Drug Misuse and Nigerian Youths

This is a CMF Webinar Session Report 8#

 

Introduction

#CovidNigeriaMedics, focused on the topic “Drug misuse and Nigerian Youths”. The webinar highlighted the problem of drug Misuse among Nigerian youths. Organizers and stakeholders as well as other participants discussed the problem of drug abuse and addiction plaguing youths in Nigerian society. The predisposing factors underscoring this problem were discussed, the impacts, both interim and long term were reviewed and suggestions were proposed on how to curtail the growing trend of addiction with its attendant social, economic, and health problems. Available treatment models used in other countries which have proved effective and avenues of implementing similar stepwise approach in the Nigerian system were explored. The webinar also highlighted major barriers to addiction management and rehabilitation to be denial and stigmatization. Two reformed addicts who had been down the road of addiction in the past and had become successfully rehabilitated shared their experiences to show it is possible to break the circle of addiction.  Opinions of some Nigerian doctors in diaspora, particularly psychiatrists were also aired with suggestions on how to contribute through advocacy for effective legislature, partnerships and possibly virtual and in person consultations at specified times were recommendations on how Nigerian doctors in diaspora could contribute to solving the problem of drug abuse in Nigerian.

 

Webinar Structure

The Webinar was organized and hosted by the coordinators of #CovidNigeriaMedics

as a continuation of the organizations efforts to identify and address targeted problems within the Nigerian health sector. Stakeholders and organizers involved doctors and other allied health personnel in Canada, UK, U.S., Nigeria and many other countries. Invitations to the webinar were distributed by the hosts through their stakeholder networks. The webinar commenced at 16:00hrs and lasted a total duration of 108 minutes. Dr. Sadiya Gumi gave the opening remark and then proceeded with the agenda of the webinar and order of proceedings. Various speakers participated in the discussion responding to specific questions from the moderators.

 

 

Coordinator                                                                        Moderators

Dr. Sadiya Gumi                                                          Prof. Abba Aji and Dr. Aisha

 

Overview of Keynote Topics

The introduction to the webinar was by Dr. Sadiya Gumi, who expressed her condolences to the Nigerian state as a whole, and family members of Nigerian soldiers who lost their lives in the recent air mishap involving a military aircraft. She laid the agenda for the webinar and introduced the topic of discussion. She narrated briefly why it was important to emphasis and address the problem of drug misuse, stating that drug misuse was a global issue among youths, citing examples of highly placed individuals who had admittedly struggled with alcohol and other drugs at some point in their lives. She stressed the need for institution of effective measures to stem the rising tide of drug misuse among Nigerian youths. She then proceeded to introduce the co-moderators and speakers for the webinar, giving a brief citation of each speaker and their roles in curbing the global crisis of drug addiction.

 

Drug Addiction: Beyond Lifestyle, A Mental Health Issue

Prof. Taiwo Latushek opened his discussion by commiserating with the families of soldiers who had just lost their lives on the recent air mishap. He then proceeded to define drug addiction, emphasizing the mental health basis of addiction. He described addiction as a chronic relapsing mental health issue which progressed through phases from casual or recreational use to dependence, a path which has been tagged the road to hell, due to its devastating impact on the individual and the community as a whole. He was of the opinion that for effective measures to be instituted in tackling addiction, the problem must be put in the right perspective. He stated clearly that addiction was not just a lifestyle as presumed by many, particularly users of substances. He enumerated a few reasons why people might tend to use drugs to include coping mechanisms, with Nigerian youths being particularly vulnerable due to numerous challenges in the Nigeria society, with a large population of youths finding succor in drugs. He referenced a study done at Ahmadu Bello University Teaching Hospital (ABUTH) which found that over 85% of drug users were between the ages of 16-34years. He shed insight on the futuristic consequences of this finding on the country, as its youths drown in the sea of drug Addiction.

 

Challenges of a Local Addiction Recovery Center in Nigeria

Hadiza Mohammed, the CEO of a Local recovery center gave an insight to the motivation behind her initiative to set up a recovery center for drug addicts. Despite not being a medical doctor, her empathy for drug addicts and appeal for counseling and rehabilitation inspired her decision to set up a recovery center as a way of helping to curb drug addiction. However, she enumerated some challenges encountered by her project to include lack of awareness on drug addiction, stigma, denial and delayed presentation by drug addicts. She emphasized the major issue to be denial on the side of addicts and awareness on the side of care givers. She gained more understanding over time, changing her mindset as an angry outsider who felt initially that addicts were to be blamed for their plight. She felt that the right information as done with the HIV pandemic needs to be made available to the public to better understand drug Addiction and rehabilitation.

 

Rehabilitation and Recovery, a Challenging but Feasible Task

Mr. Abdulabar Giwa shared his experience as a rehabilitated addict. He gave an insight to the origin of his drug use which began through getting cigarettes from his father’s ash tray. He was influenced early in life by his father’s smoking habit. In his experience, just as in many other cases, smoking served as a gateway to his drug life which escalated to involve multiple substances. He was in denial for a long time and never considered himself an addict. He attributed the reinforcing factors to drug use to availability of these drugs on the streets due to laxed importation laws and porous borders, and also denial by the addicts. He eventually succeeded in quitting and getting rehabilitated, acknowledging the role of family members in helping him quite his drug use. He also talked about the influence of refugee’s influx which is often associated negative tendencies and vices such as illicit substance use.

