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He is a clinical therapeutic consultant and health insurance expert. In this interview with EMMA OKEREH, Dr. Obinna Nwanedo, who is also the executive secretary, Health Insurance and Managed Care Practitioners Association of Nigeria, proffers answers to the nagging question on the abuse of Benylin syrup by the youth. Excerpts:
Tell us about Benylin syrup and why it has become the toast of the town among the youth.
Benylin is a trademark of a company; it has several products for cough. I believe the one you are talking about is the one that contains Codeine, Benylin with Codeine.
The codeine element is the major active ingredient in that particular medicament which we know as a centrally acting drug and a drug that can cause psychological and physical dependence. Because of this, it is a drug of abuse and a lot of people have abused it because of several reasons.
In Nigeria, especially in the North, a lot of people use it to “get ‘high’. And being high, in their parlance, means that it acts on their central nervous system, which can change their moods. It is a drug that can cause mood swing and make you have some false sense of wellbeing known as euphoria.
That false sense of wellbeing charges people up for certain things. For instance, from a pilot study we did on why people use Benylin, we discovered that they believe it energises them for sexual performance.
Of course, we live in a stressed country where most men hardly perform; but the irony here is that both male and female use it for the same purpose. They believe it improves their libido. And don’t forget, when drugs act through the central nervous system, it is what it tells you in your brain that you believe.
When you abuse a drug that is centrally acting it can depress your central nervous system or excite it, and that is the reason why an addict to a drug behaves differently. In some cases, the same aggressive addict also becomes docile, depending on how the drug acts at the time.
If you go to the medical pharmacology of codeine itself, it is a pain killer drug. In those days there was a drug called B.Codeine; it was removed from the market when people started abusing it. It had some analgesic effect, but the analgesic is said to be opiured-related.
There are two classes of pain reliever: one is known as non- steroid anti-inflammatory agent (NSAID), that is where Asprin and Paracetamol belong. We also have a class of drug called opiured analgesic. The word analgesic means pain reliever. Opiurred analgesic came from the word opium, and it is a drug used to remove pain, but it is centrally acting and causes dependence. So any drug that acts centrally is said to be opium-related. It may not come from the plant, opium.
Now that Benylin with codeine has been identified as a drug of abuse because of its tendency to make the abusers high, do you think it should be regulated?
The classification of a drug could be because of its therapeutic use; it can also be because of its poison effect. All drugs are said to be poison, but there are some drugs we call poison because they can only be handled by experts. Codeine falls under that category. Even though it falls under this category it is still an over-the-counter drug because it is used as an analgesic.
That is why, when you are using it for that purpose, there is supposed to be a regulatory effect so that the active ingredient in it will not be at the strength that it would be abused.
But in our context here, even when you reduce the strength of codeine, people can still get the effect by increasing the quantity of intake. One thing I have found out is that people can take this drug like five bottles at a go and gulp it down. To be fair to the users, some pharmacies wouldn’t mind selling.
But pharmacies that are owned by registered pharmacists and they have registered nurses in them will always insist on following the procedure. I expect a good pharmacist to recognise an addict when he sees one. There are lots of characteristics that are only related to an addict.
Apart from the sexual strength, what other thing is derivable from this abuse?
The clinical pharmacology of drugs of abuse is that they work through the central nervous system. It controls their moods and behaviour, depending on who is using it.
In the books, nobody will tell you that if you take Benylin with codeine, you are going to derive sexual strength. In fact, at the abuse level, you have what is called therapeutic window; that is, a window where a strength of a drug will give a particular effect. When taken at an abuse level, it will do so many things.
Some people use it because they feel it gives them the strength to go the extra mile. In this part of the world, due to a lot of factors, most men are not sexually active, and when they find anything that can assist them, they will abuse it. That is why Viagra was abused when it came. And this one is cheaper than Viagra, so it is easier to take.
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