Beyond the ban on codeine

For individuals, companies as well as nations, crises are a critical inflection point. Character shows in what people make out of an emergency. A Nigerian aphorism says that we know the real worth of a man in a crisis.

Smart people make the most of their crisis. They learn valuable lessons about themselves, about certain situations and how not to tackle some issues. They distil the learning and take corrective action to ensure outcomes that are so much better there is a temptation to give a backhanded compliment to the crisis for opening their eyes. Rwanda is an oft-cited example of profiting from the key learnings from a disaster.

Nigeria has spent the last fortnight acting in crisis mode following exposure by a global broadcaster of the abuse of codeine syrup in major cities of the country. Northern Nigeria has been the epicentre of the drug challenge for many years. It has now taken frightening dimensions.

Unfortunately, the official response to the codeine syrup challenge has in many instances and areas been suboptimal. There have been avoidable lapses in strategy, timing and communication of issues and actions. There is as yet no clear direction. Then there is a deafening silence by the governments of the states most affected by the drug abuse challenge.

Following the BBC documentary, the Federal Ministry of Health reacted in knee-jerk fashion by announcing curbs on the manufacture and marketing of codeine-based cough syrups. It followed on May 7 with poor communication of a regulatory audit process that is standard procedure in handling matters of a breach in the chain for controlled substances.

NAFDAC, in a news release, announced the closure of three drug manufacturing firms in Lagos and Ilorin. The NAFDAC statement stated, “Due to insufficient evidence gathered and apparent resistance to provide needed documents during our inspection on May 2, 2018 at the respective companies in Ilorin and Lagos, it has become necessary to shut down all product lines of the three companies…”

A reading of that statement led to only one conclusion: NAFDAC had shut the entire production activities of the three firms. Alas, it turned out NAFDAC closed only the production units for cough syrups. The media found out just because of checking with Emzor the consequence of the announced closure. As at the weekend, NAFDAC did not bother with a clarification leaving the media and the public to depend only on a message from Emzor confirming that production was ongoing on other lines.

Poor communication led to such a massive misunderstanding by the media and the public. It ignited severe debates on social media and offline. It also played into Nigeria’s ethnic fault lines for citizens so inclined.

NAFDAC at the weekend came out with specific administrative fines for specific offences committed by the three firms. It also ordered the reopening of the shut production lines. We commend the speed in taking corrective action.

There are other concerns. What have NAFDAC and the Ministry of Health outlined as a strategy for tackling the drug abuse challenges mainly in the Northern states but also across the rest of the country? Beyond the documentary that rehashed what Nigerian media have reported on over the years, what studies have NAFDAC and the Federal Ministry of Health carried out or commissioned on the youth drug abuse challenge? Which drugs are mainly responsible for the problem? Is it codeine in cough syrups or other painkillers? In Australia, their study found out that paracetamol or ibuprofen was involved in 55 percent of the 1200 codeine-related deaths recorded between 2000 and 2013. Australia is now looking at how to control the use of codeine implicated in 150 medications. Youths here abuse Tramadol, itself containing the opiate, and several other substances. Nigeria needs to articulate a holistic strategy for tackling an evident national challenge of drug addiction by the young and vulnerable.

No one has yet heard from the Kano State Government what it plans to do about the drug abuse challenge on its doorsteps. Nary a word. How does Kano State Government plan to tackle this problem? What resources is it deploying? What assistance does it need?

Across the world, countries are now questioning the continued use of codeine because of the tendency to abuse it. There is an opportunity here for Nigeria to join nations of the world to study and find out alternatives to the opiates in medication. Can we be one of the first countries to find alternatives to codeine? Can the Ministry of Health work with the Pharmacy Council, universities, pharmaceutical firms and our research institutes to fashion out alternatives. Can we add insights and perspectives from natural medicine for which we already have a federal agency?

Leadership and collaboration are needed and critical. The Health Minister has the experience and exposure to lead cross-cutting teams that should work collaboratively with various institutions, organs and state governments. We should treat the drug abuse issue as a national emergency and engage all our troops in tackling it.