent ones with narrow therapeutic windows.

This is best achieved through a prescription policy that limits a prescriber to prescription of drugs alone, while the dispenser is also confined to dispensing responsibilities solely.

You will have observed glaring indiscipline even within the rank and file of health providers.

Recently veterinary doctors openly canvassed at the House of Representative an act of parliament which allows them to open veterinary pharmacies as well as import veterinary drugs in Nigeria.

You know as much as I do that rational logic does not support this misnomer.

It is also imperative to put on record that there are valid court have clarified that veterinary doctors cannot seek to regulate the practice of another profession which in this instance is a reference to pharmacy.

For sake of clarity, global best practice dictates that licensed medical doctors, dentists and veterinary doctors are legitimate prescribers, while ONLY Pharmacists are duly charged with the responsibility of dispensing in Nigeria.

Today in our statute book this same position is entrenched in the Poisons and Pharmacy Act of the Federal Republic of Nigeria.

Do you recommend a nationwide ban on codeine-based products in Nigeria?

Truth must be expressed. We take a position that the decision was hasty, shallow and an attempt to play to the gallery.

It was just an escapist mechanism, which ultimately aggravates the thriving impunity in the pharmaceutical sector.

Codeine still has a place in therapy in the global arena.

There are many other drugs that are perennially abused and so how many more of these will the Minister of Health, Prof. Isaac Adewole ban?

In fact, there are so many abuse substances that are not of drug aetiology including fumes from soak-aways, super glue, paw-paw leaves etc, so are we going to decree them out of existence?


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