Today, Monday 23rd July marks the 83rd Birthday Anniversary of an Icon of Pharmacy Practice in Nigeria, Pharmacist Dahiru Suleiman Wali, FPSN, who was born in Kano City to the family of the late Wali Suleiman of blessed memory. Ever since the Pharm. D.S Wali (also known as Mallam D.S Wali, or Mallam “Tsamiya Pharmacy” clocked 80 years in 2015, the members the “Pharm. D.S Wali, FPSN Book Project Committee”, made up of Professors U.U Pateh and Ibrahim Adamu Yakasai, as well as Pharm. Aliyu Jibrin, Pharm.
Ahmed Gana Mohammed and this writer, and who jointly authored the Book: “D.S. WALI-An Icon of Community Pharmacy Practice in Nigeria”, which was presented to the Nigerian public as the first biography of any northern pharmacist and published in April, 2013, had taken it upon themselves to celebrate Mallam Wali’s birthday anniversaries with public lectures addressing contemporary topics in pharmacy education or its practice. In 2015, it was Professor U.U. Pateh, a member of the Committee, then as the Dean of the Faculty of Pharmaceutical Sciences, ABU, Zaria, and who spoke on: Pharmaceutical Care in Community Pharmacy Practice: The Way Forward. It would be recalled that Pharm. Sam Nda Isaiah, FPSN (Kakaki Nupe), the Chairman of the Leadership Newspapers Group and a distinguished pharmacist in his own right, was chairman of the lecture event.
In 2016, it was the turn of Professor Haruna Abdu Kaita the Vice-Chancellor of the Federal University, Dutsen-Ma, Katsina who presented the 81st Anniversary Lecture with title: Food Additives and Household Chemical Exposure: Pharmaceutical Information, Education and Counseling.
Last year, 2017, Professor Magaji Garba, the Vice-Chancellor of the Federal University, Gusau (FUGU), Zamfara State, presented the 82nd anniversary lecture with title: Exploits of a Pharmaceutical Chemist in Pharmacy Practice (Drug-Drug Interactions).
The members of the committee have chosen on Professor Ezzeldin Mukhtar Abdurahman as the Guest Lecturer for the 83rd Birthday Anniversary Lecture taking place today, in Arewa House, Kaduna and the former Vice-Chancellor of the Kaduna State University (KASU), Kaduna (2007-2011), and BAUCHI State University (BASU), Gadau, Bauchi State (2012-2016) will be speaking on: The Role of Pharmacists in the Campaign Against Drug Abuse.
One distinguishing feature of the four (4) speakers, besides being all pharmacists and academics and who’ve all risen to becoming professors in their various fields, they were all at one time or the other Dean of the Faculty of Pharmaceutical Sciences, Ahmadu Bello University, Zaria. This is also including the fact that they are all distinguished members of the Ahmadu Bello University Alumni Association.
The message during this fourth (4th) edition in the lecture series in honour of Mall Wali is on Drug Abuse and its scourges and the responsibility of pharmacists as manufacturers, distributors and the custodian of these drugs by law and who dispenses same to patients and users, in tackling this menace. Our former Dean in the Faculty of Pharmaceutical, ABU, Zaria and who rose to become Deputy Vice-Chancellor and later, Vice-Chancellor, ABU, Zaria, from 2010-2015,after having first served as Vice-Chancellor in Umaru Musa Yar’adua University (UMYU), Katsina, Professor Abdullahi Mustapha would be the Chairman of the Lecture event as he did in 2016 and 2017.
Prof. Abdurahman, a professor of pharmacognosy and drug development, is eminently qualified to present the Lecture.
However, as I have done during the past three editions of the anniversary lectures with articles on the life and times of Mallam Wali himself, this year, this piece is on Drug Abuse, and ostensibly from the perspectives of the celebrator himself were he to contribute to the national debate on the topic, but without prejudice to the message as contained in the Lecture to be delivered by Prof Abdurahman.
Drug Abuse Issue In Our Society:
The name Felix Hoffmann may probably not mean much to people outside the healthcare industry. To pharmacists especially, Hoffmann’s discovery of Aspirin is probably one of the greatest discoveries of medicine or pharmaceutical products the world had witnessed over a century ago. Also chemically known as Acetyl-Salicylic Acid (or ASA), Aspirin is to become the first synthetically produced pharmaceutical product, first in 1897 by Chemist Felix Hoffmann at Bayer, a German Chemical Company for the relief of pain and fever. Eventually, its use extended to treat symptoms of pain related to rheumatism, lumbago and neuralgia in the 1920s.
As with every pharmaceutical product, the issue is that of safety and efficacy, which are of main concern to the pharmacist, the professional who formulated Aspirin and other Aspirin containing substances.
