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Taming menace of drug abuse

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[FILES] Drug abuse. Photo/Pixabay

Experts Proffer Solutions, Urge Support For People With Disorders
Recently, the National Drug Law Enforcement Agency (NDLEA) launched the War Against Drug Abuse (WADA) initiative to rally Nigerians to actively partake in the war against drug abuse, which it said was taking a frightening dimension in the country, and which experts have, at various fora, also warned had risen to emergency levels.

The abuse of illicit drugs among youths in the country, in particular, has been identified to have diverse and devastating effects on the society. Aside from reports of chronic health conditions of abusers, experts have also established a nexus between the menace and rising incidences of violent crimes.

Chairman, NDLEA, Brig. Gen. Buba Marwa (rted) while reeling out some statistics said Nigeria was not only the highest user of cannabis worldwide, but stated that revelations from kidnapped victims had corroborated the facts that illicit substances were enablers of insecurity currently plaguing the country. He noted, “it is not difficult to conclude that drugs have been catalysts of terrorism, kidnapping, banditry, armed robbery and various violent conflicts currently troubling the country.

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“The enormity of the danger of drug abuse calls for urgent need to nip the problem in the bud. This is the reason we have redoubled our efforts in the past five months with the Maxim of Offensive Action. It is glaring that Nigerian youths are involved in drug abuse. Over the years, an undesirable subculture had flourished whereby adolescents and young adults wantonly indulged in the abuse of illicit substances.

“They are not only addicted to conventional substances such as cannabis and prescription opioids, such as tramadol and codeine, they also experimented with dangerous mixtures leading to novel psychotropic substances such as “monkey tail” and “skoochies”. In the context of that warped reality, they also normalised the smoking of cannabis as we have seen in some popular music videos and on social media,” Marwa said.

Worried by the development, President Muhammadu Buhari had, on the occasion of the United Nations International Day Against Drug Abuse and Illicit Drug Trafficking held recently, described the danger posed by illicit drugs as deadlier than insurgency, banditry and other threats bedeviling the country. He urged the NDLEA to step up the fight against drugs use by destroying production sites and laboratories, breaking supply chain, discouraging usage while also prosecuting offenders and traffickers.

The President also called on families, schools, civil society organisations, professional associations, religious organisations, the academia, community leaders and individuals to work for the common good in order to rid communities of drug use and trafficking.

According to the United Nations Office on Drugs and Crime (UNODC) World Drug Report 2021, globally, around 275 million people are said to have used drugs in the last year, while over 36 million people suffered from drug use disorders.

The Report noted that in the last 24 years, cannabis potency had increased by as much as four times in parts of the world, even as the percentage of adolescents who perceived the drug as harmful fell by as much as 40 per cent, despite evidence that cannabis use is associated with a variety of health and other harms, especially among regular long-term users.

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“Lower perception of drug use risks has been linked to higher rates of drug use, and the findings of UNODC’s 2021 World Drug Report highlight the need to close the gap between perception and reality to educate young people and safeguard public health,” said UNODC Executive Director Ghada Waly.

In addition, Researchers have said alcohol and other drugs are major factors in infection rates of Human Immuno-deficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS), violent crimes, child abuse and neglect, and unemployment. They said drug abuse also result in gang formation, cultism, armed robbery and mental illness, among others. Studies also revealed that most of drug addicts started smoking from their adolescence. As they grow older, they seek new thrills and gradually go into hard drugs.

Burden Of Abuse
RESULTS of the first comprehensive nationwide national drug use survey conducted in Nigeria by United Nations Office on Drugs and Crime (UNODC), titled, “Drug Abuse in Nigeria 2018”, highlighted a considerable level of past-year use of psychoactive substances, in particular the use of cannabis, the non-medical use of prescription opioids (mainly tramadol, and to lesser extent codeine, or morphine) and cough syrups (containing codeine or dextromethorphan).

According to the report, the past year prevalence of any drug use in Nigeria was estimated at 14.4 per cent or 14.3 million of people aged between 15 and 64 years. The extent of drug use was comparatively high when compared with the 2016 global yearly prevalence of any drug use of 5.6 per cent among the adult population.

The past year prevalence of psychoactive substances, excluding alcohol, overall was higher among men in Nigeria. However, the gender difference in the non-medical use of prescription opioids, tranquilizers and cough syrups was less marked.

Drug use was most common among those who were between the ages of 25 and 39 years, while the rates of past year use were lowest among those who were below 24 years of age. Cannabis was the most commonly used drug followed by opioids, mainly the non-medical use of prescription opioids, and cough syrup.

