Mohammed: Impending closure of open drug markets will reduce abuse

Registrar/Chief Executive Officer (CEO), Pharmacists Council of Nigeria (PCN), Dr. Elijah N. A. Mohammed, in this interview with CHUKWUMA MUANYA, gives insights into the health risks of drug abuse and provides evidence-based prevention tips, treatment and solutions to the problem ravaging the world.

Abuse of illicit drugs among youths in the country is soaring. And there exists a nexus between the menace and violent crimes. Why is the menace taking a frightening dimension?
The first issue for discussion is how did the world get to the situation it now finds itself as it relates to drug problems. To arrive at any solution, we need to trace the root causes of the problems and address them as appropriate.

The following were identified as reasons that led many nations to the present precarious situation we find ourselves with regards to drug problem: dramatic increase in the levels of poverty, unemployment, under-employment and disillusionment among people, especially youths, across the globe. Others are forces of globalisation drawing countries together on multiple fronts, with increasing advancement in Information Communication Technology (ICT); impunity—disobedience to the laws of respective countries by the citizens; globalisation which has increased awareness by the youths; peer pressure on vulnerable youths; too many distributors of drugs within the value chains worldwide, and indiscriminate issuance of import permit in some countries like Nigeria.

In the North, alcohol is seen as bad, but drugs or pharmaceutical opioids and other intoxicants are not so viewed. Open drug market and the failure of government to stop the markets in low-income countries such as Nigeria is another reason.

In addition to this, there is also proliferation of drug stores in low income countries with poor regulatory control; poor regulation of health professionals; decline in our value system the world over; appropriate sanctions not being imposed on persons who infringe on the provisions of the laws; porosity of territorial borders of many countries especially in Africa; diversion of legitimate exports/imports for illicit use of drugs meant for medical and scientific purposes, and over-importation of precursor chemicals by some countries.

Diverse shades of drug problems abound from one country to the other. For example, in Nigeria a recent study showed the following drug related issues. (A) One of four drug users in the country is a woman. (B) The 2017 prevalence of any drug use in Nigeria was 14.4 per cent people aged 15-64 years. (C) The extent of drug use in Nigeria is comparatively high when compared to the 2016 global annual prevalence of any drug use of 5.6 per cent among the adult population; drug use was most commonly among people aged 25-29 years; the most commonly used drug in Nigeria was, and is still Cannabis, and the next commonly used drug is Opioids – mainly the non-medical use of prescription opioids and codeine-containing cough syrups.

Mental health experts have stated that cannabis-induced psychosis is the highest basis for admission of youths into psychiatric hospitals in the country. A very strong association has been established between drug abuse and the commission of crimes such as armed robbery, raping, kidnapping, and the like.

Poly-drug use is also a fairly common phenomenon among drug users in Nigeria. This calls for caution among PPMVs who sell “akakpe”, “hada mun”, “cocktail (science students)”, and “mix am”, among others.

What are the evidence-based solutions to this menace?
Solutions that would address the root-causes, and the issues can simply be put at prevention of some events, reversing the trends of some events, managing and controlling some events, and innovating where necessary. Parents also need to check and regulate their children’s access to the Internet while censorship of materials aired in the electronic media is as important.

There has to be development and proper implementation of the National Prescription Policy in countries where such does not exist. Through this mechanism, there will be restriction of prescription of medicines, especially controlled medicines, to the practitioners who are recognised by law to do so.

Also, there will be the codification and alignment of the issuance of annual practicing license of physicians and other prescribers with the issuance of prescription sheets for the use of respective practitioners. This will in turn enhance responsibility and accountability by prescribers.

We must strengthen the workforce of all regulators and law enforcement agencies that have mandates to address drug problem. We must close open drug markets, which service unrestricted access to controlled medicines and diversion of same for illicit use. Drug laws should be reviewed with their sanctions made more stingent.

On the issue of unemployment/underemployment, there should be a reorientation on job-seeking because everybody cannot get white-collar jobs. The potential in all sectors of the economy on job creation should be explored and exploited while entrepreneurship should be included in the training curricula in all tertiary and secondary institutions.

