Misuse of prescription opioids, central nervous system (CNS) depressants, and stimulants is a serious public health problem in the United States. Although most people take prescription medications responsibly, an estimated 54 million people (more than 20 percent of those aged 12 and older) have used such medications for nonmedical reasons at least once in their lifetime. According to results from the 2014 National Survey on Drug Use and Health, an estimated 2.1 million Americans used prescription drugs nonmedically for the first time within the past year, which averages to approximately 5,750 initiates per day. Fifty-four percent were females and about 30 percent were adolescents.
The reasons for the high prevalence of prescription drug misuse vary by age, gender, and other factors, but likely include ease of access. The number of prescriptions for some of these medications has increased dramatically since the early 1990s. Moreover, misinformation about the addictive properties of prescription opioids and the perception that prescription drugs are less harmful than illicit drugs are other possible contributors to the problem.
Although misuse of prescription drugs affects many Americans, certain populations such as youth, older adults, and women may be at particular risk. In addition, while more men than women currently misuse prescription drugs, the rates of misuse and overdose among women are increasing faster than among men.
On August 5, 1962, screen goddess Marilyn Monroe, was found dead in her bedroom in her Brentwood home in Los Angeles, California. At that time, many detectives believed she was murdered, stirring a trail of controversy. The coroner however ruled ‘acute barbiturate poisoning’ as cause of her death.
On June 25, 2009, Michael Jackson also died in California after he suffered a cardiac arrest. Cause of death was related to acute consumption of potent medicines prescribed by Conrad Murray, his personal physician, who was later convicted on involuntary manslaughter charge.
Depressants, anti-depressants, opioids, morphine derivatives, and stimulants are abused when used in a way not intended by a prescribing doctor. It could be either through self-medication for medical ailments or through ingesting prescription drugs to get high. Messing around with prescription drugs is not new. It is also not new that the drugs have messed people up.
In Nigeria, there have been cases of prescription drug abuse too. A case in point would that of Chairman, board of trustees of Actors Guild of Nigeria, Prince Ifeanyi Dike who recently recovered from a kidney ailment. He actually had to endure two kidney transplants, before fully recovering. In an interview Dike granted The Nation newspaper sometime last year, he revealed his suspicion that his unregulated use of analgesics might have caused his kidneys problems.
“I think that was what knocked my kidneys down,” he said in the interview. “I used to work very hard; and every time I came back home, I’d just swallow two tablets to quell the pains, without giving my body the chance to rest and reinvigorates itself.”
In Nigeria, the drug industry has become so liberalised that in some bustling city centres, people selling both Over-The-Counter (OTC) and prescription drugs can be seen spreading their cocktail of drugs on trays and wooden shelves.
In reputable pharmacies, certain drugs cannot be purchased OTC. But that is not the across the country. For instance, clandestine sales of prescription drugs such as Rohypnol and Tramadol take place at the Abattoir at Agege, Lagos. Although strangers asking for such medications are met with suspicious looks and a denial, a careful observation of the area revealed youths exchanging and popping down the strictly prescription pills.
Rohypnol was first brought to the consciousness the Nigerian public in July last year, when traces of the drug was found in the late Osukogu’s system and confirmed to have been used in subduing her, before she died in a Festac hotel in Lagos. Rohypnol, a brand of Flunitrazepam, is a prescription depressant of the Benzodiazepine family of drugs is enjoying recreational use in the country. Acting quickly on the body, within 20 minutes of using the drug, some common effects such as dis-inhibition and amnesia, decreased blood pressure, dizziness, visual disturbances and aggressive behaviours can be noticed. This effect could last for as long as between eight and 36 hours, depending on whether it is used with or without alcohol.
At the abattoir, the street name for Rohypnol is Roche or ‘Baba Blue’ because of the blue colour it leaves on the tongue of those who pop them.
The National Drug Law Enforcement Agency (NDLEA) is aware of the problem too. According to the Head Public Affairs of NDLEA, Mitchell Ofoyeju, the issue of drugs has been a challenge to the agency. “Pharmaceutical drugs are not meant to be hawked,” said Ofoyeju. “There are instances where we conduct raid operations and arrest those who sell those pharmaceutical drugs on the streets.”
