Nigeria’s drug abuse epidemic didn’t appear by the wave of a magic wand. It has been brewing and festering for many years now. The belief that people who took “hard drugs” were morally bankrupt delinquents who deserve whatever they got pushed the early stages of the epidemic underground. As long as one’s family wasn’t affected, one got on with life and clutched one’s pearls either in pity or righteous indignation when confronted with the ills of drug abuse.
Nigeria’s Medical Situation as a Prelude to the Epidemic
The Nigerian populace is one that self-medicates due to the dearth of well-trained medical professionals. According to World Health Organisation (WHO) data published in 2017, Nigeria has a ratio of 1 doctor to 6000 people. The recommended WHO ratio is 1 doctor to 600 people. It isn’t much of a stretch to see how self-medication paved the way for many young Nigerians to find succor in drugs like Codeine and Tramadol. The typical Nigerian’s mode of treating a disease is to go to the pharmacy and describe their symptoms. The pharmacist acting as a doctor diagnoses what’s ailing the person and then prescribes drugs which can be purchased in their shop. The long wait times to see a doctor and the expensive nature of treatment means most sicknesses never make it to the hospital. Only debilitating illnesses are considered serious enough for the attention of the few doctors servicing thousands of patients in the available hospitals in each state.
Causes of Drug Abuse
The increase in the use of Codeine and Tramadol as recreational drugs came about 6-8 years ago as cool American celebs were on TV toting bottles and cups of Lean, a concoction made up of Codeine, soft drink and candy. Lean (purple drank) was the new hip thing and very soon many young Nigerians were drinking it.
While it is often the case to blame a lot of our woes on foreigners, it isn’t exactly so. Did seeing celebs drinking Purple Drank make it cool? Yes, it did but it wasn’t the only thing that contributed to the epidemic we’re seeing now. Nigeria has a large population many of whom live below the poverty line and a high rate of unemployment amongst its youth. Living in poverty with no hope of escape (either via a good job or trade) pushed many young Nigerians into the sweet arms of drug abuse. Even educated Nigerians who should know better are not immune to this. Many university graduates are underemployed, stressed and suffer ill treatment from horrible bosses. These drugs offer a sense of escapism.
The stigma associated with mental illness may have pushed others into finding a way to deal with their conditions. Any mental illness is either considered madness, a spiritual attack or acting out. Looking for something to manage their conditions have turned many mental illness sufferers into junkies.
Obtaining Codeine or Tramadol was easy as all one had to do was go to a pharmacy and complain of a cough, sore throat or pain. The pharmacist would then recommend a cough syrup like Codeine or Tramadol for pain which one buys. Add soft drinks like Coke or Sprite and one could get high as a kite without spending a lot of money.
How Codeine And Other Opiates Work in Getting One Addicted
As the Nigerian society played ostrich with the growing problem under its nose, a chunk of its youth was dancing their way into opiate addiction. Codeine and Tramadol belong to a family of drugs known as Opiates*. Opiates are often used to treat pain, cough and a few other ailments. Other popular drugs in the same family include Heroin, Morphine and Fentanyl. Heroin is illegal as is Fentanyl which made its appearance in the recreational drug scene recently. Fentanyl is often mixed with other illegal narcotics like Heroin and Cocaine and its use is on the rise.
What makes opiates addictive is effectively the same thing that makes them effective pain relievers. The human body produces a natural opioid neurotransmitter which when it binds its receptor in the brain prevents the body from feeling pain, slows down breathing and has a general calming and pleasurable effect. The body doesn’t make enough opioids to stop chronic pain. This is where opiate drugs come in. They bind to the same receptors as the neurotransmitter because they have a similar shape. Opiates have an almost similar effect as the natural body produced opioid but their effect is much stronger and a bit different.
Opiates target the brain’s reward centres and flood the body with Dopamine – another neurotransmitter that is involved in motivation and pleasure signaling. The human brain is equipped to recognise activities that give pleasure and ensure that such activities are carried out often. Because opiate drugs produce pleasure when taken, the brain sees to it that one gets as much pleasure as possible by taking the same drugs. This forms the gateway to dependency and addiction.
Given how lax the Nigerian health system is when it comes to obtaining opiates like Codeine and Tramadol, getting hooked on them is quite easy. But since the cost of these drugs has risen due to the current economic situation and the ban, many addicts have taken to seeking alternative means to derive the same effect. Some take to sniffing industrial glue or other kinds of glue. Sniffing sewage pits, especially on hot afternoons is another way for addicts to get high.
The Codeine Ban And Why It Wouldn’t Work
In May 2018, the Buhari administration banned the production and importation of all cough syrups containing Codeine. Like many Nigerian Government responses to public outcry, banning is a lackadaisical reaction to a problem that requires a multi-pronged approach. If there is one thing that history has taught Nigerians, it’s that bans are ineffective. Rather, it drives the problem underground, increases demand, removes the regulatory role of the government and hands it to individuals who are solely motivated by profit.
In 2016, the Federal government instituted a partial ban on rice importation in Nigeria. While Nigeria’s rice import figures plummeted, the rice import figures for neighboring countries, like the Benin Republic, which share a land border with Nigeria soared. The many bags of foreign rice imported into the Benin Republic are smuggled across the border into Nigeria where rice consumers buy them.
Another case is the importation ban of used vehicles via Nigeria’s land borders. This ban came in 2016 but it hasn’t done much to curtail the importation of vehicles from the Benin Republic. Rather, the government loses revenue as smugglers bribe their way through the customs agents at the borders and get on with their business.
How The Govt Should Handle The Drug Abuse Epidemic
To handle the current drug abuse epidemic, Nigeria has to try a detailed plan that will involve proper regulation and oversight. First, making Codeine and Tramadol prescription-only drugs is a step forward. The average Nigerian can walk into any pharmacy and buy these drugs by feigning symptoms of a cough, pain and sore throat. Making it a law and enforcing it will curtail the unprescribed sale of these opiates.
Secondly, Nigeria has to invest in its medical professionals and facilities. The ratio of doctors to patients is already too high. Investing in more medical infrastructure that can accommodate doctors will bring down the Doctor-Patient ratio. This will make it easier for the government to stick to enforcing prescription only opiates as a law and reduce hospital waste times. It could also help address the mass migration of Nigerian doctors abroad.
Thirdly, the regulation of community pharmacies where drugs are sold. Currently, many roadside kiosks can afford to sell all kinds of medicines. It is up to the Federal government to work with the Pharmaceutical Society of Nigeria to regulate the registration of community pharmacies and to crack down on illegal and unregistered roadside pharmacies.
Another level in this multi-layered approach is to regulate the supply chain of opiates and other drugs in general. Having licensed manufacturers and importers selling to licensed pharmacies will reduce the rate at which these drugs make it onto the black market. Punishing errant licensed manufacturers and importers with stiff fines, jail time and revocation of their licenses will ensure that the process is transparent and streamlined.
Finally, Nigeria has to invest in building, staffing and running rehab centres in different states in the country. These rehab centres will work with addicts to ensure that they get the help and treatment required to wean them off opiates. These rehabilitation centres will also handle out-patient care.
The drug abuse epidemic can be handled effectively if the Nigerian government is willing to take a layered approach to the problem rather than slapping a lazy ban on it.
*Opiates normally refers to the naturally occurring compounds gotten from the poppy plant and Opioids are synthetic drugs that bind to the same receptors as Opiates in the brain. In this article, both phrases will be referred to as Opiates.