The Guardian (Nigeria)

Taming Menace Of Drug Abuse

Experts Proffer Solutions, Urge Support For People With Disorders

- By Chukwuma Muanya, Deputy Editor

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.

“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.

“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

Social consequenc­es of drug abuse are evident in Nigeria. People who inject drugs constitute a sizeable proportion of high- risk drug users. 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 users and in particular those who inject drugs was also of concern as was the extent of self- reported Human Immunodefi­ciency Virus ( HIV)

ESULTS 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).

People who inject drugs constitute a sizeable proportion of high- risk drug users in Nigeria. One in five highrisk 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.

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.

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.

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 sciencebas­ed 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.”

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 antidrug 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.

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


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.

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