Enabling environment and the ban on codeine syrups

All it took was one feature on the BBC World Service to make officials of the Federal Ministry of Health react in knee-jerk fashion with a policy directive with consequences on businesses, employees, citizens and a whole sector. The response was without due process as there was no consultation with stakeholders nor provision of recourse of any kind to persons that it would affect. It harked back sadly to the days of “with immediate effect”.
The Federal Government declared on May 1 a ban on the manufacture and marketing of cough syrups containing codeine. This followed an increase in the intensity of the abuse of the syrup by young people. It got to an epidemic proportion in Kano. However, Nigeria requires much more than a ban on one line of opiates to tackle the evolving drug abuse challenge.
Many issues deserve attention on the matter of youth drug abuse in Nigeria. They demand careful consideration, planning and implementation of a plan that enables the country stand a chance of winning.
Groups including Government are already working on the challenge. The Senate did a study of the situation and is working on a Bill. The Federal Ministry of Health set up the Codeine Control and Other Related Matters Working Group. Given this setting, the knee-jerk response coming soon after a BBC documentary is worrisome.
Youth around Nigeria abuse more than codeine. They abuse prescription and over-the-counter drugs. They drink codeine, Tramadol, Rohypnol and Lexotan. They sniff glue, gum and methylated spirits. They abuse various local substances, from petrol to faecal matter.
Why is the incidence of youth drug abuse rising? Why more so in particular locales than others? Who are the stakeholders and what roles should they play to tackle this challenge? Who is coordinating? What, for instance, has the Government of Kano declared as its strategy for tackling this scourge?
Today, the Federal Government has banned cough syrups containing codeine. Would it also ban the other drugs and substances that the young abuse in search of a high? What would be the effect of a ban on these medications for citizens who need them as part of a health regimen and who do not abuse them?
Codeine is an opiate. Opiates are common in medications. Morphine and codeine are some of the most common opiates. In effect, many painkillers contain opiates in varying proportions. In medicine and pharmacology, these natural opiates have many uses. Morphine goes beyond pain to application in abnormal or laboured breathing (dyspnea) while codeine is deployed to pain, diarrhoea, and irritable bowel syndrome in addition to use in cough medicines. What happens to codeine for uses other than in cough syrups?
Then there is the matter of the enabling environment for business operations in the country. It does not resonate with planning and due process for government to wake up and just announce a ban that would seriously affect the operations of manufacturing enterprises. Nations plan these things, and give notice. The cough syrup with codeine is one of the lines of no fewer than 22 pharmaceutical manufacturing companies. The popular Benylin with codeine has been manufactured by a firm that has been in our country for more than 50 years. Government ought to have given a notice of at least one quarter to stop the sale and manufacture of the drugs whose abuse have now brought out their potency as opioids.
The ban also raises a more fundamental question about drug use in Nigeria. Because of the structure of the drug trade over the years, there is hardly any line between over-the-counter and prescription medicines. The norm across the world is to have a fairly rigid line when it concerns prescription medicines. In Nigeria, people just walk into a pharmacy, chemist shop or medicine store in the market and buy any and all drugs. The Federal Ministry of Health and the Pharmaceutical Council should go to the drawing board to fashion out new modalities and templates for drug distribution and use in the land. Even in neighbouring smaller countries on the West coast of Africa, they uphold the distinction and do not sell or buy drugs the same way as tomatoes.
The call is on the Federal Ministry of Health to collaborate with sector stakeholders to devise preventive measures against drug abuse. One of those measures would be to adopt best practice standards in drug distribution and sale as applies across the world. The Federal Government and state governments should also work with sociologists, psychologists, doctors and therapists as well others in the health eco-system to tackle this growing challenge of drug abuse. We must borrow best practices from other jurisdictions to ensure we save our young from this problem.