When the news broke on May 1, 2018 that the Federal Government through the Minister of Health had banned the importation of codeine and the manufacture of codeine containing syrups in the country, I received it with excitement that finally someone is waking up to draw to a halt the menace of codeine addiction in Nigeria. However, the excitement was short lived.
Since coming of age, I have heard/read the Federal Government ban the importation of several items ranging from rice, textile, used cars, cement, sugar, etc. The argument shoved down our throats has always been the need to encourage local manufacture of these items. Sadly, the ban did not translate to a cessation of the entry of these products into the Nigerian market. Rather than discourage, the ban served as motivation since the prices skyrocketed owing chiefly to the absence of locally manufactured items in quantities sufficient to meet its demand, and the craving of Nigerians for foreign things. The end result was Nigeria and Nigerians lost in, at least, two ways – loss of revenue accruable from import duties, presence of fake, substandard products in the market.
Nigeria lost revenue from import duties because instead of importing these goods directly to Nigeria, the importers, as a result of the ban, import them into neighbouring countries and smuggle them through our ever porous borders into the country. At the end, it is neighbouring countries’ lone goal, Nigeria zero. Substandard products usually flood the markets following bans because businessmen know our craving for anything foreign. They therefore package whatever they can in cloned packs of the foreign goods and sell to unsuspecting Nigerian populace, usually at the price if the foreign counterpart.
Will the ban on the importation of codeine be different? Only time will tell. But judging by antecedents, it may not solve the problem of the availability of codeine in the Nigerian market. The codeine as raw material will still be smuggled into the country for use in the clandestine manufacture of codeine containing syrups. This will be done in hiding away from the prying eyes of the regulators, who will then regulate the quality? On the other hand, what stops the dare devil manufacturer from opening a factory in a neighbouring country with the sole aim of manufacturing codeine containing syrups which will then be imported into Nigeria? Nothing!
The way forward:
Two approaches are readily available:
- Sanitization of the Nigerian drug supply chain. From manufacture to sales to the final consumer, who may or may not need the product, there are issues to look at.
- Do manufacturers have a daily quota they must not exceed in their manufacture? If they do, are they monitored and enforced? Who enforces them? At the moment manufacturers employ non pharmacists as representatives and saddle them with the responsibility of marketing these highly addictive drugs. These agents who know nothing about drugs go about selling to even those who should not sell ethical products like the patent medicine vendors. This has the consequence of making these drugs readily available, one of the factors that favour drug abuse and addiction. Even where companies have distributors, they are almost always operated by non-pharmacists who sometimes do not even employ pharmacists who should advice on who should be given drugs like codeine for retail based on his knowledge of the laws governing the marketing of pharmaceutical products.
- Most of retailers of pharmaceutical products in Nigeria are operated by non-professionals who do not know the difference between an over-the-counter (OTC) medicine and a prescription-only-medicine (POM), thus selling any drug on their shelves to any and everyone who walks in waving a few Naira notes.
The sanitization of the drug distribution chain in Nigeria to ensure only those seasoned professionals who have the requisite training and knowledge to handle medicines do so, and where a non-professional must do it, it must be in concert with and under the direct guidance of a professional. The only people so trained about drugs, not just in Nigeria but worldwide, are the pharmacists. This must be done in practice and not just on paper as is the practice now.
- The Federal Government needs to do the hard work. Do we have an estimate of the drug needs of the over 180 million Nigerians? Do we know, for example, how many tablets of Ciprofloxacin Nigerians will consume in the next one year? FG needs to carefully generate a data on the real need of codeine and codeine containing substances in Nigeria. Based on the data of the need, manufacturers will be allocated quotas which will be strictly monitored to avoid breach.
The wholesale ban of importation and manufacture of codeine containing medicines in Nigeria means companies manufacturing for markets outside the Nigerian borders will not be able to continue with their business even in those markets. Will that not amount to asking them to relocate? Besides, it is not only cough syrups that contain codeine; what becomes to pain medications containing codeine with this wholescale ban approach?
Without a careful thought of the different ways the matter could have been handled and a careful analysis of the ripple effects of the ban on the economy and the manufacturers, this may be but the proverbial cutting the head off to cure a headache.
Pharm AMENE Terhemen