 

Similarly, Mr. Isa Sani Gachi, also a self-admitted recovering addict who was 13-14 years drug free narrated how he began using drugs while in secondary school, and admitted to using lots of drugs most of which he could no longer recall. His decision to quit was driven by the fact he longer derived pleasure from the drugs he took and that was the motivating factor for him to check into a rehabilitation center. He eventually got rehabilitated in Cairo to separate himself from his high risk environment at the time and also due to paucity of rehabilitation centers in Nigeria at the time. He stressed the need for acceptance and none denial as a key step towards breaking the circle of addiction.

 

Nigerian and Diaspora intervention Models Shared by Two Psychiatrists

Dr. Nwonkolo Esioma a UK based consultant psychiatrist gave a brief background into her journey as a psychiatrist which began in Nigeria. She narrated her involvement in multiple programs while working with various organizations back in Nigeria. Earlier in her career, she addressed drug use problems through innovative programs such as health education in schools on the dangers of illicit drug use and addiction, organization of soccer competitions and music concerts with the aim of reaching youths and other vulnerable persons such as commercial sex workers’ resident in areas considered dangerous and crime ridden. She also offered free treatment and rehabilitation services, followed by a vocational training, all of which was possible because of her private health facility which she owned in Nigeria at the time.

 

Dr. Daniel Ogbolotei, a consultant child and adolescent addiction psychiatrist based in Northern Ireland gave an overview of the stepwise approach to care in his region of practice, with each level comprising various health professionals. A bulk of substance users are cared for by voluntary service organizations. The profile of his clients was typically young persons with difficult childhoods such as those from broken homes, family difficulties, deprived communities etc. He stated that although a large proportion of youths’ experiment with drugs early in life, only as few as 10 percent eventually becomes addicted. This phenomenon, he attributed to underlying social anxiety and other problems among these few who consider drug use as a coping mechanism. Treatment of such individuals extends beyond the drugs but also includes creation of a good supportive, non-judgmental social structure. This he explained proceeds through three phases of stabilization, motivation and psychotherapy. All these were made possible through collaboration between health, voluntary and criminal services departments, with emphasis on not giving up on addicts.

 

Challenges of Psychiatrists in Nigeria

Prof. Taiwo spoke on the challenges faced by psychiatrists in Nigeria. He enumerated these challenges to include stigmatization of Psychiatrists. He also spoke on the need for revision of the national mental health service delivery policy which is long overdue for review to an encompassing one that addresses the problem of addiction with a strategic action plan to match. There is also a need for revision of the now obsolete mental health law which deals with substance use, advocating a shift from the Lunacy act of 1916, and encouraged legitimization by passing into law the mental health bill. There is also need for increased funding at all healthcare levels to integrate care and rehabilitation of individuals with substance use disorders. He also spoke on the need for mass education through grass root mobilization and awareness creation.

 

Regional Based Approach as Efficient Solutions To Drug Abuse

Prof. Agbaji was of the opinion that there is no one solution that fits all but modalities should be region based due to sociocultural differences. He was alarmed at the extent of abuse based on the statistics quoted. He highlighted the need for adoption and modification of regional policies from the standard international guidelines. These modalities should be made available, affordable, and evidence based. He also emphasized the role of cultural context in the care of persons with drug abuse problems, citing examples of the Aboriginal people in Canada. He identified intervention points at various levels of health care which include early identification and intervention at the primary level which aims at preventing long term addiction. There is also need for adoption of a policy framework to support functioning of the mental health act, and training of personnel to adequately care for individuals with substance use problems. He spoke also on limitations such as availability of early testing capabilities to deal with a large population of person’s addicted.

 

Summary

The key points from the webinar include:

• There is a significant problem of drug abuse or misuse among Nigerian youths. If no appropriate interventions are put in place to curtail this problem, portends a bleak future for the Nigerian workforce and society in general.
• There isn’t sufficient skilled and unskilled manpower to effectively provide the requisite care for persons with drug use problems. There is an urgent need for improved training of health personnel in addiction treatment and rehabilitation. Task shifting will do much in bridging this deficit in the interim.
• There is a need for formal legislation and passage into law of the mental health bill into law to provide a legal backing for care of persons with addiction and drug use disorder. Increased partnerships with NGOs for health education and awareness campaigns in schools and local communities on the dangers of illicit drug use, provision of well-staffed and funded rehabilitation centers, and establishment of a legal framework to de-criminalize victims of drug abuse are some measures to aid in care and rehabilitation of addicts.
• Stigmatization and denial are some of the key factors hindering effective rehabilitation of addicts, including those in the health sector who are also concerned about confidentiality. Other barriers include high costs of care, inadequate manpower and facilities, poor or absent knowledge in some instances about the exact dynamics of addiction due to oversimplified religious beliefs.
• Telemedicine has a lot to offer in bridging the gap between diaspora and Home based doctors. If properly applied, it can serve as a means of consultation and training.
• The webinar highlighted possible ways to intervene in addressing the enormous challenge of drug addiction among Nigeria youths. This webinar highlighted the predisposing and Perpetuating Factors, barriers to care and rehabilitation, suggested means of multilevel interventions from Stakeholders and will put forward recommendations to the relevant authorities to outline a roadmap to address this issue in the near future.