Government at all levels will need to step up advocacy, public education and enlightenment, as well as campaigns against drug abuse, misuse and addiction by educating and creating awareness in the public on rational use of controlled medicines and dangers associated with misuse and abuse of controlled medicines. Governments should also deploy media such as social and electronic media, Ministry of Information – National Orientation Agency (NOA), and the entertainment industry to increase awareness. There is also need to engage the three tiers of government on treatment and rehabilitation of victims of drug and substance abuse. The engagement of traditional and religious leaders within the community in public campaign against drug and substance abuse at the grassroots is also very critical.

There should also be restriction of issuance of import permit to reputable pharmaceutical manufacturing companies and importers, coupled with the intensification of inspection/monitoring activities with focus on fewer pharmaceutical companies dealing in controlled medicines for better regulation.

On another hand, enhancement of tracing and tracking of controlled medicines within the value chain cannot be overemphasised.

The Federal Government must consider the establishment of joint task force of relevant regulatory and law enforcement agencies on drugs and substance abuse. This will boost collaboration among them and ensure effective monitoring and tracking of controlled medicines and substances in the drug distribution chain.

We must enforce compliance with the National Drug Distribution Guidelines (NDDG). This is long overdue. The Federal Government should also establish standard treatment and rehabilitation centres and equip existing ones across the country. This will ensure the treatment, rehabilitation and re-integration of the victims of drugs and substance abuse. Government must also ensure the availability of treatment and rehabilitation centres in all states of the federation and the Federal Capital Territory in order to improve access to treatment and rehabilitation.

Finally, there is need to understand the dynamics of world drug problem, and address them in a comprehensive manner through concerted efforts.

What steps is the country taking to stem rising cases of drug abuse, misuse, and adulteration?
The factors contributing to drug abuse and misuse are multidimensional and include chaotic drug distribution systems, characterised by the existence of open drug markets, the proliferation of illegal and unregistered premises, particularly the Patent and Proprietary Medicine Vendors (PPMVs), easy access to substances that could be abused, and peer pressure, among other factors.

As highlighted earlier, the full implementation of the National Drug Distribution Guidelines, which in effect would ensure the closure of all open drug markets, is key to addressing this problem. The regulator’s platform, which comprises the PCN, National Agency for Food and Drug Administration and Control (NAFDAC), and indeed, the Federal Ministry of Health is very committed to this project. The progress recorded so far, as mentioned earlier, in the ongoing construction of CWCs where the stakeholders operating in these markets will be relocated to, clearly indicates that the closure of these markets is imminent and will happen sooner than later.

Also, the ongoing enforcement activities by PCN are targeted at checkmating the proliferation of illegal premises. The PCN also carried out advocacy programmes among critical stakeholders that are the vulnerable groups in line with the recommendations of the Codeine Control and Other Related Matters Working Group (CCRWG), as approved by the Federal Ministry of Health. The goal is to reduce the influence of peer pressure and discourage the indiscriminate use of drugs. Similarly, Information, Education, and Communication (IEC) materials were produced and distributed among registered community pharmacies to serve as a public health approach to reinforce positive behaviour in relation to medicine and substance abuse.

Let me state that these efforts in collaboration with relevant Ministries Departments and Agencies (MDAs) have contributed largely to the reduction of this menace, particularly as it relates to codeine and related substances abuse among vulnerable groups in the country.

What have been the major challenges militating against the realisation of your mandate of drug regulation and distribution?
The challenges facing PCN include weak laws and regulations, inadequate personnel, logistics, and funding.

Nevertheless, I wish to state that the reviewed PCN Bill, which is currently in the final stages of the law-making process is all encompassing and provides adequate provisions for sanctions. It also adequately addresses gaps inherent in the current law, among other benefits.

The challenge of inadequate logistics, particularly in the area of operational vehicles is of great concern to the PCN. It is noteworthy that operational vehicles are very essential for inspection, monitoring, and enforcement activities and other regulatory functions such as accreditation, internship monitoring and the likes. Unfortunately, a majority of the few operational vehicles currently available are gradually becoming unserviceable. We are, however, making concerted efforts to address this problem.

Also, PCN operates eight zonal offices and 35 state offices across the country. Currently, the number of personnel in these offices is grossly inadequate for effective regulatory activities. To improve the impact of regulatory activities of PCN, which was the primary purpose of decentralisation, we are working through the Federal Ministry of Health (FMoH) with relevant MDAs to secure waivers for the employment of additional personnel.