A dichotomy in the past year prevalence of drug use was, however, found between the North and South geopolitical zones. Highest past-year prevalence of drug use was found in the southern political zones: South East, South West, and South-South zones (past year prevalence ranging between 13.8–22.4 per cent of the population) compared to the North (ranging between 10–14.9 per cent of the population).

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People who inject drugs constitute a sizeable proportion of high-risk drug users in Nigeria. One in five high-risk drug users injects drugs. The most common drugs injected in the past year were pharmaceutical opioids, followed by cocaine and heroin. While more men were injecting drugs, women were more likely than men to report injecting heroin. The extent of risky injection practices and sexual behaviours among the high risk drug users and in particular those who inject drugs was also of concern as was the extent of self-reported Human Immunodeficiency Virus (HIV) among this group.

Chairman/Chief Executive of the NDLEA, Brig. General Mohamed Buba Marwa (Retd). Photo: TWITTER/NDLEANIGERIA/OLAWALEADEKOLA

Women who injected drugs were more likely than men to engage in high-risk sexual behaviours, further compounding their risk for acquiring HIV, among other infections.

There is a clear gap in meeting the needs for treatment and care for people with drug use disorders. Two-thirds of high-risk drug users reported a self-perceived need for drug treatment. Around 40 per cent among these, reported that they had wanted to receive drug treatment but were unable to access such services. The cost of treatment, stigma associated with accessing such services as well as stigma associated with substance use in general, and availability of adequate drug treatment services were the major barriers in accessing drug treatment.

Past-year users of tranquilizers, heroin and methamphetamine were more likely to report chronic health conditions and poorer health status as compared with other drug users or the general population. Access to services to reduce the adverse consequences of drug use was also limited. Less than half of the high-risk drug users had received HIV testing and counselling while in treatment. While this proportion was higher among women, it was lower among those injecting compared to all high-risk drug users. Only 12 per cent of the high-risk drug users reported referral to anti-retroviral therapy.

Nearly one quarter of high-risk drug users had been arrested for a drug-related offence during the course of their drug use, while the majority (73 per cent) had been arrested for possession of drugs, many high-risk drug users had also been arrested for burglary, sex work, shoplifting and theft.

The social consequences of drug use are also evident in Nigeria. Key informants considered that there were major social problems such as disruption in family lives, loss in productivity and legal problems as a consequence of drug use in their communities. Also, nearly one in eight persons in the general population had experienced consequences due to other peoples’ drug use in their families, workplace and communities.

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According to the United Nations Office on Drugs and Crime (UNODC) World Drug Report 2021, released ahead of the International Day against Drug Abuse and Illicit Trafficking (IDADAIT), June 26, around 275 million people used drugs worldwide in the last year, while over 36 million people suffered from drug use disorders.

The report emphasised the importance of strengthening the evidence base and raising public awareness, so that the international community, governments, civil society, families and youth can make informed decisions, and better target efforts at preventing and treating drug use, and tackling world drug challenges.

According to the Report, the percentage of Δ9-THC – the main psychoactive component in cannabis – has risen from around six per cent to more than 11 per cent in Europe between 2002-2019, and around four per cent to 16 per cent in the United States between 1995-2019, while the percentage of adolescents that perceived cannabis as harmful declined by 40 per cent in the United States and by 25 per cent in Europe.

Moreover, most countries have reported a rise in the use of cannabis during the pandemic. In surveys of health professionals across 77 countries, 42 per cent asserted that cannabis use had increased. A rise in the non-medical use of pharmaceutical drugs has also been observed in the same period.

Based on demographic changes alone, current projections suggest an 11 per cent rise in the number of people who use drugs globally by 2030 — and a marked increase of 40 per cent in Africa, due to its rapidly growing and young population.

According to the latest global estimates, about 5.5 per cent of the population aged between 15 and 64 years have used drugs at least once in the past year, while 36.3 million people, or 13 per cent of the total number of persons who use drugs, suffer from drug use disorders.

Globally, over 11 million people are estimated to inject drugs, half of whom are living with Hepatitis C. Opioids continue to account for the largest burden of disease attributed to drug use.

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The two pharmaceutical opioids most commonly used to treat people with opioid use disorders, methadone and buprenorphine, have become increasingly accessible over the past two decades. The amount available for medical use has increased six-fold since 1999, from 557 million daily doses to 3,317 million by 2019, indicating that science-based pharmacological treatment is more available now than in the past.

While the impact of COVID-19 on drug challenges is not yet fully known, the analysis suggests that the pandemic has brought increasing economic hardship that is likely to make illicit drug cultivation more appealing to fragile rural communities. The social impact of the pandemic – driving a rise in inequality, poverty, and mental health conditions particularly among already vulnerable populations –represent factors that could push more people into drug use.

