Reducing incidences of substance abuse to reduce humanitarian crisis, by experts

In the year 2022, United Nations International Day Against Drug Abuse and Illicit Trafficking is being observed today, and health experts have cautioned members of the public who inject drugs against such practice.

They said that such abuses were among the most marginalised and disadvantaged drug users as they experience poor health outcomes with greater chances of premature death, high rates of potentially life-threatening infectious diseases, such as HIV, hepatitis and tuberculosis, and an increased risk of both fatal and non-fatal drug overdoses.

With the theme, ‘Addressing Drug Challenges in Health and Humanitarian Crisis,’ the Director-General, National Agency for Food and Drug Administration and Control (NAFDAC), Prof Christianah Mojisola Adeyeye said this year’s theme is pertinent, considering the high prevalence of substance use amongst Nigerians and the disturbing rate at which people are internally displaced particularly in distressed communities.

She explained that the high prevalence of the non-medical use of prescriptions was confirmed by the 2018 Drug Use Survey, which revealed that about 14.4 per cent or 14.3 million people aged between 15 and 64 years used drugs in Nigeria as compared to a 2016 global annual prevalence of any drug use of 5.6 per cent among the adult population.

The Survey also revealed that the highest level of drug use was among those aged between 25 and 39 years, which is a matter of great concern, being the main productive age range in the youthful population of Nigeria. The youths, the report established, are the most vulnerable as they possess lots of energy, which can be misdirected either because of peer pressure, frustration, or sheer curiosity.

Adeyeye noted the 2018 report further revealed that about 376,000 (0.4 per cent of the population aged 15 to 64) were estimated to be high-risk drug users defined as people who had used opioids, crack/cocaine or amphetamines in the past 12 months and had used those drugs on at least five occasions in the past 30 days. Among the high-risk drug users, 21 per cent or an estimated 80,000 users, are people who inject drugs with attendant health risks.

She stated that drug abuse is threatening a significant portion of the population in Nigeria, with a potential to negatively affect state capacity and contribute to poverty, state failure and national destabilisation.

In addition, co-morbidities, HIV/AIDS, viral hepatitis and tuberculosis are a real threat to the economy in terms of lost productivity and declining quality of life. In establishing public health as an issue of national security, Price-Smith (2001) observed that any agent that directly threatens to destroy a significant proportion of a state’s population constitutes a direct threat to that country’s national security.

She said: “Although about 40 per cent of high-risk drug users wanted treatment, access to treatment was considered difficult and costly. The stigma associated with drug use is another barrier to seeking treatment. People who need treatment and support are stigmatized and marked as unacceptable”.

Adeyeye noted that the trafficking of prescription medicines including opioids and psychotropic substances is an increasing threat to public health and national security. Criminal elements in the society having easy access to drugs and light weapons have turned the country into a theatre of war. The facts and trends in drug-related problems, including violence, may to some extent illustrate the topic of insecurity.

At the level of organised crime, violence between and amongst various drug gangs may be more related to the drug business than to being intoxicated. At the street level, both offenders and victims are intoxicated. In the case of street robbery, the offender may be intoxicated or suffering from withdrawal symptoms. In the latter case, it is the craving for drugs that motivates the person to be violent and not the effects of the psychoactive substance.

She said: “Drug users commit violent crimes to generate money to buy drugs to continue to experience the effects of the drug or to avoid the discomfort of its absence. Having a mental disorder does not equate to being violent or dangerous but people who are struggling with untreated or poorly treated mental health problems may self-medicate on illicit or prescription drugs and could be willing accomplices in crimes. That is why early, and effective treatment of mental health disorders is very critical to the health and well-being of society”.

Adeyeye said the relationship between drug abuse and extreme violence amongst terrorist groups employing sustained anti-establishment agenda to establish credibility is complex, but understanding the relationship is a prerequisite for adequate democratic responses. All terrorist groups are adept at attracting and manipulating followers from low socio-economic backgrounds, many of whom lack a solid education.

Youth on drugs were easily conscripted due to poverty and unemployment among drug addicts and the vulnerability to financial inducement.

