Nigerians of different age groups engage in self medication. SADE OGUNTOLA profiles the commonly abused drugs in the country and examines the dangers inherent in this practice.

FORTY-SIX-YEAR-old mother and trader, Mrs Seyi Balogun, had to be rushed to the nearest hospital by her son after she found it difficult lying down because she kept coughing and was very weak. But it did not start on that day. For some time, the big trader in textiles had actually been finding it difficult selling her wares because she got tired easily. Since January, even taking a short walk affected her breathing. And often, she needed to use extra pillows to support her head to prevent heartburn. In fact, her experience of fatigue over any little exertion and having to wake up at night, coughing and sweating profusely were a major reason she had to buy some medications from a patent medicine vendor who visited her shop regularly at the market.

Mrs Balogun thought nothing of the fact that the symptoms did not subside ever after her self-medication. Many people had told her to just relax and ensure that her shop assistant helped her with all her work. But it was when she was rushed to a hospital, because her breathing was difficult, and the doctors told her that her heart was about failing, that she realised the gravity of her problem. It dawned suddenly on her that a good and functioning heart was central to her existence.

It is commonplace to hear Nigerians say they have been treating different ailments without relief for weeks, after, in many cases, opting for self-medication. Unfortunately, many end up going to the hospital after much damage  have already been done to their health. The delay in getting the appropriate treatment, sometimes, result in inability to achieve quick recovery, and disability. A major shortfall of self medication is the lack of clinical evaluation of the condition by a trained medical professional, which could result in missed diagnosis and delay in appropriate treatment. Its major shortfall is the emergence of many ineffective antibiotics and antimalarials. Some people, however, may engage in the practice of self medication due to ignorance, poverty and unavailability of health facilities.

Experts’ review of self-medication at the general outpatient department of the Federal Medical Centre, Owo, Ondo State,  between June and December, 2007 found that the drugs utilised could be single, usually analgesics (26.5 per cent) and anti-malaria (15.9 per cent) or in combinations, usually antimalarial-analgesics (22.4 per cent), antimalarial analgesic-antibiotic (15.3 per cent) and antibiotic-analgesic (10.0 per cent). The reasons they cited for resorting to self-medication were their perception of their complaints being minor enough to be amenable to self-medication (54.7 per cent) and financial constraint (22.4 per cent).

Over-the-counter availability of many drugs (including prescription drugs) in an environment like Nigeria’s, where legal restrictions are few, makes many pregnant women also to take medications even when they are not prescribed. In 2011, exactly 19.2 per cent of pregnant women admitted to self-medication, mostly blood forming medications and pain-relieving pills (paracetamol or acetaminophen). These are among 410 antenatal clients attending primary, secondary and tertiary centres in Ibadan, Oyo State, in a study documented in the Nigerian Medical Journal.

In Nigeria, pain killers and antibiotics top the list of medications many self medicate on. Dr Ibrahim Oreagba, consultant pharmacologist and coordinator, Pharmacovigilance, South-West Nigeria, Lagos University Teaching Hospital, said the phenomenon is not deterred by the prices of these medications since they are easily accessible. According to him, when antibiotics are abused, people could develop illnesses which would take longer to go away if such antibiotics had been previously abused. Dr Oreagba pointed out that the dangers of abusing pain killers like paracetamol is increased when taken along with alcohol.

Also,  common drugs that many buy over the counter without any prescription include those for cold and cough.

Self-medication, road to addiction

Dr Benjamin Olly, a psychologist at the Faculty of Social Sciences, University of Ibadan, said many people now erroneously think they know so much about medicines like paracetamol that they will even tell others  the appropriate doses to take. Self-medication, a habit which Dr Olly said would overtime lead to psychological dependence, is something that starts with the body getting used to the drugs, and over time, wanting more despite being aware of its possible negative consequences.

“For instance, many people have got addicted to such preparations as Alabukun because of its caffeine content. Caffeine gives euphoria; it increases their concentration span while helping them to cope and be more tolerant of pain. Those with laborious jobs take it because it makes them work harder. However, Dr Olly said, many people do not consider the physical and psychological consequences of medications they abuse, adding that even where chemists request for prescriptions, some in desperation would falsify one.

Dr Kazeem Adebayo, a consultant psychiatrist, LAUTECH Teaching Hospital, Osogbo observed that all medicines are chemicals that have effects on the human body, admitting that it is possible to be addicted to common drugs such as paracetamol, sleeping pills and others. Although different people may react to medications differently, he said, analgesics had contributed to cases of kidney failure. He added that medications such as sleeping pills cause dependence just like alcohol and, as such, over time, the need to continually increase the dose taken to ensure sleep. Dr Adebayo however said that people get psychologically addicted to many medicines which were not listed as drugs of addiction. He listed these medicines to include paracetamol, Alabukun, cough mixtures that contain codeine, sleeping pills and antihistamines.

The role of patent medicine vendors

Patent medicine vendors are easily blamed for many people’s resort to self-medication. Some of them , it was said, sell ….??? drugs as against legal provision.

