28/03/2018
RECOMMENDATIONS TO THE SENATE JOINT COMMITTEE ON DRUGS AND NARCOTICS AND HEALTH AT ITS ONE-DAY PUBLIC HEARING ON “THE NEED TO CHECK THE RISING MENACE OF DRUG ABUSE AMONG YOUTHS IN NIGERIA”
1.The distinguished senate is hereby specially admonished to ensure that the proposed constitutional amendments and reforms championed by the All Progressives Congress (APC) does not remove drug matters currently listed on the Exclusive Legislative List as item 21 of part I in the second schedule of the 1999 constitution.
Most responsible and responsive countries place drug matters under federal or central control because of the need to place premium on safety and well being of consumers of health . A country with a history of poor regulatory control in the pharmaceutical sector which continues to encourage a fake drug syndrome and challenges of drug abuse/misuse cannot afford multiple regulatory agencies to control and regulate narcotics, registration of food and drug products as well as licensure of drug premises.
Placing drug matters on the concurrent list would imply having a minimum of 37 licencing authorities to carry out the present responsibilities of the NDLEA, NAFDAC and PCN with dire consequences to the health and security of our nation.
2.The Pharmaceutical Society of Nigeria conveys its appreciation to the National Assembly for heeding the sensible clarion call which led to the passage of the amended Pharmacy Council of Nigeria Bill. We strongly urge the National Assembly to ensure a speedy Presidential assent to enable the new Act of Parliament reshapen the course of monitoring and control procedures in Nigeria.
3.The envisaged Pharmacy Council of Nigeria Bill is well grounded in law to boost the inspectorate activities of Pharmacists Council of Nigeria (PCN) which has statutory powers to regulate and control all pharmaceutical premises in both public and private sectors. This mandate also gives PCN latitude to modulate the activities of any stakeholder in the drug distribution channels in Nigeria.
The Pharmaceutical Society of Nigeria appeals to the National Assembly to consider dispensing meaningful budgets for the inspectorate activities of the PCN. In similar spirit, these enhanced budgets must be extended to NAFDAC and NDLEA.
4.The recurring menace of drug misuse and abuse is now taking unprecedented toll on the health consuming public in Nigeria.
The Pharmaceutical Society of Nigeria advocates an amendment of the NDLEA Act to accommodate a new directorate of Consumer Protection to be headed by a Registered Pharmacist.
5.This directorate will be empowered to Coordinate Health Advocacy and monitoring/control of narcotics and other medicines with abuse and misuse potentials in Nigeria.
6.It is important that the amended NDLEA Act provides for the establishment of National Rehabilitation Centres for victims of drug abuse in the six (6) geo-political zones of the country. The rehabilitation centres will be under the supervision of the directorate of Health Advocacy and Monitoring/Control.
7.We strongly urge the National Assembly to ensure that the Executive arm to constitute the governing council and boards of the plethora of agencies involved in drug distribution. This is particularly germane to an effective ex*****on of the statutory mandate of the three (3) principal agencies of the Federal Government involved in drug distribution endeavours in Nigeria. For the records these are PCN, NAFDAC, NDLEA.
DRUG ABUSE VS MISUSE: THE NIGERIAN EXPERIENCE
Prescription drugs are intended to help us, but can end up hurting us when misused or abused. What truly is the difference between drug abuse vs. misuse as witnessed in our clime.
When a person misuses or abuses a prescription drug, there is no medical oversight of the risks. For example: a person who misuses or abuses opioids such as Codeine based drugs can die from respiratory failure. Prescription sedatives like benzodiazepines such as Diazepam cause withdrawal seizures. The risks from these drugs are worse when they are combined with other drugs or alcohol.
Additionally, when a person misuses a prescription drug, even on a single occasion, that individual might enjoy the experience so much that they begin to seek out the drug more often. Thus, drug abuse and drug dependence are serious risks of misusing prescription drugs.
What is Drug Misuse?
