Empowering pharmacists to check drug misuse & abuse in Nigeria   

In the year 2001 or thereabout, I was a member of a delegation of the Nigerian American Chamber of Commerce (NACC) that visited President Olusegun Obasanjo at Aso Rock. The delegation was led by the President of the chamber at that time, Mrs Priscillia Kuye SAN. When Mrs Kuye finished addressing the President, she graciously requested if I had something to add. I rose up to grab the opportunity. But before I would speak, she introduced me to the President as a pharmacist and chairman/CEO of Neimeth International Pharmaceuticals Plc, a successor company of Pfizer Products Plc.

As I tried to open my mouth, the President charged at me: “You pharmacists, you are the ones that import fake drugs into the country!” I was stunned, but quickly remonstrated that his statement was untrue. When he insisted, I told him emphatically that no trained and licensed pharmacist will deal in fake, adulterated or counterfeit drugs, except if he was insane (mentally deranged) or did so unknowingly. I told him that there were many interlopers and business miscreants who were pretending to be “pharmacists”, who actually were the ones making merchandise out of the suffering and death of innocent Nigerians. To further push his point as we all know that OBJ will never voluntarily lose an argument; he raised another accusation against pharmacists. He said:” But some of you make copies of your certificates and licenses and place them in many shops without adequate supervision”. Here I conceded that such could have happened in the years of yore, when there were very few licensed pharmacists in the country. I assured him that with the new Pharmacists Council decree of 1992, such practices had stopped and that as a matter of fact, there were many unemployed pharmacists looking for jobs, so it would be unacceptable to the profession and council for one person to oversee more than one premises or outlet while others were without job. We concluded this altercation which was now beginning to make Mrs Kuye ‘uncomfortable’ by the question OBJ asked me. “Ok you have defended your people well, what should we do to stop or minimize the problem of fake drugs?” I answered swiftly: Put the round peg in a round hole. After the meeting, I was asked to stay back. I was given paper to write out my thoughts and proposal. Few months later, late Pharm Dora Akunyili was appointed as the Director General of the National Agency for Foods & Drugs Administration and Control (NAFDAC). I do not in any way take credit for her appointment but for once Nigerians saw how a professional pharmacist put her life on the line to battle the fake drug merchants and the great success she accomplished for Nigeria and Nigerian medicine consumers. We also noted what happened when a non professional pharmacist was appointed to succeed her. Some of the achievements were rolled back, because no other professional has the in-depth knowledge on drug matters including the drug trade as the pharmacist.

After this encounter I began to reflect on why OBJ should place the problem of fake drugs importation and distribution on the lap of pharmacists. Pharmacists are the only professional group that are licensed by the government” to manufacture, mix, produce, warehouse, import, export, distribute and dispense, “poison & drugs” in Nigeria. In short they are the custodians of drugs and poisons in Nigeria. Poisons? Yes poisons- chemicals and concoctions that can kill. Which is really the main reason government assigned this weighty responsibility to a group of people who are thoroughly trained and disciplined to manage these items called drugs or medicines. The real truth is that most drugs and medicines are potentially poisons. That is to say that they can really main or kill those who take them. That is the major reason the profession of pharmacy was created to be custodians of drugs and medicines, first to limit access to these potential poisons, and secondly to ensure that those who need the drugs or medicines are sufficiently counselled and guided as to how to take the medicines, when to take the medicines, what quantity to take at a time and for how long, what to avoid when taking particular medicines and how to respond should unanticipated reactions occur or should an overdose be  mistakenly taken. The pharmacist is expected to be the intermediary between the medicine (prescribed by a doctor or purchased over the counter) and the patient. The truth is that anytime this intermediation is breached, the patient or consumer of the medicine is actually putting his life in danger, because the same drug that can heal when taken appropriately as prescribed and dispensed may kill when taken inappropriately. And the tragedy is that very many Nigerians have more or less committed suicide through taking medicines inappropriately, often without the intermediation of the professional pharmacist.

Therefore from OBJ’s point of view, if pharmacists are the only ones licensed to produce or import drugs, we should not search far for whom to blame when we encounter fake drugs in the system. Indeed this was the same thinking of our distributor in Lagos in the 80s. We had gone to Richson Pharmaceutical Company to show him that a set of Pfizer pharmaceutical products which he sold to a retailer in Ikeja were fake drugs. Richson laughed at us and asserted” Sam, I do not manufacture, I do not import Pfizer products, all that I sell are gotten from you. So if you say these items are fake or substandard, then it must be that Pfizer now produces fake drugs”. Of course I assured him that there was no way Pfizer could manufacture fake drugs. To cut a very long story short, we eventually found out how the fake drug importers infiltrated his system by coming to his boys in his absence to claim that they had bought products from us on credit and were finding it difficult to pay and that Pfizer was putting a lot of pressure on them to pay or face legal action. They claimed to have decided to discount the products by 50%, so that they could quickly raise cash to stave off the legal action. Richson’s staff saw a good opportunity to make “a kill” and inadvertently procured the fake drugs and mixed them with the genuine ones they had brought properly from Pfizer in Nigeria.

Ordinarily, this thinking should be seen as reasonable and logical. But in our country many unreasonable and illogical things happen. The painful truth is that over many years, the pharmaceutical professional space has been invaded by all manner of people who see drugs just as items of commerce or mere medical disposables and in some way the government’s acts of omission or commission have intended to undermine the custodian status of pharmacists. It is not unusual these days to find decisions about drugs and medicines taken without the input of pharmacists. In many clinics, drugs are dispensed without the intermediation of a pharmacist. Even in some government hospitals and primary health care centres, drugs are procured and dispensed without any pharmacist’s oversight. Here there seems to be the misinformed and simplistic view that all that pharmacists do is to ask patients to “take two tablets three times a day” and as such any ‘idiot’ who can speak English can do the same. This misinformation surprisingly gets hearing even in some high government quarters, peddled by agents who profit from the suffering of Nigerian medicine consumers. In the community, many private consumers of drugs can get any drug- ethical or OTC (prescribed or not) from roadside kiosks, moving intra and intra-city buses and trains, open market stalls and even in bars, lounges and nightclubs. This does not happen in most nations of the world including our African neighbours. So why must Nigeria be allowed to continue to operate in this way?

The result we face today is the growing incidence of drug misuse and abuse. Recently the nation was embarrassed by the international codeine scandal and there is so much misuse and abuse with varying morbidities and mortalities, mostly unreported. So like the fake drug issue, who is to blame for the high incidence? The answers will be as varied depending on who you ask, sometimes with disproportionate blame on the victims. For me the official and legal custodians of drugs- pharmacists, their professional associations and their regulatory agencies- Pharmacists Council of Nigeria (PCN) and the National Agency for Food & Drugs Administration and Control (NAFDAC) cannot absolve themselves. Yes, when asked, they blame delay in signing the amended PCN act into law, and other lacuna in drug control legislation, poor resourcing and funding of the regulatory agencies, discriminatory and poor remuneration, lack of executive political will and support for effective ring-fencing of the pharmaceutical space to admit only those qualified and licensed to legally operate, following orderly guideline. My take is that these problems are not insurmountable. I believe the call is for a new approach to ensuring that professional pharmacists take full responsibility as custodians of medicines in Nigeria, ensuring only responsible access to bring down the current level of damage caused by unbridled access and consequent misuse and abuse. I believe that the support of the governments of Nigeria and other healthcare professionals should be taken as granted.

 Mazi Sam I. Ohuabunwa OFR, FPSN