EMPOWERING PHARMACISTS TO CHECK DRUG MISUSE & ABUSE IN NIGERIA


In the year 2001 or thereabout, I was a member of a delegation of the Nigerian American Chamber of Commerce (NACC) that visited President Olusegun Obasanjo at Aso Rock. The delegation was led by the President of the chamber at that time, Chief (Mrs) Priscillia Kuye SAN. When Mrs Kuye finished addressing the President, she graciously requested if I had something to add. I rose up to grab the opportunity. But before I would speak, she introduced me to the President as a Pharmacist and Chairman/CEO of Neimeth International Pharmaceuticals Plc, a successor company of Pfizer Products Plc. As I tried to open my mouth, the President charged at me, “You Pharmacists, you are the ones that import Fake Drugs into the Country!”. I was stunned, but quickly remonstrated that his statement was untrue. When he insisted, I told him emphatically that no trained and licensed Pharmacist will deal in fake, adulterated or counterfeit drugs, except if he was insane (mentally deranged) or did so unknowingly. I told him that there were many interlopers and business miscreants who were pretending to be “Pharmacists”, who actually were the ones making merchandise out of the suffering and death of innocent Nigerians. To further push his point as we all know that OBJ will never voluntarily lose an argument, he raised another accusation against Pharmacists. He said ”But some of you make copies of your certificates and licenses and place them in many shops without adequate supervision”. Here I conceded that such could have happened in the years of yore, when there were very  few licensed Pharmacists in the Country. I assured him that with the new Pharmacists Council Decree of 1992, such practices had stopped and that as a matter of fact, there were many unemployed Pharmacists looking for jobs, so it would be unacceptable to the profession and Council for one person to oversee more than one premises or outlet while others were without job. We concluded this altercation which was now beginning to make Mrs Kuye ‘uncomfortable’ by the question OBJ asked me. “Ok you have defended your people well, what should we do to stop or minimize the problem of fake drugs?”. I answered swiftly: Put the round peg in a round hole. After the meeting, I was asked to stay back. I was given paper to write out my thoughts and proposal. Few months later, late Pharm (Dr)Dora Akunyili was appointed as the Director General of the National Agency for Foods & Drugs Administration and control (NAFDAC). I do not in anyway take credit for her appointment but for once Nigerians saw how a professional Pharmacist put her life on the line to battle the fake drug merchants and the great success she accomplished for Nigeria and Nigerian medicine consumers. We also noted what happened when a non professional Pharmacist was appointed to succeed her. Some of the achievements were rolled back, because no other professional has the in-depth knowledge on drug matters including the drug trade as the Pharmacist.

...no other professional has the in-depth knowledge on drug matters including the drug trade as the Pharmacist.

 After this encounter I began to reflect on why OBJ should place the problem of fake drugs importation and distribution on the lap of Pharmacists. 
Pharmacists are the only professional group that are licensed by the government ”to manufacture, mix, produce, warehouse, import, export, distribute and dispense, POISONS & DRUGS” in Nigeria.
In short they are the custodians of drugs and poisons in Nigeria. Poisons?. Yes poisons - chemicals and concoctions that can kill. Which is really the main reason government assigned this weighty responsibility to a group of people who are thoroughly trained and disciplined to manage these items called drugs or medicines. The real truth is that most drugs and medicines are potentially Poisons. That is to say that they can really main or kill those who take them. That is the major reason the profession of Pharmacy was created to be custodians of drugs and medicines, first to limit access to these potential poisons, and secondly to ensure that those who need the drugs or medicines are sufficiently counseled and guided as to how to take the medicines, when to take the medicines, what quantity to take at a time and for how long, what to avoid when taking particular medicines and how to respond should unanticipated reactions occur or should an overdose be  mistakingly taken. The Pharmacist is expected to be the intermediary between the medicine (prescribed by a doctor or purchased over the counter) and the patient. The truth is that anytime this inter-mediation is breached, the patient or consumer of the medicine is actually putting his life in danger, because the same drug that can heal when taken appropriately as prescribed and dispensed, may kill when taken inappropriately. And the tragedy is that very many Nigerians have more or less committed suicide through taking medicines in appropriately, often without the inter-mediation of the professional Pharmacist.