To misuse a drug is to use a drug for purposes it is not intended for. Using Codeine based Cough Suppressant for a headache, diazepam for nausea, or any other example of people believing a drug can make them ‘feel better.’ Misuse involves not following medical instructions, but the person may not necessarily be looking to ‘get high’ from their use. If a person isn’t able to fall asleep after taking a single sleeping pill, he or she may take another pill an hour later, thinking, that might induce sleep.
Though many drugs claim to cover a wide variety of symptoms, there is no panacea out there that can cure everything. It’s important to note that all drugs can produce adverse events (side effects), but the risks associated with prescription drugs are managed by a health care professional. Thus, the benefits outweigh the risks when the drug is taken as directed and dispensed by a pharmacist.
Features of Drug Misuse
*Taking a dose at the wrong time
*Forgetting to take a dose
*Stopping a medication too soon
*Accepting prescription medication from a friend
*Taking drugs for reasons other than what they were prescribed for
Drug misuse is defined as the use of a substance for a purpose not consistent with legal or medical guidelines (WHO, 2006). It has a negative impact on health or functioning and may take the form of drug dependence, or be part of a wider spectrum of problematic or harmful behavior. Drug misuse is a condition that may cause an individual to experience social, psychological, physical or legal problems related to intoxication and/or regular excessive consumption, and/or dependence.
Dependence is defined as a strong desire or sense of compulsion to take a substance, a difficulty in controlling its use, the presence of a physiological withdrawal state, tolerance of the use of the drug, neglect of alternative pleasures and interests and persistent use of the drug, despite harm to oneself and others (WHO, 2006).
The diagnosis of dependence is clearest with opioids. The WHO states that:
‘opioid dependence develops after a period of regular use of opioids, with the time required varying according to the quantity, frequency and route of administration, as well as factors of individual vulnerability and the context in which drug use occurs. Opioid dependence is not just a heavy use of the drug but a complex health connotation that has social, psychological and biological determinants and consequences, including changes in the brain. It is not a weakness of character or will.’ (WHO, 2006)
However, dependence, as characterised by the above definition, can also occur with stimulants and cannabis.
Repeated use of a drug can lead to the development of tolerance in which increased doses of the drug are required to produce the same effect. Tolerance develops to opioids, stimulants and cannabis. Cessation of use leads to reduced tolerance and this may present significant risks for individuals who return to drug doses at a level to which they had previously developed tolerance. This can result in accidental overdoses and, in the case of opioid misuse, could lead to respiratory depression and death.
Opioids, stimulants and cannabis also produce intoxication, that is, disturbances in psycho-physiological functions and responses, including consciousness, cognition and behaviour, following administration (WHO, 2006).
People who misuse drugs may present with a range of health and social problems other than dependence, which may include (particularly with opioid users):
*physical health problems (for example, thrombosis, abscesses, overdose, hepatitis B and C, HIV, and respiratory and cardiac problems)
*mental health problems (for example, depression, anxiety, paranoia and suicidal thoughts)
*social difficulties (for example, relationship problems, financial difficulties, unemployment and homelessness)
*criminal justice problems.
Drug dependence is associated with a high incidence of criminal activity, with associated costs to the criminal justice system.
What is Drug Abuse?
People who abuse drugs typically do not have a prescription for what they are taking. Not only do they use it in a way other than it is prescribed, but they also use it to experience the feelings associated with the drug. Euphoria, relaxation, the general feeling of ‘getting high’ is always associated with drug abuse. The abuse of drugs in the op**te and benzodiazepine families frequently leads to unavoidable side effects, including dependency and addiction. For example, someone taking Codeine based medicines frequently with no prescription, no symptoms and believing they ‘need’ it in order to feel better is an example of drug abuse.
Features of Drug Abuse
*Using a drug to ‘get high’
*Using without a prescription
*Exceeding a recommended dose
*Chronic or repeated abuse
*Developed tolerance
What is drug misuse or abuse?
There are at least three general categories that may be applied to the use of legal or prescription drugs:
*Use as Appropriate
This implies that there are no specific directions for frequency and quantity of use. One generally learns the boundaries of use that generally does not lead to undesirable consequences.
