Female Medics speak on drug abuse
Does the dose of codeine really matter?
Sylvia Cole, Consultant Anaesthetist
Iwill like to look at the ban of codeine from a different angle. Looking at the effect it will have in Nigeria, I will take only one slant, it needs to be available for nursing mothers who need pain relief when they are nursing their babies in and out of hospitals. I say so because a local study needs to be done on how it affects our local communities and our different tribes, then we can adjust the dose to fit the different tribes.
Take for instance the findings following the incidences with codeine intoxication associated with ultra rapid CYP2D6 metabolism; breastfeeding mothers were given 2 tablets of co codamol 8/500 instead of 30/500 regularly for pain relief on our unit. This study aimed to determine whether the dose of codeine made any difference to the intensity of pain felt. A secondary aim was to determine if multimodal therapy also reduced pain felt.
The method used was a prospective observational study of 174 parturient caesarean section deliveries with neuraxial anaesthesia conducted. All the patients received diamorphine 300-400mirograms in their spinal or diamorphine 1-3mg in their epidural top up. They were all prescribed regular co codamol dose adjusted if breastfeeding and diclofenac unless contraindicated. The patients were followed up post operatively. Factors assessed were regularity of analgesia, worst pain felt since operation, requirement of morphine, whether pain affected care of baby.
The result was that150 patients received spinal anaesthesia while 24 had their epidurals topped up. In the breastfeeding group (BF)(n=90) 71.11% had mild pain, 23.33% moderate pain and 5.56% severe pain. In the non-breastfeeding group (NBF)(n=84) 78.57% had mild pain, 17.85% moderate pain and 3.57% severe pain. 83.33% of all patients received regular co codamol. In the BF group reporting mild pain 76.71% of patients received regular co codamol while 54.79% of the patients received regular co codamol and diclofenac while in the NBF group reporting 74.24% received regular co codamol and 53.03% received regular co codamol and diclofenac.
The conclusion was that the findings identify that the dose of codeine did matter and that multimodal analgesic therapy reduced the intensity of pain felt.
Maymunah Yusuf Kadiri, Medical Director, Pinnacle Medical Services Consultant Psychiatrist
The rate of drug abuse is increasing and this is very alarming. Here are some of the reasons why our youths abuse these substances:
To fit in: Many teens use drugs “because others are doing it”’ or they think others are doing it.
To feel good: Abused drugs interact with the neurochemistry of the brain to produce feelings of pleasure.
To feel better: Some adolescents suffer from depression, social anxiety, stress-related disorders, and physical pain. Using drugs may be an attempt to lessen these feelings of distress.
To do better: Some adolescents may turn to certain drugs like illegal or prescription stimulants because they think those substances will enhance or improve their performance.
To experiment: Adolescents are often motivated to seek new experiences, particularly those they perceive as thrilling or daring.
Recently, @bbcafrica crew went undercover to review the epidemic of codeine cough syrup among our youths in Nigeria.
The role the different sectors, families, schools, religious organisations, media houses, social media, policy makers, government, law enforcement agencies, and so on play is key to this time bomb waiting to explode.. What’s your role in fighting drug abuse in your community? What is our government doing to help curb this issue?
Abiola Paul-Ozieh, Immediate Past Chairman of the Association of Community Pharmacists of Nigeria, Lagos State branch
The use of cocaine, tramadol, codeine, dexamethasone, marijuana, and other types of mind altering substances have a far more negative effect than it seem on the surface.
Many of those engaged in such practices will not only have their lives’ dreams cut short, they also become less contributory to the society. A man who is degraded due to hard drugs will of course be unable to add value to the society.
Hard drugs cause a number of vices, including armed robbery, kidnapping, raping, prostitution, and even health challenges like madness. There is also a high risk of liver and kidney diseases, including cancer, and other terminal illnesses.
Sometimes when these youths approach a pharmacy for the drugs and they are rejected, they simply go to another shop (most often quacks) and buy them. So it’s becoming too easy to get these drugs. Codeine, tramadol, rehypnol, are becoming too easy for them to get. When people are not accessible to drugs, it will be easily controlled.
As long as we have the open drug market places, as long as people walk into anywhere, hawk drugs, we will always have issues with drug abuse. You can imagine how many times closure of open drug market has been postponed; now we are saying by December it will be totally out. We are praying it will happen. It is left for stakeholders to see how we can get rid of uncoordinated system of drug distribution and install a sane distribution system where people can get drugs that are documented and can even be traced to the last user of the medicines.
Re-launching war against drug abuse with banners that would be placed in all community pharmacies across the state, she stated: “Through the banners, we will warn the entire community that drug abuse kills. We want our youths to come out of drug abuse. Those that need help, we will link them to facilities where they will undergo rehabilitation procedures and that way, they will be reintegrated back to the society. All hands need to be on deck.”
“Pharmacists are now exposed to current trends to render more care to the patients and ultimately improve the health outcome of the patients.”
ZAINAB SHINKAFI BAGUDU, Her Excellency, The First Lady Of Kebbi State Consultant Paediatrician
The use of cocaine, tramadol, codeine, dexamethasone, marijuana, and other types of mind altering substances have a far more negative effect than it seem on the surface.
Many of those engaged in such practices will not only have their lives’ dreams cut short, they also become less contributory to the society. A man who is degraded due to hard drugs will of course be unable to add value to the society.
Hard drugs cause a number of vices, including armed robbery, kidnapping, raping, prostitution, and even health challenges like madness. There is also a high risk of liver and kidney diseases, including cancer, and other terminal illnesses.
Sometimes when these youths approach a pharmacy for the drugs and they are rejected, they simply go to another shop (most often quacks) and buy them. So it’s becoming too easy to get these drugs. Codeine, tramadol, rehypnol, are becoming too easy for them to get. When people are not accessible to drugs, it will be easily controlled.
As long as we have the open drug market places, as long as people walk into anywhere, hawk drugs, we will always have issues with drug abuse. You can imagine how many times closure of open drug market has been postponed; now we are saying by December it will be totally out. We are praying it will happen. It is left for stakeholders to see how we can get rid of uncoordinated system of drug distribution and install a sane distribution system where people can get drugs that are documented and can even be traced to the last user of the medicines.
Re-launching war against drug abuse with banners that would be placed in all community pharmacies across the state, she stated: “Through the banners, we will warn the entire community that drug abuse kills. We want our youths to come out of drug abuse. Those that need help, we will link them to facilities where they will undergo rehabilitation procedures and that way, they will be reintegrated back to the society. All hands need to be on deck.”
“Pharmacists are now exposed to current trends to render more care to the patients and ultimately improve the health outcome of the patients.”
Kemi Ajumobi