Therefore from OBJ’s point of view, if Pharmacists are the only ones licensed to produce or import drugs, we should not search far for whom to blame when we encounter fake drugs in the system. Indeed this was the same thinking of our Distributor in Lagos in the 80s. We had gone to Richson Pharmaceutical company to show him that a set of Pfizer pharmaceutical products which he sold to a retailer in Ikeja were fake drugs. Richson laughed at us and asserted ”Sam, I do not manufacture, I do not import Pfizer products, all that I sell are gotten from you. So if you say these items are fake or substandard, then it must be that Pfizer now produces fake drugs”. Of course I assured him that there was no way, Pfizer could manufacture fake drugs. To cut a very long story short, we eventually found out how the fake drug importers infiltrated his system by coming to his boys in his absence to claim that they had bought products from us on credit and were finding it difficult to pay and that Pfizer was putting a lot of pressure on them to pay or face legal action. They claimed to have decided to discount the products by 50%, so that they could quickly raise cash to stave off the legal action. Richson’s staff saw a good opportunity to make “a kill” and inadvertently procured the fake drugs and mixed them with the genuine ones they had brought properly from Pfizer in Nigeria.

Ordinarily, this thinking should be seen as reasonable and logical. But in our country many unreasonable and illogical things happen. The painful truth is that over many years, the pharmaceutical professional space has been invaded by all manner of people who see drugs just as items of commerce or mere medical disposables and in some way the government’s acts of omission or commission have intended to undermine the custodian status of Pharmacists. It is not unusual these days to find decisions about drugs and medicines taken without the input of Pharmacists. In many clinics, drugs are dispensed without the inter-mediation of a Pharmacist. Even in some Government General Hospitals, drugs are dispensed without any Pharmacist’s oversight. In several Primary Health Centres in Nigeria, drugs are procured and dispensed to patients without any Pharmacist’s  input. Here there seems to be the misinformed and simplistic view that all that Pharmacists do is to ask patients to “take two tablets three times a day” and as such any ‘idiot’ who can speak English can do the same. This misinformation surprisingly gets hearing even in some high government quarters, peddled by agents who profit from the suffering of Nigerian medicine consumers. In the community, many private consumers of drugs can get any drug- ethical or OTC (prescribed or not) from roadside kiosks, moving intra and intra-city buses and trains, open market stalls and even in bars, lounges and nightclubs.This does not happen in most Nations of the World including our African neighbors. So why must Nigeria be allowed to continue to operate in this way?

The result we face today is the growing incidence of drug misuse and abuse. Recently the Nation was embarrassed by the international Codeine scandal and there is so much misuse and abuse with varying morbidities and mortalities , most unreported. So like the fake drug issue, who is to blame for the high incidence? The answers will be as varied depending on who  you ask, sometimes with disproportionate blame on the victims. For me the official and legal custodians of drugs - Pharmacists , their professional associations and their regulatory agencies - Pharmacists Council of Nigeria( PCN) and the National Agency for Food & Drugs Administration and Control (NAFDAC) can not absolve themselves. Yes, when asked, they blame delay in signing the amended PCN act into law, and other lacuna in drug control legislation, poor resourcing and funding of the regulatory agencies, discriminatory and poor renumeration, lack of executive political will and support for effective ring-fencing of the pharmaceutical space to admit only those qualified and licensed to legally operate, following orderly guideline. My take is that these problems are not insurmountable. I believe the call is for a new approach to ensuring that professional pharmacists take full responsibility as custodians of medicines in Nigeria, ensuring only responsible access to bring down the current level of damage caused by unbridled access and consequent misuse and abuse. I believe that the support of the governments of Nigeria and other healthcare professionals should be taken as granted.



Comments

  1. Samuel John uduak13 November 2018 at 00:02

    Anywhere there are drugs or drug related issues there should be a pharmacist who oversees them.
    Good one sir

    ReplyDelete
  2. This is great. My president you got our full support.

    ReplyDelete
  3. My President, you have always represented the profession well before this mandate was overwhelmingly given to you to lead us in the PSN. I am believing God will use you to take our profession and it's practictioners to the next level of our desires.

