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Finding lasting solution to drug abuse

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“AS for me, I hardly get hungry when I take Tramadol and I think that is what caused my weight lost. I used to take 100 milligram (mg) but now I do not feel it again.

If I want to feel the effect, I will consider from 200mg and above,” Nnaemeka Ikechukwu said.

Tramadol is an opioid pain medication used to treat moderate to moderately severe pain.

Considering his level of Tramadol consumption, one would worry for his health but defiant Ikechukwu said whether he takes drugs or not, he would still die.

“Why should I not be high because something must kill a man? Oga reporter you are boring me here.

In fact, I even need to smoke now. If you do not smoke, drink and do not do all these things you still die, so there is no need,” he queried.

Tramadol is delivered in two forms. For medical purposes, such as surgeries or for severe pain, it is given as intravenously as an injection or passed as drips.

It is also sold in Nigeria as an over-the-counter medication in green capsules of between 50mg to 400mg.

When taken in pill form at high doses, some of its less desirous side effects include nausea, diarrhoea, loss of appetite, and dry mouth.

In the inverse, Tramadol can produce a euphoric high similar to another commonly abused opiate medication, codeine.

In addition to this high, it is also abused for the feeling of numbness from pain, lucidity and extreme alertness that it gives by heightening the senses.

The numbness that Tramadol brings is one of the main reasons why it has become a drug of choice. Users describe the feeling of being high on Tramadol as “forgetting everything that doesn’t matter”.

The 25 years old graduate of Industrial Chemistry from a university in the Eastern part of Nigeria is one of the educated folks caught in the web of drug abuse. One would think that formal education is enough to deter him from being an addict; rather his quest for success was the propelling force.

He said a friend introduced him to Tramadol that is cheap and readily available but he does not take codeine, which he thinks has different effects on people.

Another widely abused and misused drug in Nigeria is codeine-containing cough syrup because of its high addictive and habit-forming potential thereby inducing a state of psychosis-a severe mental disorder with physical damage to the brain, marked by a deranged personality and distorted view of reality.

Teens take large doses of codeine-containing cough syrup to make them go ‘high’ with symptoms including hallucinations, delusions and paranoia. Experts also say that codeine causes sedation and drowsiness.

An Industrial Chemist Kayode Ojewale, said: “Excessive intake of codeine can cause organ failure and brain impairment. Dextromethorphan suppresses cough about half as effectively as codeine but with little addictive potential due to its low narcotic activity.

Ojewale said Tramadol is said to be a narcotic analgesic because it works in the body to change how the body feels and responds to pain.

The industrial chemist said pharmacists should sell no narcotic pain medication such as Tramadol over-the-counter but it is unfortunate that Tramadol can readily and easily be purchased without a prescription in most pharmacies in Nigeria.

He said: “A friend once told me that some teens take high dose of tramadol to numb and deaden their appetite for food.

“Those teenagers, as reported, when they take excess doses of tramadol, may not go hungry for the next 24 hours or more-shocking! Another close contact once said after taking a recommended dose of Tramadol, had no appetite for food all day.

“It is recommended that tramadol should not be given to children under age 12, pregnant women, breast-feeding mothers and people allergic to it or people with severe asthma or breathing problem.

“Tramadol may be habit-forming even at normal dose, how much more if abused and overdosed as the fatal side effect of misused or overdosed Tramadol, like any other narcotic may lead to reduced breathing, seizure (convulsion) and eventual death.”

Other addictive and habit-forming drugs include: cigarettes, caffeine, inhalants, benzodiazepines, barbiturates, methadone, oxycodone, tramadol, codeine, morphine, chemicals, cannabis or marijuana, opiates, heroin, stimulants like methamphetamines and cocaine, hallucinogens and many others, when consumed alter the mind, feeling, perception and behaviour because they exert action on the brain.

Advising people to desist from drugs abuse, Registrar, Pharmacists Council of Nigeria (PCN), Elijah Mohammed, said there is no complete cure to it, adding that use of psychoactive drugs are borne out of curiosity, peer pressure especially among school children and adults as well as social cultural problems.

“The effects of drug abuse and addiction vary from health problems to behavioural challenges, depending on how long one is exposed to it. The biggest issue with addiction is that once addiction takes priority, nothing else matters. It is therefore necessary to avoid drug abuse by all means,” he emphasised.

He added that the council has strengthened its enforcement activities on all facilities to ensure compliance to regulations.

“The Codeine Control and other Related Matters Working Group is a multi-ministerial, multi-agency and multi-sectorial platform constituted by the Honourable Minister on January 23, 2018 to review issues related to the current abuse of codeine, tramadol and other related substances and come up with appropriate recommendations for short, medium and long term application to address the menace of codeine, tramadol and other related substances abuse in Nigeria.

