Can Nigeria win its fight against codeine addiction?

Can Nigeria win its fight against codeine addiction?

Accurate date is hard to come by but the number of young people in Nigeria addicted to codeine syrup could be in the hundreds of thousands – or more.

(AFP)
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At just a few minutes past 7pm on a Thursday night, 19-year-old Nsikak and three of his friends show up at an open bar in Uyo, the capital of Nigeria’s south-central Akwa Ibom state. They are carrying with them a 75cl transparent plastic bottle containing codeine cough syrup. “I got it from the black market,” he tells Equal Times. “It is not something you can find easily these days.”

Codeine is an opiate that is highly-addictive and, when taken in excess, can cause hallucinations, delusions, schizophrenia and organ failure. But this doesn’t put off the tens, possibly hundreds of thousands of young people (or even more – accurate data is hard to come by) that consume codeine in the form of cough syrup in Africa’s most populous country. For over a decade, codeine syrup has been bought and sold in nightclubs, pharmacies and back streets all over Nigeria, but the high levels of addiction uncovered in a recent BBC exposé led the Nigerian government to ban the production and importation of cough syrup with codeine in May. Still, as Nsikak and his friends show, it is still possible to purchase the drug illegally.

As his friends take to their seats in the far corner, Nsikak goes to the bar and orders five bottles of Coca-Cola, a drink that not many customers ask for without some accompanying liquor. However, Nsikak and his friends have brought their own mixer.

For the next two hours, the boys work through all of the codeine syrup they came with, as they become louder and increasingly obnoxious with each other and with fellow patrons, particularly female ones. According to the Addiction Center, a web guide for persons struggling with substance abuse, codeine consumption can lead to impaired judgment, lack of coordination and apathetic behaviour. Over the course of the evening, the boys clearly show signs of these behaviours.

Since Nsikak was introduced to codeine syrup by one of the boys in the group, the teenager tells Equal Times that he has consumed at least five bottles of the cough syrup a week for the three months, all of which he buys on the black market for “less than 1,000 naira (US$2.70) per bottle [of 100ml].” When asked why he takes codeine, Nsikak simply says: “I just want to feel high. I like the feeling.”

At the start of the year, the United Nations Office on Drugs and Crime (UNODC) warned the Nigerian government that a growing number of young Nigerians were consuming pharmaceutical substances such as codeine and tramadol in an abusive manner. Both opioids, the agency noted, are the most abused drugs in Nigeria.

Like codeine, which sells for as low as US$1 for a 60ml bottle, tramadol – a painkiller that is prescribed to help manage moderate to severe pain but that can trigger a euphoric high when taken in large quantities – is relatively cheap to acquire. The drug, which can cause memory loss and hallucinations when abused, can be purchased for as little $0.05 for a 200mg capsule. Health experts in Nigeria say tramadol has been used in robbery operations and to sedate rape victims in recent times.

Although the codeine itself is imported, the syrup, until last May, was made in Nigeria by at least 20 pharmaceutical companies, and is often consumed by students who, like Nsikak and his friends, mix it with soft drinks before drinking.

“It is actually more than an epidemic,” Oluyemisi Ogun, medical director at the Federal Neuro Psychiatric Hospital in Yabai, Lagos, said at a symposium titled Emergency Response to Disease Outbreaks: The Way Forward in Nigeria, put together by the Health Writers Association of Nigeria. “In all the nooks and crannies around us there are people selling drugs.”

CRISA’s responses to a crisis

A few metres away from the bar where Nsikak and his friends spent the evening drinking codeine-laced Coca-Cola is the Centre for Research and Information on Substance Abuse (CRISA), a non-profit organisation devoted to drug and alcohol research as well as the prevention and treatment of substance abuse.

Since its creation in 2016, nearly 500 drug users – a quarter of which are codeine addicts – have received psychosocial support and counselling from the CRISA. Because of the stigma around drug misuse, addicts in Nigeria are often reluctant to seek help; as a result, only a handful of addicts visit the centre, most of whom have to be persuaded or coerced by family members and loved ones to make the move.

“Our outreach workers go out [to the streets], talk to drug users, and encourage them to come [to the centre],” Ediomo-Ubong Nelson, a project manager for CRISA, tells Equal Times. “We also have parents bring in their children and pastors bring in church members.”

Although codeine syrup is not illegal to drink in Nigeria, it can only be legitimately sold to people with a doctor’s prescription or those who have a pharmaceutical license. However, because of the vast sums of money that can be made on the black market, much of the syrup is now being sold illegally, even after the so-called ‘ban’.

“Pharmaceutical stores may require prescriptions but not patent medicine dealers [chemists],” says Nelson. “The black market is also available, and it is responsible for a larger chunk of illicit opioids.”

Although the Nigerian government claims that its May ban on codeine syrup was based on an internal investigation, it did follow on from the aforementioned BBC documentary. In the programme, one pharmaceutical representative boasted that he was capable of selling “one million cartons” in a week on the black market.

“The Pharmacists Council of Nigeria (PCN) has been directed to continue enforcement activities on Pharmacies, Patent and Proprietary Medicine Vendor’s Shops and outlets throughout the country,” the Federal Minister of Health, Isaac Adewole, said in a statement in May. “The Federal Ministry of Health shall ensure that drug treatment intervention for victims of substances abuse shall be undertaken across the spectrum of healthcare delivery system in the country.”

But the codeine ban may not be enough to curb Nigeria’s addiction crisis, especially as the syrup is still being smuggled into the country. In late July, just two months after the ban was imposed, the Nigeria Customs Command in Lagos seized 498 cartons – each containing 200 bottles – of codeine cough syrup imported from the United Kingdom. There is further concern that the syrup is being brought in through the country’s porous land borders, as most contraband goods that arrive in Nigeria do. “There’s very little restriction on drugs coming in through our borders,” says Nelson.