The 2021 World Drug Report provided a global overview of the supply and demand of opiates, cocaine, cannabis, amphetamine-type stimulants and new psychoactive substances (NPS), as well as their impact on health, taking into account the possible effects of the COVID-19 pandemic.

Experts Proffer Solutions
A PUBLIC health rights advocate and Abuja-based Medical doctor, Dr. Henry Ewunonu told The Guardian that, “drug abuse is more of a social problem than it is medical. So its solution has to be centered on the social dynamics of the society that promotes such behaviour. That an idle brain is the devil’s workshop doesn’t mean much these days as the society has given up on itself about the unimaginable rate of unemployment in Nigeria.

“Imagine that Imo state has 47.3 per cent unemployment rate. What will those be doing after sulking their notorious fate? They resort to drugs to escape the reality of their situation. So, the NDLEA boss, Gen. Marwa has a great deal of work in his hands. For now, he is merely scratching at the symptom manifestations of the malady, not the cause – remote or direct.”

So, what should be done by the authorities? Ewunonu said: “Job creation should be seriously mainstreamed. It is just verbose statistics for now. When many youths are gainfully employed, it would be obvious. Then, seeing youths gather in their tens around corners in a street by 10am in the morning will not be common sight.”

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He added that idle youths, apart form paid employment, should be provided with amenities to deploy the time they waste in seeking pleasures to take a flight from the stabbing reality of hopelessness. He said sports facilities should be made available. “It is very painful that estates are built these days without an express provision for leisure activities. The available sporting grounds have been converted to either shopping centres or residential buildings. Years ago, there was a basketball court at UTC in Area 10 Garki, around the Catholic pro-cathedral in Area 3, and another around Zone 3 neighbourhood centre. Today, they are all gone,” he said.

The public health analyst said the concept of neighbourhood centre encompasses leisure/sporting facilities, but today, the rich have converted those facilities for private use on connivance with state authorities.

“Look at the Jabi Lake Leisure Park, Abuja Gardens in the Central Business District (CBD) and others that are in limbo, bedeviled by unending Court cases. It is sad,” he added.

Ewunonu said earlier propositions like including drug abuse in school curricula and highlighting their dangers, formation of anti-drug abuse clubs, rejuvenating the anti-drug war campaigns and so on may also help. “Let us snatch these young ones from the grip of the devil by providing them with more wholesome avenues of entertainment and pleasure,” Ewunonu said.

A consultant radiologist with a bias in Oncology and Non Communicable Diseases (NCDs) control and management, Prof. Ifeoma Okoye, told The Guardian that every individual must do their part by knowing and sharing genuine facts along with their solutions about the risk of drug abuse.

Okoye said the world lost 255 million jobs in 2020, and over a 100 million people were pushed into global poverty and the resulting lockdowns deepened inequalities and precipitated mental health disorders, which contributed to the rise in drug use disorders.

She said changes have already been observed in drug use patterns during the pandemic, including increases in the use of cannabis and the non-medical use of pharmaceutical sedatives.

The radiologist said underlying socioeconomic stressors have also likely accelerated demand for these drugs. She said drug traffickers have quickly recovered from initial setbacks caused by lockdown restrictions and are operating at pre-pandemic levels once again, driven in part by a rise in the use of technology and crypto currency payments, operating outside the regular financial system.

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Okoye said rapid technological innovation, combined with the agility and adaptability of drug traffickers who are using new online platforms to sell drugs and other substances, are likely to increase the availability of illicit drugs.

What are the solutions? The oncologist said governments, from all levels, must intensify healthcare support for people living with drug use disorder.

These, she said, include developing evidence-based prevention programmes that would reach inaccessible populations in rural areas and subsidising the development of drug rehabilitation centres across the country; and governments must avoid the temptation to adopt a draconian posture against drug abuse by over-criminalising it.

Okoye said rather, drug abuse should be viewed rightly as a public health crisis deserving empathy as opposed to societal scorn.

She said doctors, medical professionals, clinicians and other allied professionals must be placed at the fore front of this fight, collaborating with drug enforcement officers to mobilise a massive public health campaign on the dangers of drug abuse and the availability of help for those with addictions.

Okoye said government must also earmark more funds to train and better equip drug law enforcement agencies to detect and apprehend drug traffickers. “That is, technological innovation must be leveraged to address the supply of illicit drugs,” she said.

Consultant pharmacist and medical director, Merit Healthcare, Dr. Lolu Ojo, said evidence-based prevention, health risks and solutions are available to tackle the world drug abuse treatment and care.

Ojo said poverty reduction must be an essential part of the strategy to tackle drug problem in Nigeria. “Lack of gainful employment and young men (and women) engaged in menial jobs take solace in drugs and for extra power,” he said.