“PCN in collaboration with United Nations Office for Drugs and Crimes (UNODC) and other professional regulatory bodies in health are reviewing the curriculum for pre and in-service training for all healthcare professionals with the goal of promoting rational use of control drugs.”

Although, there is no standard prescription format to enable community pharmacies differentiate between genuine and the fake, Mohammed said the Federal Ministry of Health (FMoH) is developing a policy that will explain roles of healthcare professionals as it relates to prescribing and dispensing of drugs.

He stressed however that the issue of access to medicines (prescription only medicines or over the counter-OTC) is not limited to the pharmacies and urged doctors and pharmacists to work together in mutual respect, recognition and appreciation of individual professional competencies.

Mohammed added that cooperation of healthcare team would better patients’ outcome.

In his words: “Federal Government has developed national master plan on control medicines in Nigeria and recently established 24 treatment centres in various states to treat cases of dependence, withdrawal management and rehabilitation of persons involved in drug abuse.”

Director, Narcotics and Controlled Substances, National Agency for Food and Drug Administration Control (NAFDAC), Dr. Musa Umar, said the agency has taken a number of counter measures to ensure a society free of illicit drug practices.

He expressed that the agency has a lot of challenges making it difficult to carry out their duties effectively.

He explained: “The supply chain is really not secured and enforcement has not been effective, it has not been supported and strengthened. You find out that people are not being effectively monitored.

Our surveillance is also not too good and most of this issue of abuse is because a lot of price distinction between the regulated market and the unregulated market, even the illicit channel.”

Umar added: “We have classified these drugs especially the codeine containing cough syrup from OTC.

Unfortunately the problem is that enforcing provision prescription of these codeine prescriptions is difficult because of all these haphazard and erratic distribution system.

“Again, due to the complicated mode of movement of products that are being imported. You find out that a lot of brand is being imported and we have not being able to effectively manage that.”

Umar said the fight against drug abuse cuts across, a lot of agencies the National Drug Law Enforcement Agency (NDLEA) was part of it, because they want to bring in this issue of drug abuse into the curriculum as its school age drug prevention programme seems to be very effective.

“We have set up narcotic drug officers dedicated to the issue of carrying out activities on drug abuse prevention. We have done that already just waiting for the approval of the appropriate people as desk officers.

Also, we have nationwide drug abuse campaign which is called youth against drug abuse campaign which will go on in the six zones we are expecting the campaign to be flagged off by the first lady any moment from now,” he said.

Umar also said the Customs, Police has a whole lot to do in the area of boarder control and arrest of defaulters. He urged the NDLEA not to focus only on codeine; there are other issues like tramadol, and arrest dealers of 200mg of tramadol.

It is illicit formulation, which has not been approved for the use in Nigeria. It is an illicit product and should not be in circulation.

Executive Director, Nigerian Heart Foundation (NHF), Dr. Kingsley Akinroye, said: “Available statics show that tobacco use is increasing among the youth, more people smoke in the north than south as young girls now smoke more than boys.”

Akinroye, who is a consultant cardiologist, explained that the effect of tobacco takes about 20 years to manifest in the body, predicting that more avoidable deaths will occur as a result of the increase in tobacco and tobacco substances among the youth.

He enjoined the Civil Society Organisations (CSOs) the government and law enforcement agencies to do more in other to curtail the impending disaster.

A community pharmacist in Lagos, Nwachukwu Chibuzor, advised pharmacists to up their game by adhering strictly to ethical practices, adding that there are certain medications that should not sold without doctor’s prescription.

Chibuzor noted that breakdown in the line of prescribing and dispensing of drugs is the sole cause of increased drug abuses.

"I employ pharmacists to ensure ethical standard in management of these products. However, the ban on codeine and related products is a welcomed idea considering the number of lives that are directly or indirectly affected.

“For hospitals to discontinue non-emergency medication dispense, there should be an in-house pharmacy.

You have nurses who are there dispensing medications for the doctors in some private hospitals and it should not be so. Everyone should maintain his own line of training,” he said.

Ojewale called on the government through its appropriate authorities, ministries and enforcement agencies to take drastic actions by arresting this increasing ugly trend of some OTC and ‘behind-the-counter’ drugs being abused in the country.

The industrial chemist said as done in the case of codeine, when a BBC documentary aired on April 30, 2018 allegedly implicated an official of Emzor Pharmaceutical Company selling a codeine cough syrup without prescription, the federal government acted swiftly with a ban on the production and importation of codeine on the May 1, 2018.

Also, President, Association of General Private Medical Practitioners of Nigeria (AGPMPN) Dr. Tunji Akintade said no pharmacist can sell codeine without prescription and should be prosecuted when they are found guilty.”

Akintade added that health professionals are not to jeopardise the health of its citizen is as people are dying and the young ones are becoming drug addicts, adding that prescription right be adhered to for drugs that are under control and not only codeine.


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