Negative impact of substandard and fake drugs on our health system

Recently, the National Agency for Food and Drug Administration and Control (NAFDAC) in Alliance with the Pharmacy Council of Nigeria (PCN) has closed down several major open drug markets in Nigeria following the discoveries of the continued circulation of falsified and substandard pharmaceuticals in most markets. Notable among these markets are the popular “Ogbo Ogwu” in BridgeHead in Onitsha, Anambra State; the Idumota Open Drug Market in Lagos; the Ariaria Drug Market in Aba, Abia State; etc. Following the closures of these open drug markets, many startling Discoveries have been made and these have all led to the seizures of falsified and substandard drugs worth billions of naira. Another very important discovery is that some of these unwholesome products were found dumped and hidden in some of the adjoining or nearby markets that deal in building materials, surgical and beverages, etc.

Despite all these frantic efforts by NAFDAC and PCN to sanitise our chaotic drug distribution, some notable Nigerians, organisations, and pressure groups are condemning and faulting their activities as well as calling on the presidency and National Assembly to pressurise NAFDAC to reopen these markets. It is very disturbing that even in the 21st century, Nigeria is still allowing the operations and existence of open drug markets contrary to what is obtainable even in more impoverished nations. One wonders how and why the quest to make money through drug businesses should be placed above Nigerian lives and health.

Going through history, the early British colonial masters came into Nigeria without the pharmacists; rather, they introduced the Patent & Proprietary Medicine Vendor License (PPMVL) that allows non-pharmacists to handle over-the-counter drugs (OTC). Hence, the standards of pharmacy practices were compromised as laymen could be allowed to handle drugs, which is in sharp contrast with what is obtainable globally. The continued existence of this PPMVL has so much compromised the standards of pharmacy practices that drugs are now seen as items of trade and no longer as poisons. It is even an irony that drugs, being in the exclusive list of the federal government, are treated as items of trade and merchandised by all categories of people in Nigeria. Today, school dropouts, quacks, illiterates, etc., are seen in the profession handling all categories of drugs.

It may interest you to know that pharmacists are the only healthcare professionals legally authorised and well-trained and equipped with skills and knowledge to handle drugs in other climes. Having realised that all drugs are poisons as well as the associated potential complexities with their uses even under the physician’s watch, the global communities have even upgraded the minimum qualification of persons handling drugs to be the possession of a Doctor of Pharmacy Degree (Pharm D) after a didactic 6 years of training in the schools of pharmacy in the universities. Also, such a doctor of pharmacy is expected to undergo a further minimum of 4 years of postgraduate pharmacy training under pharmacy residency and fellowship to become a specialist consultant pharmacist. These consultant pharmacists now specialise in specific areas of pharmacy where they provide expert advice and other pharmaceutical care interventions to the physicians and other healthcare professionals on drug-related matters. The only set of persons that could be allowed to work under the strictest supervision and control of the pharmacists are the pharmacy technicians. It is, therefore, very surprising how traders, quacks, and illiterates, who do not have any formal knowledge in pharmacy or drugs, are allowed under the PPMVL policy to handle drugs in Nigeria. Even the ordinary paracetamol we classify under “OTC” drugs has the potential to cause infertility in an unborn female foetus if the pregnant mother misuses such a drug due to its effect on the female hormone!

The essence of history is to learn from the past and prevent future or present mistakes. The lessons from the “Thalidomide Drug Disaster” of millions of innocent newborns in the USA in the 1960s should have taught Nigerians lessons that all drugs are poisons, irrespective of their classifications. Thalidomide was a drug that was administered to pregnant women in the early 1960s to reduce the signs and symptoms of “early morning sickness” usually seen in early pregnancies. Surprisingly to the world, the majority of pregnant mothers gave birth to children with either short or no limbs. It is also on record that a study done in the US discovered that someone with a drug prescription is 10 times more at risk of being bodily harmed or killed than the same person being at risk of bodily harm or death under road traffic accidents, suicide, poisoning, and others put together. Studies from both the US and UK have all shown that up to or more than 30 percent of patients on admission are due to drug-related complications. The US government discovered that billions of dollars are wasted on treating drug-related complexities.