The pharmacist said public awareness programme and advocacy must be intensified to highlight the dangers of drug abuse.

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“Traditional and religious institutions must be involved. A community ‘No-drug vanguard’ must be put in place to assist government efforts in this regard,” he said.

Ojo added: “Education is also key. Our public education system, today, is nothing but a travesty of its glorious past. The long years of neglect have turned our public primary, secondary and even tertiary institutions into drug havens. We must resuscitate the system and make them vibrant and true citadel of learning.

“The youths must be actively engaged in sports, entertainment and other vocations that will occupy their time, energy, and inquisitiveness. The distribution system must be sanitised to reduce the ease of access to drugs. Today, drugs are available anywhere and everywhere, mostly under the control of untrained hands. We must be creative in our actions to implement the demand and supply reduction strategies.”

Also, members of the National Executive Committee of the Board of Fellows (BOF) of the Pharmaceutical Society of Nigeria (PSN) called for the speedy implementation of drug distribution law in the country to ensure health security and curb substance and drug abuse.

They said the implementation of the drug distribution law prohibits the production, importation, manufacture, sale and distribution of any counterfeit, adulterated banned or fake drugs. It also prohibits persons to sell any drug in an open market without permission from authority.

Chairman, BOF of PSN, Prof. Mbang Nyong Femi-Oyewo, during its mid-year meeting, to commemorate its third public lecture said: “As a profession, we play a key role in the economy of Nigeria. The pharmaceutical industry and indeed pharmacists contribute to the country’s revenue through our products and services to the entire healthcare. National Development that will ensure drug and health must be in place. As Fellows and elders of the profession, we need to understand this and consciously take up this responsibility.”

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She explained that it is no longer news that the incidence of drug/substance abuse in Nigeria has assumed an epidemic dimension, especially among children/adolescents and youths, which calls for widespread intervention.

“As you are aware, pharmacists are custodians of medicines. It has therefore become very necessary for the BOF to get involved in checkmating this menace through advocacy, campaign against drug abuse and rehabilitation of victims.”

She added that some of the drugs are now packaged in cookies and distributed at different super markets in Nigeria, which youths and children purchase knowingly or unknowingly, increasing their chances of addiction. She called urged parents to be careful with what they buy for children while school administrators should be observant with vendors in school premises.

Reacting to substance abuse by Nigerians and the role of the association, Chairman, Pharmaceutical Wholesalers and Distributors Association of Nigeria (PWDAN), Mr. Ernest Okafor, stated that it is not the duty of the association to enforce laws but to produce drugs for the people. He, however, disclosed that the association was trying to set a standard that would enable Nigerians know the dos and don’ts in drug related matters.

“The problem we are having is accessibility. People now have access to these drugs anywhere and everywhere. And we have doctors whose duty it is to prescribe but do not understand what they are doing. What we can do is to set a standard, which will help people know the dos and don’ts when it comes to drug,” he said.

A study titled, “Crime and adolescent drug use in Lagos, Nigeria,” published in Sociology International Journal, also stated: “Besides crime and drug use being major public health challenges, the group that is most vulnerable to drug abuse is that which could most objectively be regarded as the drivers of Lagos’ economy in the foreseeable future. It is along this line that public policy has to compel the investment of appropriate intellect, social resources and a range of other resources to rescue these at risk population from being consumed by the deadly social conditions to which drug abuse have the capacity to expose them.

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“While this study may not be sufficient to make generalisable predictions on the nexus between adolescents, drug abuse and criminality, it does point to a significant decisive pattern in drug consuming habit of adolescents in Lagos. The socioeconomic and political location of Lagos makes it not well protected from the challenges of drug and drug abuse. As a result, its youth must be provided jobs and relaxation resources that could lower their frustration such that the patronage of drugs as temporary means of escape from disappointing realities would no longer be attractive and irresistible.

“Consequently, this paper calls for further research to adequately understand the impact of drug use in Lagos particularly and Nigeria in general. Although the use of drugs is not entirely new in Lagos, its current prevalence does not only raise some public health, social welfare and law enforcement concerns to policy makers and executors, it now bothers the household and causes health threatening fright to residents.”

The study made several recommendations. To reduce adolescents’ drug abuse induced trauma in society, it suggested that indigenous child socialisation that emphasises the concept of ‘Omoluabi,’ meaning gentleman, should be reintroduced, strongly articulated and put into use.

The researchers said law in Lagos should discourage indiscriminate drug economy and its patronage, and government should embrace community-based drug abuse control and behavior monitoring of adolescents.

According to the study, public policy should empower social workers to partner with parents, teachers and workers at religious places in the socialisation of adolescents to embrace lives that do not tolerate drug abuse so as to ensure public safety and future sanity of Nigerian youths.

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