    ReplyDelete

Post a comment

Popular posts from this blog

IS INEC REALLY PREPARING FOR SUCCESS OR FAILURE?

RACISM, ETHNICITY AND TRIBALISM .... What's the difference?

THE GROWING MISERY INDEX OF NIGERIANS AND THE SEARCH FOR GOVERNMENT Nigerians readily point out what Governments ought to do which they are not doing. Indeed, virtually every problem in Nigeria is blamed on the government. And for many Nigerians, the government to be blamed often is the Federal government. Many are oblivious of the other tiers of government, especially the local governments. It is as if the local governments have no responsibilities or may be the people have come to expect little from them. The many years of over centralization fostered on the Nation by the military now makes most Nigerians think and act as if the Federal government is the only government in Nigeria. The 1999 Constitution sustains this misnomer by granting the Federal government a long exclusive list and the freedom to dabble into every other matter, some of which should better be left with the traditional councils in the states. This has led many Nigerians to allow the local and State governments get away with With 'blue murder' while holding only the federal government to account,even if feebly. While it is justifiable to blame government for poor infrastructure, poor education, poor healthcare, high unemployment, high insecurity, and even for hunger, corruption and traffic hold ups, it is beginning to look to me that this is an orchestrated ploy by some Nigerians to take a permanent flight from being held responsible for our individual and group conducts. In the first place, the governments we blame so frequently for failing us are run by Nigerians. Indeed the irony is that some of those who blame government for everything are in government themselves! Sometimes, it looks like that there is a mystery man called 'government'. But no, government is no mystery man, but a collection of persons who are first citizens and who run the government on behalf of and for the good of all the citizens. For convenience, they are grouped into the EXECUTIVE, LEGISLATURE AND JUDICIARY. And that includes politicians, civil servants, public servants, professionals and non professionals of all cadres and categories; from cleaners,security men and permanent secretaries to ministers; from legislative aids to the House Speaker and Senate President; from the court bailiff to the Policeman, to the Registrar and to the Supreme Court Judge; from the gatemen to the Director Generals of Parastatals and Agencies, they are all constituent parts of the government, agents of the State. And that's why they are paid from the tax payers money.Every action, each one of them takes or omits to take reflects on the effectiveness or in effectiveness of the government they are part of. But it looks to me that this realization does not exist sufficiently. Some how, you get the impression that the President or the State Governor alone is the government and everybody else is either the governed, observer, bystander, supporter,complainant or critic. Perhaps this may explain why there is a woeful failure of the"government " to satisfy the expectations of Nigerians. It is practically impossible for only the President to satisfy the 170 million Nigerians or the Governor to satisfy all the over 12 million people in Lagos for example. Everywhere you go,you meet people who work in the government institutions who act as if they care very little about the success or citizen perception of the government they serve in. When you complain about the poor service you are getting,the same people who are part or agents of the government turn around to blame the 'government', absolving themselves of any blame and often the complaining citizen seems to either agree or empathize with the government employee that the problem is with the mystery ' Mr Government ' Early this year, I wanted to make a trip to the United Kingdom and applied for the UK Visa. Few days after submitting my visa application, I received a call from the British Embassy that there was no space left in my passport to affix the visa. I quickly collected my passport and ran to the passport office in Ikoyi Lagos to get a new one. It took me six visits to the passport office over a period of six weeks to collect a new passport.Reasons ranged from missing file to long queues, mismatch of finger prints, the absence of the engineer and late approval from Abuja. It was an ordeal. Mean while I missed the trip to the Uk and was almost missing a trip to the USA because my subsisting US visa was in my old passport which had been 'quarantined' in the passport office. At the end of this rigmarole I was still expected to show 'gratitude' In August last year, I went to renew my driving license and I was told to fill out forms and make payments. Thereafter I was asked to come back one year after in July this year at the FRSC camp in Ojodu, Lagos for what they called 'capture'. I wondered why it would take a year to come for the 'capture'. I was told that many people were on the queue and their 'capture' equipments were few. I was told that a photocopy of my form on which the July date had been written would serve as my temporary driving license until that date. I shook my head and left. On the assigned date and at the stipulated time of 7am, I arrived. First, it took a lot of pleading to let me drive in through the gate. With one year scheduling, I had expected few people but was shocked by the large crowd milling around the place. I moved from place to place and after several hours when I arrived in front of the 'capture' machine, I was told that my name had not dropped. 