The Niche Editorial: Tackling the Codeine epidemic in Nigeria

The uproar that greeted the recent report by the British Broadcasting Corporation (BBC) on the abuse of codeine cough syrup in Nigeria and the criminal cartel behind it is typical.

Our knee-jerk response to issues that require deep introspection and analytical savvy is legendary.

BBC Africa’s new investigations unit, Africa Eye, penultimate week aired a report titled, “How cough syrup in Nigeria is creating a generation of addicts.”

The report went ahead to detail how codeine epidemic is destroying young lives across West Africa, particularly young Nigerians.

Now, everybody is talking about the problem, even those who don’t know the issues and are rather more interested in pointing fingers of blame and stoking ethnic tension.

The Federal Ministry of Health had also directed the National Agency for Food and Drug Administration and Control (NAFDAC) to ban further issuance of permits for the importation of codeine as an active ingredient for cough preparation.

And in demonstrating its oversight role over the manufacture and sale of drugs in the country, the NAFDAC on Monday shut down the Peace Standard Pharmaceutical Limited, Bioraj Pharmaceutical Limited (both in Ilorin, Kwara State), and the Emzor Pharmaceuticals Limited, Lagos; the three firms named in the BBC report, as it probes the codeine-based syrup epidemic.

Director General of the Agency, Prof. Mojisola Adeyeye, said in a statement that the clampdown was due to the companies’ failure to provide required documents for NAFDAC officials during the inspection of the facilities at Ilorin and Lagos.

“Due to insufficient evidence gathered and apparent resistance to provide needed documents during inspection on May 2, 2018 at the respective companies in Ilorin and Lagos, respectively, it has become necessary to shut down all product lines of the three companies.

“The companies are the Peace Standard Pharmaceutical Limited at Plots 3 & 8, Adewole Industrial Estate, Lubcon Avenue, Ilorin, Kwara State and Bioraj Pharmaceutical Limited, No 405 Kaima Road, Ilorin, Kwara State.

“Also shut down was the Emzor Pharmaceuticals Industries Ltd., Ajao Estate, Lagos.

“This is to allow for a full and comprehensive investigation; the three companies therefore remain closed,’’ the statement said.

The statement continued: “On May 2 and 3, a  team of nine NAFDAC officers were sent to  carry out investigational inspection at the companies that are licensed to manufacture codeine-containing syrup, and which were implicated in a BBC documentary.

“The team comprised two from Drug and Evaluation Research – DER and seven from Investigation & Enforcement – I&E) and ten mobile police officers.

“The focus of the assignment was to access and monitor from records the utilization, sales and effective distribution of the codeine containing cough syrups to the end users.

“Meanwhile, meeting of the stakeholders mentioned above is being planned while the shut down and full investigations continue.

“The reopening of the manufacturing companies will depend on the level of cooperation that is shown during the comprehensive investigation.’’

Regardless of NAFDAC’s intervention to save its face, we make bold to say that drug abuse with its huge consequences is a crisis that has been there for years, yet all the institutions of government responsible for checking the menace chose to treat it with levity.

Codeine, though an opioid, has its medical values. But like all opioids, if it is consumed excessively, it could have devastating impact on the mind and body, including kidney damage and mental psychosis.

To be sure, there is nothing new in the BBC report.

For instance, in September 2015, the Daily Trust newspaper, did a feature titled, “Codeine abuse spikes in women, teens across North,” the first of several stories on how cough syrups and Tramadol tablets were destroying several Nigerian families.

And in 2016, the National Drug Law Enforcement Agency (NDLEA) Commander for Gombe State, Mr. Aliyu Adole, was reported as saying between 20 to 30 per cent of the young people in the country, including school children, were into substance abuse.

A picture of how endemic this epidemic has become was graphically painted in the BBC report, thus: “Grief, depression, a desire to be cool are just some of the reasons Nigerians are falling for this drug. Musicians sing about the high it gives you. Dealers peddle it in nightclubs and on the streets. Teenagers mix it with soft drinks, or swig it straight from the bottle at “syrup parties.”

The Nigerian Senate last year estimated that as many as three million bottles of codeine syrup are drunk every single day in just two states, Kano and Jigawa.

Commander Hamza Umar of the NDLEA in Kano agrees.

“We may not even arrest 10 per cent (of cough syrup in the market).

“It crosses all class, no matter the level – rich and poor, educated and illiterate, a beggar and a toddler,” he said.

But any attempt to insinuate that this is a crisis that bedevils only the north is an act of mischief. Therefore, it cannot be true that some unscrupulous Southern drug merchants are deliberately producing these codeine-based cough syrups for youths in the north.

It is a national health crisis that affects the entire country and the agents of death who are oiling the pandemic come from all the nooks and crannies of the country just as the victims.

It is sad that even when the issue was officially mooted on the floor of the Senate last year by Borno Senator, Baba Kaka Bashir Garbai, his motion was on the “increasing abuse of cough and prescriptive drugs among the youth and women across the 19 northern states” which he argued “has devastated many upper and middle class families in the region.”

Senator Aliyu Wamakko’s clarification while supporting the motion, that the challenge was not peculiar to the north; hence it should be treated as a national social problem, is the way to go in seeking solution to the problem.

The “reports about young girls in tertiary institutions, who have taken to an alarming abuse of the codeine cough syrup, which is often taken, mixed with soft drink,” as Garbai noted applies nationally.

And the mothers who are using “codeine and other drugs as an escape from their abusive relationships and invariably get hooked on them,” can be found both in the North and South.

The truth is that there is a national health crisis which has been festering for years and must be tackled holistically as other countries faced with the same problem have done.

For instance, in 2016, India banned multiple brands of codeine cough syrup following reports of addition.

Agreed, abuse of prescription drugs is a global menace, but it is even more so here because of the ease with which they are sold over the counter (OTC).

Amphetamine-type stimulants and several dangerous drugs, which are increasingly abused by Nigerian youths are not OTC drugs and should not be procured without legal restrictions.

It is unacceptable that codeine cough syrup which has been a prescription only drug since 2012 can be bought and sold whimsically over the counter, and in most cases hawked by all manner of people who own kiosks to make money.

In solving this problem, there must be a multi-dimensional approach and all stakeholders must be involved.

Weak institutional links in the control chain must be strengthened.

Our healthcare sector must be revamped. The pharmaceutical companies must abide by the prevalent code of conduct.

Nigeria’s borders are too porous, thereby making the smuggling of these dangerous substances easy.

It is reassuring that the ‘National Drug Control Bill, 2018,’ which seeks “to provide for the effective response and regulation of the production, distribution and consumption of controlled substances in Nigeria and for related matters,” is in the Senate.

That bill must be fast-tracked. We must begin to put a premium on the health of Nigerians and the sanctity of human life must be seen as sacred as it is in other climes.

What we have on our hands is an existential crisis. Nigeria cannot afford a generation of delusional, hallucinating and schizophrenic drug addicts and substance abusers. It is too much of a risk for any country to take.

Anyone or institution found to have contravened the law, thereby endangering the lives of others must be appropriately sanctioned.