The Guardian (Nigeria)

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

- Mohammed:

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? Hefirst

Tissue 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.

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

 ??  ?? Mohammed

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