Codeine belongs to the family of drugs derived from opium. Opiates cover a huge variety of drugs, ranging from licit drugs, such as codeine and morphine, to illegal drugs, such as heroin.
Codeine is an opiate used to treat pain in cough medicine and is used for the treatment of mild to moderate degrees of pain. Codeine is less potent than its relative, morphine. It, however, holds powerful addictive properties for the many people who abuse it worldwide.
Codeine and other opiates in pharmaceutical preparations for the suppression of cough and pains associated with cough are therapeutic agents dispensed by the pharmacist after a patient is issued a prescription by a licenced medical practitioner or dentist. However, in the words of Aguwa (2002), in the treatment of severe visceral pain with opiates or their analogues, the danger of addition exists.
That is the position of ethics within the healthcare provider facilities, whether at the primary, secondary or tertiary tiers of the healthcare system in Nigeria. However, codeine and other opiates have always been abused in Nigeria and other countries. What is of prime concern to Nigeria, as clearly articulated in the remarks by the Senate President, Dr. Bukola Saraki, a Medical Doctor by training himself, during the Retreat by the Senate at the Bristol Hotel, Kano in December 2017, was the concern by the Senate and indeed the National Assembly, as the representatives of the people, of the alarming rate of the abuse of codeine containing substances, especially cough syrups in the States of Kano, Katsina, Jigawa, Kaduna, etc by married women, girls and boys alike. There is a social, pharmaceutical, medical and psychiatric dimension to this issue.
Indeed, there is the religious dimension, as I proffered during the retreat where I made a presentation on behalf of the Arewa Consultative Forum (ACF).
What my now forty (40) years of practice as a pharmacist cutting across all the four areas of pharmacy practice as well as in the regulation of pharmaceutical products tells me is that, appreciating the side effects of these products is as important as monitoring the therapeutic benefit for the patients and/or users. What researchers attempted and succeeded in avoiding in the likes of heartburn, nausea, irritation and possible gastric bleeding, as the side effects in the use of Aspirin, led to the discovery of Non-steroidal Anti-Inflammatory Drugs (NSAIDs), such as Diclofenac and Piroxicam, etc to the rescue, but it become a challenge with the opiates as analgesics because of addiction.
It is the eventual habituation tendencies by the long-term uses leading to addiction that formed the basis of the concerns by the Federal Minister of Health in slamming the ban on Codeine containing substances in Nigeria. Commendable as it is, the ban has only won the battle while the war rages on. Shutting down production in some three (3) pharmaceutical manufacturing companies who were initially licenced to produce their various brands of codeine containing cough syrups is tantamount to relieving the symptoms and not the effect.
It is very easy to identify the cause of the drug addiction epidemic in respect of codeine containing substances among the population in predominantly Muslim dominated States, such as Kano, Jigawa, Katsina, Kaduna and others as mentioned.
The misunderstood or the citizen’s refusal to understand that it is not only the consumption of alcoholic drinks or substances that Islam forbids, but any substance consumed or used which has the tendency of elevating the mood to “high” to such an extent that the believer is not in control of his/her faculties is totally forbidden in Islam. In the case of Codeine containing cough syrups, willingly consumed by a Muslim in doses beyond the therapeutic level for the purpose of getting “high”, they have the same level of crime (sin) as the consumption of the more conventional intoxicant drinks, such as beer, wines, etc.
The Muslim cannot deceive himself/herself or indeed think he/she can deceive Almighty Allah (SWT) with these consumptions beyond therapeutic levels, notwithstanding the fact that the consumption of alcohol is a taboo in these states mentioned, in addition to the religious repercussions.
The Consumption of intoxicants & drugs: what the Qur’an and the Sunnah (prophetic tradition) say regarding intoxicants and narcotics.
Allah Almighty states in the Noble Qur’an: “O You who believe! Indeed, intoxicants, gambling, [sacrificing on] stone alters [to other than Allah], and divining arrows are but defilement from the work of Satan, so avoid it that you may be successful.” [Quran: 5:90] Allah Almighty has described using intoxicants, amongst other things, as appalling, despicable and hateful acts of Satan and He has commanded us to abstain from them. Allah, thereafter, states in the next verse: “Satan only wants to cause between you animosity and hatred through intoxicants and gambling and to avert you from the remembrance of Allah and from prayer. So will you not desist” [Quran: 5:91] This Aayah (verse) tells us how it is a detestable act of Satan, because intoxicants, in addition to sowing the seeds of enmity, prevent one from the remembrance of Allah.