 

Discussion

The Q&A session was interactive. The discussion session was interesting with contributions from the participants.

 

Prof. Taiwo in response to a question put forward about the insufficient number of trained staff for efficient management of people with substance use disorders emphasized the gross deficit in number of psychiatrist and other personnel needed to care for such individuals. He advocated task shifting through the use of non-highly skilled workers to go the grass roots to create awareness and encourage early referral.

He responded to a question from the chart box about available support systems for physicians with substance use problems. Denial was still listed as a measure barrier to care for doctors and other health workers. He admitted to haven lost both doctors and nurses to illicit drug related complications. He lamented the view point of some doctors towards drug abuse. He also alluded to similar risks factors for suicide and drug abuse which are potential challenges in the health sector. He ended by reemphasizing confidentiality when caring for persons with drug use problems especially those in the health sector.

 

Dr. Isioma in response to a question from the moderator, about what she would want to do differently if she were to return said she would like to seek more formal legislation beyond the efforts of the NGOs to cater for individuals with drug use problems. She also would network more given the fact she now has more knowledge haven experienced treatment options on both sides. The problem of funding was not alien to the UK as addiction funding has also been reduced in the UK with charity organizations being the prevailing support system. Establishing a government supported formal treatment unit available for people at the grassroots organization and health education in schools were also listed as some of the things she would do differently if she were to return to Nigeria.  

 

Dr. Bida shed more light on some of the complications of illicit drug use in young adults. Available data indicated an increasing trend with children as young as seven not being exempt. Seizures and intoxication were some common complications, with the most commonly abused drugs being alcohol, cannabis, tramadol, and codeine which is often ingested as a cocktail of cough syrups. He also explained that following emergency treatment and detoxification, patients are prepared for rehabilitation which is fraught with multiple problems. These he said include financial constraint even for well-motivated clients or in some instances, refusal of caregivers to fund the rehabilitation process while at the same time, blaming the client.

 

Prof. Agbaji while reiterating the enormous financial impact of illicit drug use cited a UNODC report on the huge social cost of illicit drug use estimated to be about 1.7% of a country’s GDP .

 

Dr. Anthony, suggested creation of a programs to give back to the Nigerian society through intermittently scheduled intervention programs and outreaches which he said he would be very willing to participate either virtually or by returning for a brief period to offer services if such a program was in place.

In his opinion, Dr. Wale, decried the high level of addiction among Nigerians and also reiterated the view of the previous speaker. He suggested technological means as an intervention tool for societal engagement given the large availability of mobile devices in Nigeria.

The moderator expatiated further that tele-health could be a means of liaison between home and foreign based Nigerian Psychiatrists for training, discussion and consultations.

 

Dr. Adelekun spoke on the role of musicians who in his opinion, glorify and promulgate the negative culture of drug abuse. He was also concerned on the evolving trend of injecting drug use as indicated by the UN study. He stressed the underlying role of poverty and proposed for a larger meeting to come up with recommendations to be forwarded to the ministry for action. He suggested another meeting to discuss recent treatment models which can be applied in Nigeria.

 

Dr. Mark made a request for help to enable them familiarize themselves with the socio-cultural and religious elements to aid their work in rehabilitation of Nigerian youths who cross over into Europe and present with PTSD and drug use problems.

 

Prof. Taiwo spoke on the tendency of societies to blame poorly understood or stigmatized conditions or negative spiritual influences. This could be addressed through community education. The burden of mental illness among incarcerated persons within the Nigerian custodial centers was brought to light with consideration on the unhealthy conditions under which these inmates are kept. Often, these centers serve perpetuate a vicious cycle of drug misuse. He proposed criminalization of drug merchants and dealers while decriminalizing the users through the mental health bill when accented to. This, he said was because users were ill and deserved compassionate and human care and therefore ought not to be treated as criminals as is the current practice in Nigeria. He suggested effective rehabilitation rather than prison sentences which is not a good strategy to manage person’s with drug misuse issues.

 

This was further reemphasised by the moderator, Prof Abaji who expressed his curiosity about the level of development and application of forensic psychiatry in Nigeria especially as it relates to the Nigerian custodial facilities and the criminal justice system.

 

Conclusion

The webinar ended with appreciation from Dr. Magaji of all participants. The recording of the webinar was to be made available at the YouTube channel of CovidNigeriaMedics, and was also to be sent to participants through their contacts. She encouraged those willing to collaborate to do so with the organization whose arms she said were open to partnership, and suggested a conference on the same topic if possible in the near future. An announcement of the next webinar titled “Surgical training in Nigeria?” was made and the webinar was ended.