'From where ?' I asked. I made three other visits over a period of five weeks, because either, my name was still traveling from wherever to the 'capture' machine, or because there was no 'network' to capture me. I finally got another temporary driving license. And so I will have to return to Ojodu in 60 days when it expires or wait to be called to come and collect the permanent driving license when it is ready and who knows how many more trips that will take, because I saw People who had been called to come and collect, and they came, only to be told that the license was not yet ready. I do not know of any other country in the World where citizens are subjected to this kind of torture just to obtain a driving license. When my son-in-law heard my story, he sympathized with me because he went through an 'agent' and got his with ease! I suffered the same fate in trying to renew my plate numbers as demanded by FRSC. I have completed my registration for the National Identity card at a special unit set up by the National Identity Commission at an interaction in Lagos. I was given a temporary National Identity card. I do not know when I will get the permanent one. Now I have been asked by the Central bank to go to my bank and obtain another Universal identity card. I do not know how many trips I will have to make to obtain a temporary card before I struggle to get the permanent one. I will still go for my voters card and do biometrics and for my Pension, another set of biometrics and identity card. How many Identity cards is a normal law-abiding Nigerian expected to carry?.Why the National identity card can not suffice for all these is what I am asking. I am searching for Mr Government to ask him, because that is what I am asked to do. Can't these government agencies and officers who are asking for these many identity cards share information ? Or is it the fault of Mr government ? Why do we relish in making life difficult for fellow Nigerian citizens and then blame government. Any where Nigerians are to receive service from a government agency, the story of misery and denigration of human dignity is repeated. Who is government? What can be the problem? Is it a matter of lack of a compelling vision, or lack of motivation, or lack of empowerment or plain lack of commitment. What ever it is, I believe that something must be done urgently and in a holistic manner to remedy this anomaly which is creating a lot of problem for the citizens in Nigeria. The unnecessary suffering to which Nigerians are subjected to at every point can not continue this way. What is worse is that the pains intensify when people are doing their best to obey the laws and be responsible citizens. This backlash may seem to promote deviant behavior or corner cutting. Some are 'compelled' to 'settle' police on the highway than go through the torture of trying to get a driving license. All those who are part of government at all levels will need to undergo a fresh orientation to make them understand that point, that a chain is as strong as its weakest link. That Government is not about a single person but a chain of persons who deliver service to the Citizens and that the best President or best Governor will achieve little if all other parties are not playing their roles with the same efficiency and consistency. The leaders of our Governments must therefore take appropriate initiatives on building this consciousness in all persons in government. For empowerment and motivation, the leaders must ensure proper skilling up and motivation of all those involved in the governance process. The right persons must be put in the right positions to ensure the integrity of the chain.For commitment,the leaders must demand evidence of performance down the line. This must be measured and rewarded so that the unskilled for the assignment, the unprepared and the indolent are weeded from the system, so that the impact of good governance can be felt by citizens leading to improved quality of life and the reduction of the misery index. It seems this is perhaps the most critical responsibility of the leaders of the different tiers and arms of government and may actually be the differentiating characteristic of the effective government leaders. Sitting at the capital and hoping that all the 'beautiful' policies, projects and programmes are yielding the desired result will not do. If those who are part of government are blaming the government,one can then understand why some other Nigerians make a past time of blaming government for every problem. If the gutter overflows, it is the government that must be blamed and nothing to do with the citizens who throw pure water satchets and sundry rubbish into the gutter. When the road is blocked, it is the government and nothing to do with the indiscipline of citizen drivers who refuse to give way to each other. In those Countries that we admire and aspire to be like, most Citizens regulate themselves and accept responsibilities for the good order of the society, thus allowing the regulatory enforcement agencies to effectively contain the few deviants. If everybody is a deviant, no government can effectively manage public order. That is my point and it does not in any way absolve the government in power from its statutory responsibilities. There is a role for the government and there is a role for the citizen. Any dereliction on either side will create problems for the society, just as we are having,Period. Mazi Sam Ohuabunwa OFR