Bear in mind that when the term “intoxicant” is used, it also encompasses narcotics, because they, too, among other things, result in the loss of self-control. There are also many narrations stated by the Noble Prophet (may Allah exalt his mention) with regards to intoxicants, such as: Ibn ‘Umar, may Allah be pleased with him, reported that the Messenger of Allah said: “Every intoxicant is Khamr (wine) and every intoxicant is Haraam (unlawful). Whosoever drinks wine in this world and dies whilst having consumed it and not having repented from it will not drink it in the next world [i.e. in Paradise].” [Muslim] Ibn ‘Abbaas, may Allah be pleased with him, reported that the Messenger of Allah said: “If a habitual drunkard dies, he will meet Allah like the one who worships idols.” [Ahmad & Ibn Maajah] In other narrations, Prophet Muhammad described intoxicants as:
1) The key to all evils.
2) The head of all errors and lapses.
3) The most terrible of major sins.
4) The mother of all atrocities.
5) The mother of all evils.
Umm Salamah, May Allah be pleased with her, said: “The Prophet prohibited every intoxicant and Muftir (every substance which slackens the mind).” The unanimity of the Ummah (or Muslim nation) on the prohibition of narcotics is also narrated from many scholars. Imaam Az- Zarkashi stated:
“The consensus of the Ummah is narrated from several scholars on the prohibition of hashish; those scholars include Qiraafi and Ibn Taymiyyah.”
If that was not enough, Imaam Ibn Taymiyyah has further stated: “Whosoever regards it lawful has become a Kaafir (disbeliever).”
The scholars of all the four schools of Islamic jurisprudence (Imam Abou Haniifah, Imam Maalik, Imam Shaafi’i and Imam Hambali) unanimously agreed that consuming anything intoxicating is Haraam. Certain plants have also been included in this, as Imaam Rafee’ clearly stated that: “The scholars have included intoxicating plants, etc. within this prohibition.”
So far, the prohibition of drugs has been proven by means of the Quran, Sunnah and Ijmaa’ (the consensus of scholars). It can further be proved by Qiyaas (analogical deduction), i.e. logical reasoning. When a person is intoxicated (or ‘stoned’ in street language) he does not know what he is doing. He could easily kill someone or fornicate, etc. In the same manner, to feed his habit, he will most probably have to steal. These are, without a shadow of doubt, unlawful. There is a general rule that whatever leads to something Haraam (unlawful) is in itself Haraam. Thus, drugs have been proven as Haraam by all four sources of Islamic jurisprudence (Qur’an, Sunnah, Ijama’a and Qiyass).
I had the following to say at the Retreat in my paper with title: The Evil Effects of Drug Abuse in Nigeria: The Northern States Perspectives” on Tuesday, 19th December, 2017:-
The venue for this retreat, Kano is appropriate, as Kano State has the largest population in the country, the North inclusive. The metropolis of Kano has the Second largest population only after Lagos in the country. One factor that must be taken into account is the homogenous nature of the populace of Kano, ethnically and religiously being demographically composed of Hausa-Fulani and Muslims, respectively. The homogeneity of the ethnic group as well as the religious belief of the populace of Kano as well as other States in the North is key to this discussion. Islam prohibits the consumption of alcohol in any form……”
One thing leads to the other, as getting out of one’s mind is followed by committing crime or, to put it mildly, behaviours that are socially unacceptable to the society, such as rape, theft, insulting elders, etc. The consumption of these “mind bending” drugs makes the user “bold” to commit these and more without shame, contrary to the cultural and traditional norms of the people.
The 25 or so companies issued licences by NAFDAC to produce codeine containing preparations at the time the products were not banned should have been invited for a meeting by NAFDAC, which issued the licences, as well as to the importers issued licence to import similar substances from abroad for a discussion. The totality of the products in the various stores of these companies codeine containing substances should be collated and the Government to buy them off from the companies, convey same to General Hospitals and Teaching Hospitals and other public healthcare provider facilities to be dispensed by the pharmacists to patients on the presentation of prescription generated from within the hospitals.
The National Agency for Food and Drugs Administration and Control is responsible for the registration of all the pharmaceutical products (drugs), foods, medical devices, bottled water, cosmetics, detergents and chemicals in Nigeria, among the prominent functions. What is important here is that NAFDAC is responsible for the registration of pharmaceutical products with substances classified under Scheduled II, that is, substances that could be used – amphetamine, pethidine, morphine, etc but in doses that are allowed for therapeutic purposes and which could be monitored by a clinical pharmacist, a medical practitioner or a nursing care personnel.
An item that comes to mind is Benyline with Codeine and Tramal. These two (2) and the likes of them are meant for therapeutic purposes but unfortunately somehow find their ways out of the official drug distribution system and are accessed by the youths, married women, and girls in their teens and consumed without prescriptions.
NAFDAC is responsible for the importation and/or allocation of opiate substances like raw Codeine to the pharmaceutical manufacturers, who produce these products, and is responsible to ensure the proper monitoring of real use in manufacturing and not sold on the streets or underground in their crude forms.