*Use as Directed
This usually means that there are specific directions on use frequency and quantity.
*Use as Prescribed
Refers to drugs that require a physician’s approval that describes the safe frequency and quantity of use.
If a drug is used inappropriately (too often and/or at too high a quantity), not as directed, or not as prescribed, the drug is being misused/abused.
What is addiction or a substance-use disorder?
In the medical model, the word “addiction” has been replaced with the terms substance abuse and dependency to help professional distinguish the severity of an individual’s use patterns. More recently, the term Substance-Use Disorder has been chosen for diagnostic purposes. To classify an individual as having a Substance-Use Disorder, he/she would need to manifest at least two or more of the maladaptive patterns of substance use listed below, leading to clinical impairment or distress occurring within a 12 month period.
The evaluation criteria below are taken from the Diagnostic Statistical Manual of Mental Health Disorders or DSM IV published by American Psychiatric Association:
• Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home. (e.g. repeated absences or poor performance at work, suspensions or expulsion from school, neglect of children).
• Recurrent substance use in situations in which it is physically hazardous. (e.g. driving, operating machines).
• Continued substance use despite having negative or recurrent social or interpersonal problems caused by the effects of use. (e.g. arguments with partner, physical fights)
• Tolerance as defined by the following:
o A need for markedly increased amounts to achieve intoxication or desired effect.
o Markedly diminished effect with continued use of the same amount of the substance.
• Withdrawal, as manifested by either of the following:
o The characteristic withdrawal syndrome for the substance.
o The same ( or closely related) substance is taken to relieve or avoid withdrawal symptoms.
• The substance is often taken in larger amounts or over a longer period than intended.
• There is a persistent desire or unsuccessful effort to cut down or control use.
• A great deal of time is spent in activities necessary to obtain the substance, use the substance or recover from the substance.
• Important social, occupational, or recreational activities are given up or reduced because of the substance use.
• The substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
• Craving or a strong desire or urge to use a specific substance.
What are the terms used to refer to drugs that might be misused?
Drugs of misuse are those likely to cause negative consequences if used too often or at too high a quantity. These drugs tend to cross the blood-brain barrier and, in some way, achieve alterations in arousal, affect (feelings or emotions), or sensory perception and cognition experience. These drugs are referred to by one or more names and are classified by the substance they came from, such as: op**tes or by their effects on the human nervous system, such as stimulants, hallucinogenic or psychotropic drugs.
What are street drugs?
There are several classes of drugs referred to as illicit or street drugs. Most often this refers to drugs which are sold illegally, taken recreationally, and/ or manufactured unprofessionally. Designer drugs are synthetic drugs which are equal to an existing drug but with minor modification.
In Nigeria the problems of drug abuse have been stretched to unconventional dimensions as some youths now resort to substances other than medicines for abuse. Some of these substances include:-
*Super glue
*Petrol fumes
*Septic tank fumes
*Excreta and urine from lizards.
The unfortunate practices of drug abuse and misuse have been largely exacerbated by the unwieldy drug distribution channels which promote unrestricted access to medicines in Nigeria.
Conclusion
The key difference between drug abuse and drug misuse is the individual’s intentions when taking the drug. The PSN stresses that both misuse and abuse of prescription drugs can be harmful and even life threatening to the individual. This is because taking a drug other than the way it is prescribed can lead to dangerous outcomes that the person may not anticipate.
When revolving around prescription drugs, these terms are often used interchangeably and mislead people who have a potential for addictive behavior. It is important not only to recognize the difference, but to also be aware of the consequences of each. Though many people may chop up the difference to be semantics — that using any prescription drug outside of its intended use and dose should be prohibited — there is indeed a difference…and a significant one at that.
Reference
1.DSM IV Published by the American Psychiatric Association
2.PSN position paper on Drug Misuse and Abuse.
Pharm. Ahmed I Yakasai, FPSN
President, Pharmaceutical Society of Nigeria (PSN)