Today, many countries where physicians and some other designated healthcare professionals are allowed to prescribe under the “collaborative practice agreement” with the physicians have evolved stricter measures on the handling and dispensing of drugs. It is a known fact that one is stripped of his or her practice license if he/she is caught dispensing or handling drugs without being a pharmacist. Many countries consider it a jailable offence to handle drugs without being a pharmacist. The popular Omnibus Drug Budget Reconciliation Act (OBRA 1990), operational in the US, makes it mandatory for anyone using a drug to be counselled by the pharmacist. Any act of negligence or failure to counsel the patient makes the pharmacist liable, unless the patient voluntarily rejects such.

One then wonders about the unquantifiable and undocumented magnitude of health risks we subject our innocent patients and clients to in Nigeria, where fake and substandard pharmaceuticals are in the hands of non-pharmacists and quacks. The former NAFDAC DG, late Prof. Mrs. Dora Akunyili, narrated how her blood sister died as a result of fake “insulin,” an antidiabetic medication. Many Nigerians have been sent to their untimely and early graves due to fake and substandard products. The issue of drug resistance and therapy failures should not be mentioned? Today, it takes an average physician to use very expensive drugs to treat ordinary infections that should have been treated with cheaper drugs. Nigeria has become the hub of “Antibiotic Resistance,” as many of these traders even cut and dispense one capsule of antibiotic medication.

The continued existence of this chaotic drug distribution and the handling of drugs, otherwise poisons, by untrained persons have really worsened our health indices. Today, most of our privileged Nigerians have lost confidence in our health system. It is very disheartening to see how drugs are being stored in these open drug markets. Most of these drugs are heat-sensitive products that require special storage facilities. Our insulin, vaccines, etc., are already expired in the hands of these quacks who are allowed to handle all manners of drugs in the name of business.

The recent calls by some highly respected Nigerians, pressure groups, and lawmakers faulting the divine interventions by NAFDAC and PCN should be highly condemned, as lives are more important than making money. Most of these open drug markets have even killed more Nigerians than the Nigeria-Biafra Civil War of 1967. These Markets should better be tagged as, “Centres of Terrorism or Biological Weapons.” The bitter truth is that Nigerians should be ready to permanently close all these open drug markets and replace them with the Coordinated Drug Distribution Network as recommended by the Pharmaceutical Society of Nigeria (PSN) and adopted by the federal and state governments.

Our National Assembly should have a rethink on the recent passage of the bill that intends to allow the independent existence of another regulatory council for pharmacy technicians and technologists. Globally, only the Pharmacy Technicians Cadre exists, and they are under the control of the respective Pharmacy Council of such a nation. There is nothing like pharmacy technologists, as claimed by this parallel group. Pharmacy Technology is a postgraduate program in the universities only for persons who are already pharmacists. It is quite worrisome and disheartening how the highly respected members of the House of Representatives could allow a parallel council to PCN. Again, the standard of persons to be allowed to handle over-the-counter drugs (OTC) could be upgraded to the minimum possession of a “Pharmacy Technician Certificate” from schools only approved & accredited by PCN. The idea of allowing persons without the knowledge of drugs should be reviewed as a matter of urgent national importance. If possible, PPMVL should be changed to “Pharmacy Technician Medicine Vendor License” (PTMVL) to allow only pharmacy technicians to handle OTC where pharmacies or pharmacists are not available instead of allowing quacks who complicate drug-related problems as well as handle falsified and substandard drugs.

NAFDAC and PCN should intensify their campaigns and activities towards safeguarding the health of Nigerians against the selfish desires of some “merchants of death” who place more value on wealth rather than on lives. The PSN-approved coordinated drug distribution should replace this obsolete “death trap” called “open drug markets”!

Dr Nwako is a fellow of the West African Postgraduate College of Pharmacists.