According to him, most drugs should be kept in a cool dry place but exposing them in the sun through hawking makes them lose their efficacy “due to the hot conditions they have been subjected to.”
He also said “Only pharmacists can sell such drugs.”
According to Ofoyeju, the most abused controlled drugs are the sleeping pills like diazepam. He also said potent pain relieving drugs are also abused. He revealed that Demoline is mostly abused in the northern parts of the country. “If you take five tablets of demoline, you won’t feel tired if you are working because it kills pains in the body,” Ofoyeju said.
He also said “The implication is that one person can do the work of two people.”
Another group of people whom the NDLEA spokesman accused of abusing drugs are the long distance drivers. “They would tell you that if you take five tablets, you can drive from here (Lagos) to Sokoto and sleep would not come to your eyes.”
He also singled out commercial sex workers as offenders in this category, as they use drugs to withstand the demands of their clients. He however warned that the cumulative stress is paid for somewhere.
Ofoyeju said the prescription drug abuse pattern globally is of concern. “The abuse pattern varies,” he continued. “Some drugs may not be controlled now but may be controlled in the future.”
That is the case with cough syrups which contains codeine. But it is still widely available and can be bought over the counter and some Nigerians are basking in the consumption. Adebola, a 24 year old student of the Federal Polytechnic, Ilaro, Ogun State, who uses Codeine recreationally says he likes the feeling he gets when he drinks it. For him, a session involves drinking a bottle of Benylin with codeine in a gulp. Asked to describe his feelings, he responds; “It is different from alcohol. This one is a slow and steady high.”
Many of his peers are also involved in taking codeine for pleasure. Such cravings have generated a huge demand for cough syrups, which contain codeine, a situation that in recent times has culminated in a rise in their prices.
According to a report, Abubakar Jimoh, Deputy Director of Public Relations and Protocols, National Agency for Food and Drug Administration and Control (NAFDAC), is concerned about illicit drug abusers in the country. However, it believes that because of the huge rural population, selling such drugs by prescription only could limit access to a large number of people.
Abuse of prescription and OTC drugs has also been a cause for concern for pharmacists.
“OTC drugs are more prone to abuse than the prescription drugs because they are available without prescription and anybody can pick it,” she said.
According to MedlinePlus, a website published by the US National Library of Medicine, ‘People who take nonsteroidal anti-inflammatory drugs (NSAIDs) (other than aspirin) such as ibuprofen may have a higher risk of having a heart attack or a stroke than people who do not take these medications.’ The website also states that the risks may be higher for people who take NSAIDs for a long time.’
Akonoghrere also said that anti-malarial which should be prescription drugs have become OTC because of the prevalence of malaria in the country, making them to be highly abused. However, apart from anti-malarial, a thin line blurs the sales and consumption between prescription and OTC drugs.
But self-medication has proved it could be dangerous. And Akonoghrere revealed that “We discover that most ailments that are reported in the hospital are the effects of the drugs that are either abused or misused but many of them (patients) may not know.”
According to the National Institute on Drug Abuse in the US, in 2010, approximately 16 million Americans reportedly use a prescription drug for nonmedical reasons in 2009.
Recently in the UK, the 2014 annual DrugScope survey of drug workers reported an increase in the use of the prescription drugs, pregabalin and gabapentin, especially amongst heroin addicts and within prisons. According to survey, the two drugs are used to treat epilepsy, neuropathic pain and anxiety. However, combined with depressants, they cause drowsiness, sedation, respiratory failure and even death. Official statistics show the two drugs were cited on 41 death certificates in 2013.
With unregulated sales by these medicine sellers, the citizens stand the risk of using counterfeit medicines. According to the Force Public Relations Officer, Commissioner of police Emmanuel Ojukwu, “it is NAFDAC’s responsibility to check the activity of drugs.” He however, said the police work in collaboration with associations of pharmacists’ patent medicine sellers to carry out raids.