Mrs Yejide Oseni, Deputy Director  and Head, South West Zonal Head of Pharmaceutical Council of Nigeria (PCN), said patent medicine vendors are licensed by PCN only to sell simple household medicines, medicines without much negative effects. While entrants into the sale of medicines go through orientation programmes by PCN and receive continuous education programmes subsequently every two years, Mrs Oseni said, they are not licensed to prescribe drugs. “If you tell them that you have headache, for instance, since they deal in simple household medicines, they can ask the person to take painkillers like paracetamol. But they are not to probe further saying the person has hypertension,” she said.

However, Mrs Oseni declared that going to the chemist to buy paracetamol, for example, because of headache cannot be termed abuse but rather self-medication. Although many people self-medicate on over the counter drugs, she said it is important, when the symptoms persist after two or three days, to see a medical doctor. The habit of taking akapo or akape, a collection of many drugs all at once, she said, is as risky and a misuse of medicines.

Behold the commonly abused drugs…
HERE are common abused medicines and their implications:

Codeine

This is very common among students, especially those that abuse codeine-based cough syrups. Abusers purchase large quantities of cough syrups from patent medicine stores, claiming that they have cough. They drink the whole content of a bottle of cough syrup in one go or mix it with alcohol. Abuse of codeine poses a risk of depression and death.

Sedatives

Sedatives, commonly referred to as sleeping pills, are commonly abused by adults, especially people with sleeping problems and young people with crazy motives.

Strong analgesic

Individuals with conditions like sickle cell disease become potentially addicted to strong analgesics like pentazocin injection. This drug is a powerful but potentially additive analgesic which is used for severe pains resulting from conditions like sickle cell crisis and post-surgical procedures. Although a strictly controlled drug, sicklers “self medicate” on it and thus are potential addicts to this drug.

Emergency contraceptive pills

Morning after pill or what is sometimes called emergency contraceptive only such as Postinor-2, are not intended as a regular method of contraception. Users are advised not to use the emergency contraceptives more than twice in a 28-day period. But it is commonly abused by young ladies.

Paracetamol

This is such a popular painkiller that it has almost become the victim of its own success. When patients are asked “Do you have any pain killers at home?” they often shrug when answering: “Not really, just ordinary Paracetamol.”

Many people consider it so common that they assume that it can never be harmful to the body. But it is commonly abused by most people; some in fact take more than the recommended dose. One of the main attractions of paracetamol is that it has few side-effects. But this does not mean that it can be taken with impunity, because there are possible side-effects which can be devastating. One of them is liver failure. Indeed, according to a study published in the journal Spine, men who are taking prescription pain pills in high doses and over long periods of time are more likely to experience erectile dysfunction — characterised by the inability to develop or maintain an erection of the penis during sexual performance!

Chloroquine

This drug, popularly used to treat malaria some years back and widely abused, has been associated with many medical issues. Many abusers have developed irreversible damage to the retina of the eye. Common side effects of chloroquine also include vision problems, trouble reading or seeing objects, hazy vision; hearing loss or ringing in the ears; seizure (convulsions); severe muscle weakness, loss of coordination, underactive reflexes; and severe skin reaction.

Viagra

This drug has the generic name of sildenafil citrate, and is prescribed for men who suffer from erectile dysfunction, commonly referred to as ED.  Australian researchers in a new study reported that the use of Viagra could wreak havoc on men’s eye, especially on those suffering from retinitis pigmentosa, which is a rare hereditary eye condition that could eventually lead to blindness.

Still, the common side effects of Viagra may include headache, upset stomach, diarrhoea, urinary tract infection, and flushed skin. Viagra may be linked to more harmful side effects, including painful erections that may last for several hours, and the lowering of blood pressure to unsafe levels if Viagra is taken with drugs known as nitrates and alpha-blockers. Low blood pressure may lead to additional harmful problems such as heart attacks or strokes.

Ibuprofen

People who take nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen may have a higher risk of having a heart attack or a stroke than people who do not take these medications. These events may happen without warning and may cause death. This risk may be higher for people who take NSAIDs for a long time.  NSAIDs, such as ibuprofen, may cause ulcers, bleeding, or holes in the stomach or intestine. These problems may develop at any time during treatment, may happen without warning symptoms, and may cause death. The risk may be higher for people who take NSAIDs for a long time, are older in age, have poor health, or who drink three or more alcoholic drinks per day while taking ibuprofen.

Laxatives/purgatives

These are about the most abused drugs. This abuse is probably based on unfounded beliefs about the importance of bowel opening or cleansing. There is also the misplaced belief that flushing the intestine can cure fever, malaria, ‘jedi-jedi’, weight gain as well as other disease conditions. Herbal concoctions and tablets are used routinely by some to ‘cleanse their system’. This practice is very bad and dangerous. They deplete the body’s fluid giving the person the false feeling of weight loss. They also create a condition in which patients get dependent on them and a few other problems.

Akapo/Akape

This is a collection of many drugs, including painkillers and antibiotics, sold in the open market. Unfortunately, taking both ibuprofen and felvin, the same kind of drugs can lead to overdose. Of course, rather than patients getting better, they can experience terrible stomach pain.