An evolving drug control response in Nigeria
Drug dependence takes a terrible toll on an individual’s health and well-being. However, the consequences of drug use are not limited to the individual – the illicit use of drugs can be emotionally, socially and financially catastrophic for the families of drug users and the communities where they live and work. These adverse effects are universal and not bound by geography, culture, religion or gender. Drug dependence and its impact on Nigeria have been a visible part of public debate in the past few years, but due to the clandestine nature of drug use, credible information that could inform evidence-based responses on this issue has not been readily available. This has now changed with the release of the first ever National Drug Use Survey in Nigeria in January 2019 conducted by the Nigerian Bureau of Statistics, Centre for Research and Information on Substance Abuse and the Federal Ministry of Health with the support of the United Nations Office on Drugs and Crime and the European Union.
What does the data tell us? The number of past year drug users in Nigeria is staggeringly high at approximately 14.3 million people. This is an estimated 14.4 per cent of Nigeria’s population in the age group of 15 to 64 years. The data suggests that the prevalence of past year drug use in Nigeria is more than twice the global average of 5.6 per cent. Alarming is also the considerable use of prescription opioids (mainly tramadol and to a lesser extent codeine) and cough syrups for non-medical purposes – with 4.6 million people using these in the past year. This places Nigeria among the countries with high estimates of non-medical opioid use globally. While cannabis is the most widely used drug globally and in Nigeria, use of opioids are responsible for most of the negative health impacts of drug use. Over the past 20 years, West Africa has become a transit point for cocaine trafficking; worryingly the data now shows cocaine has become a drug of choice for use by a sizeable number of Nigerians.
While the misuse of these substances is worrying, we have to also recognise that they have a legitimate medical use and it is important to ensure that such prescription opioids are made readily available to those who have a medical need. Any response at the policy and intervention level will need to be nuanced and be mindful of this complexity. The gender dimension is an important, yet lesser known aspect of drug use in Nigeria. One in four drug users in Nigeria is a woman, yet less than 5% of those in treatment for drug use are women. A key question is whether enough is being done currently to support Nigerian women to deal with their drug use? There is a clear gap in meeting the needs for treatment and care for people with drug use disorders. With close to 3 million Nigerians living with some level of drug dependence, the extremely limited availability of drug counselling and treatment services exacerbates this health crisis.
What is the way forward from here? Any response on drug use needs to be rooted in an understanding of the nature of the condition. Drug dependence is a chronic relapsing medical condition. The reasons why people use drugs are complex and are based on various social and health vulnerabilities – not on factors such as personal weakness or lack of morals. In the past, drug responses have focused mainly on criminalisation and law enforcement. However, globally and in Nigeria the approach to drug control has shifted treating drug use first and foremost as what it is – a health issue. In the pursuit of a “balanced approach” the focus has been increasingly on drug use prevention, treatment and care. In Nigeria, this balanced approach is an underpinning principle of the National Drug Control Master Plan 2015 – 2019 and should be even further strengthened in the new National Drug Control Master Plan 2020-2024 presently being developed by Government.
The release of the National Drug Use Survey is an opportunity for Nigeria to evaluate its national response to drugs and to take it to the next level. Recognising the seriousness of the issue, in late 2018, President Buhari inaugurated the Presidential Committee on the Elimination of Drug Abuse. Under the leadership of First Lady Aisha Buhari and Brigadier General Buba Marwa, the committee is tasked to provide recommendations on addressing the issue of drugs in the country in all its dimensions.
Furthermore, the Federal Ministry of Health has established a Drug Demand Reduction Unit that works in collaboration with the National Drug Law Enforcement Agency (NDLEA). The NDLEA itself has taken positive steps to improve its counselling services through capacity building and monitoring of staff. Indeed, since 2014, with European Union funding, the UNODC has trained over 2,000 Nigerian health professionals in evidence based drug treatment and counselling methodologies. Effective action will require evidence based and integrated responses that are sustained in the long term and utilize the considerable expertise and experience available in Nigeria. The extent of the problem is such that it cannot be addressed alone by any single entity within the government or indeed even by the government alone. In particular, in the area of drug counselling and treatment, there is a need to move from the hospital-based model to models that are affordable and offer integrated treatment in the community. These community-based services should offer access to a menu of ethical, evidence-based treatment options from which clients can choose depending on their level of drug use and dependency.
As we move forward, I am hopeful that the country will build on and continue to employ a balanced approach to drug control. This strategy could not only increase access to drug treatment services, in particular for women, but also shift law enforcement responses away from the arrest of drug users to focus on targeting mid to high level drug traffickers. At the same time, such a balanced approach could go a long way to ensure availability of essential medicines while preventing their diversion for misuse. The link between drug trafficking, drug use and terrorism remains an area that needs to be better understood in the Nigerian context. More research is needed to determine whether terrorist groups in Nigeria engage in drug trafficking and use drugs in carrying out their operations. As Africa’s economic and demographic giant, Nigeria stands poised to meet the challenges associated with drug use. At the United Nations Office on Drugs and Crime (UNODC) we are looking forward to supporting Nigeria in a new era of sustained action on drug control that is in line with the 2030 agenda for sustainable development, and is effective, humane and builds on a health-oriented response to drug users’ needs.
• Kato is Director, Division for Operations, United Nations Office on Drugs and Crime at Vienna.