The National Drugs Law Enforcement Agency (NDLEA) was established through Act 48 of 1989 and saddled with the responsibility to enforce laws against the cultivation, processing, sale, trafficking and use of hard drugs and to empower the Agency to investigate persons suspected to have dealings in drugs and other related matters. The Agency also has roles to play in curbing the unethical use/consumption of these products beyond therapeutic doses.
In conclusion, for pain relief, let us go back to Aspirin (ASA), which has been formulated as powder, sustained released, parenteral, ointment, enteric coated, etc and beside being antipyretic, analgesic, antirhuematic, it has been found to be useful in saving lives in Angina Pectoris, heart attack, and blood clots, which could lead to stroke migraines, etc.
As I have always argued, the very important discoveries to modern medicine – Anesthesia, Syringes and Antibiotics (another ASA), of course not forgetting the discovery and uses of vaccines and x-ray, should be the focus for all healthcare professionals to advance and not be bothered about the unethical uses of drugs.
The next challenge to modern healthcare is cures or vaccination for malaria, cancers, sickle cell and congenital conditions like autism, downs syndrome, etc. Only time will tell.
No to drugs (opiates), Yes to life as the popular saying in curbing the menace of drug abuse, which was coined in the mid 1980’s, is equally appropriate now.
Parents, teachers, and religious scholars as well as elders and regulatory agencies have a role to play towards reducing the ill-effects of drug abuse, which include:
(i) Parents: It is an obligation of parents to keep a firm eye on their children. Once parents begin to notice any sort of changes concerning the behavior of their children, like new friends with suspicious character, petty theft and overstaying night curfews, then they should take necessary action.
Also, physical attributes like dry mouths or lips, increased sweating and perspiration without any actual cause or the trembling of any part of the body should be looked into.
(ii) Teachers: Teachers are the second parents. Once a teacher also notices his students with any of the above attributes, then he/she should peer into it to avoid a catastrophe;
(iii) Religious Scholars: It is imperative for religious leaders to preach on issues that would direct the society towards enjoining what is good all the time, especially avoiding substances and drugs of abuse. Once a scholar notices a practicing faithful declining from religious obligations or is portraying the attributes mentioned above, he should be looked at and preached to appropriately;
(iv) Elders in the Society: Chiefs, District and Village heads also have a huge role to play in this course. Once new faces are noticed in the community as well as extraneous occurrences or other attributes quite contrary to the norm, then it is necessary to look into the matter further;
(v) Regulatory Agencies: There are numerous regulatory agencies, and a few among them are:
· National Agency for Food Drug Administration and Control (NAFDAC): It is the duty of NAFDAC to register, control and regulate all kinds of drugs. Any drug that is not properly registered, whether manufactured in Nigeria or imported, is automatically fake. Sealing all the sources and markets of fake and counterfeit drugs as well as stopping the illicit sales of such drugs in open markets, motor stations and by drug hawkers are all part of the responsibilities that NAFDAC officials. They should take them seriously and prosecute offenders, as they are all means of distributing drugs of abuse;
· National Drug Law Enforcement Agency (NDLEA): NDLEA officials have enshrined in their duty the elimination of trafficking, and the growing, distributing and use of the drugs of abuse. Since the inception of NDLEA in Nigeria, the agency has played an important role in curtailing drug peddlers from distributing these drugs of abuse. It is also imperative that NDLEA officials should put in more efforts for better success. A string punishments and penalties should also be conferred on the traffickers of drugs of abuse;
· Nigerian Immigration Service (NIS): Some of the peddlers of drugs of abuse are not really Nigerians. The Nigerian Immigration Service (NIS) has the function of arresting both foreigners and citizens in every nook and cranny of the country involved in peddling and trafficking the drugs and substances of abuse;
· Hospitals: Ensuring the stocktaking of all drugs in hospitals across the nation would reduce pilferage and abuse by the bad apples among workers and patients resorting to drugs abuse;
· Increased Awareness: It is necessary for regulatory agencies and the media to introduce write-ups or digital images just like it was done before to sensitize citizens;
·Nigerian Customs Service (NCS): Most of the drugs of abuse are not manufactured in Nigeria. They are imported. There are special laws promulgated on the importation of all manner of drugs into Nigeria. It is necessary for customs officials to be duly equipped to stop and reduce the illegal importation of these drugs, especially drugs of abuse, such as opiates.
As such, we can now infer that indulging in drug abuse by youths arose mostly due to unemployment. If a youth is jobless, he/she indulges in drug abuse, because he/she assumes the intoxicants would suppress the thoughts and disappointment of lack of job opportunities. As the youth runs out of cash, he/she resorts to theft and robbery for money to satisfy the addiction.
– Mora is a Consultant and Professor of Pharmacy Practice at the College of Pharmacy, Igbinedion University, Okada, and also Chairman of the “Pharm. D.S Wali, FPSN Book Project Committee.