She disclosed that during the terrorism phase, drugs were used to reduce fear and anxiety in carrying out the dastardly acts and used by troops and civilian volunteers fighting the terrorists for the same reason. The internally displaced persons also used drugs to cope with their deprivation. During the resettlement phase, victims used drugs to cope with reality forget the pains of losses, and bereavement and have fun again.

She said: “The NAFDAC Act empowers the Agency to, amongst other functions, regulate and control the importation, exportation, manufacture, advertisement, distribution, sale and use of food, drugs, cosmetics, medical devices, bottled water and chemicals”.

She, however, noted that NAFDAC Act also mandates the Agency to collaborate with the National Drug Law and Enforcement Agency (NDLEA) in measures to eradicate drug abuse in Nigeria. The control objective is to ensure availability for medical, scientific and industrial uses while minimizing the possibility of diversion to illicit channels and abuse.

She said: “NAFDAC is committed to the effective regulation and control of narcotic drugs and psychotropic substances; and considering the increasing abuse of controlled medicines across the country, it is important to develop early warning systems that look at the emergence and consequences of the non-medical use of prescription medicines.

The National Policy on Controlled Medicines was developed in collaboration with the Federal Ministry of Health to support the local manufacture of selected narcotic medicines to reduce the cross-border trafficking of controlled medicines to fill supply gaps”.

“Our drug demand reduction activities include targeted sensitization, education and awareness campaigns with community participation to decrease the demand for drugs among vulnerable groups and to equip the public to be able to make informed decisions. We have developed assessment guidelines for the quantification of narcotic drugs and estimation of psychotropic substances and precursors together with the FMoH in 2017 and conducted two surveys in 2017 and 2019 to generate reliable estimates of national needs of narcotic drugs and psychotropic substances”.

Adeyeye noted that the drug use situation remained multifaceted and is characterized by the concurrent and sequential use of many illicit substances, including conventional plant-based drugs, synthetic stimulants, prescription drugs and new psychoactive substances, by both conventional and regular drug users. The abuse of controlled medicines results from both their diversion from licit channels and the availability and distribution of illicitly manufactured/imported opioids and psychotropic substances. Hence the need for product owners to pay due diligence to protect the integrity of the distribution chain.

He said: “The experience of NAFDAC shows that success against the diversion of controlled medicines to illicit channels and abuse is adversely affected by corruption and unethical practices resulting in-laws not being enforced and criminals not being prosecuted and convicted for their crimes. In most cases, justice is not swift, and the punishment is not deterrent enough to prevent a recurrence. Nigeria has vast porous borders and a large and diverse patient base such that extra-territorial authority is required to identify, disrupt and dismantle organised criminal groups operating across borders”.

Adeyeye explained that the challenges arising from drug abuse are not restricted to people who use drugs but have wider health, social and economic consequences on the family, community, and country. Expectedly, in countering the world drug problem, the international community has recognized that this is one problem that cannot be addressed effectively if it is not addressed collectively.

“It is a common and shared responsibility. We are required to strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol. The goal is good health and the well-being of society. And we shall continue to work collectively to combat the national drug problem”.

Chairman, Nigeria Medical Association (NMA) Lagos State chapter Dr. Adetunji Adenekan, said that his association uses the United Nations International Day Against Drug Abuse and Illicit Trafficking to educate people on avoiding the act.

He said the Association reaches out to people every year in the healthcare sector to bring out programmes that will help to reduce mental health because people who abuse drugs are coming down with mental health issues, especially youths.

He said that youths should be employed in order to remove them from the street and keep them busy so that they will become important personalities in the future time.

The Country Director, Johns Hopkins Programme for International Education in Gynecology and Obstetrics (JHPIEGO) Dr. Oniyire Adetiloye said drug abuse is a very big problem everywhere in the World especially in Nigeria, children are abusing drugs mostly in the northern part of the country, abusing substances such tramadol, marijuana among others.

He said the earlier Nigerians sat down to tackle the problem, the better for us as a country because drug abuse is leading to poor education and joblessness, break down of social structure and normal culture, and breaking down of religion. Therefore, there is a need for collective efforts to educate Nigerian youths.

He said JHPIEGO has been working hard in Nigeria since 1974 to educate people to avoid drug abuse including fighting to improve the health and safety of women and families everywhere.