Alarm raised as more Kenyans get hooked on prescription medicines

Some pharmacists are unwilling to provide their sale records to the authorities for scrutiny

DESIGN | MUTUURA KEN KAMAU 
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Musicians like Michael Jackson and Prince have sung about getting “high” after taking prescription opioids.

In Kenya, dealers peddle them in nightclubs and on the streets. Teens are known to mix the drugs with soft drinks and khat or swig them straight from the bottle. Pharmacists are bending the rules to make quick money from the sale of highly addictive opioid-based medicine.

Opioid dependence does not just affect the jobless. Pilots, teachers, law enforcers, lawyers and other professionals are addicts. Heck! Even the doctor in your consultation room and the nurse in the triage are hooked on prescription medications. Read story of a nurse who was addicted to opioids here.

The United Nations Office on Drugs and Crime (UNODC) released its 2018 report last month. According to the World Drug Report, the non-medical use of prescription medicine is becoming a serious threat to public health and law enforcement. Opioids accounted for three in four deaths where drug use disorders were implicated.

There were 1,338 drug related deaths in Kenya in 2016, reveals a review of drug abuse data by Nation Newsplex. The leading cause of the deaths was opioid overdoses.

Globally, about 127,000 people die of opioid overdose every year. Women are more likely to misuse prescription opioids and tranquillisers.

UNODC estimates that 33 million people use opioids — prescription opioids and opiates such as opium and heroin. Two million of the users are in Africa, with East Africa having 260,000.

The youth are increasingly getting addicted to cough syrups with codeine and codeine-based painkillers. The worst affected are aged 22 to 35 and are mostly found in Mandera, Mombasa and Nairobi counties.

Opioid addiction is said to be the worst epidemic in the US history. Drug overdose kills more than 64,000 people in the US every year, lowering the country’s life expectancy for two years in a row.

Almost 90 per cent of pharmaceutical opioids seized, mainly the painkiller Tramadol, were in African countries, mostly west, central and North Africa.

READ: Nurse who was addicted to painkillers warns it can happen to anyone

READ: Codeine addict: ‘This drug made me drop out of college’

Codeine addiction has been reported in Kenya, Nigeria Ghana, Niger and Chad. Whereas the number of Kenyans addicted to painkillers pales in comparison with figures in the developed world, the problem is growing.

The youth are increasingly getting addicted to codeine containing cough syrups and codeine-based painkillers. The worst affected are aged 22 to 35 and are mostly found in Mandera, Mombasa and Nairobi counties.
A recent Pharmacy and Poisons Board report shows that youth in Mandera County abuse Benylin with codeine syrup and Cozepam tablets widely. Read story of codeine abuse in Mandera.

Cozepam, also known as Diazepam, is used to treat anxiety disorders, alcohol withdrawal symptoms and muscle spasms.

Warning labels

Records from January 1 to September 23, 2017 indicate that the amount of Benylin with codeine sold in Mandera and select pharmacies in Eastliegh was almost double that of five other Benylin range of cough syrups without codeine.

The board said most pharmacies that sold large quantities of the cough syrup had poor records or intentionally failed to provide them for scrutiny.

Early in the year, the board banned the sale of codeine-based medicines without prescription. Manufacturers were asked to put warning labels on packaging and include information highlighting the risk of addiction.

Previously, these drugs were available over the counter. That was against the Narcotic Drugs and Psychotropic Substances (Control) Act.

However, attempts at reducing access to codeine have yielded little fruit.

Painkillers 

Doctor’s prescription.

While compiling this report last week, the Nation bought a box of 10 vials of pethidine — an opioid painkiller — injections, four boxes of Betapyn tablets and three bottles of Benylin with codeine cough syrup without prescription. No pharmacy demanded a doctor’s prescription.

Factors driving dependency on prescription drugs include clinical symptoms like stress, fatigue and depression.

Medical experts say the availability and ease of access to the medicines also lures more people into abusing them.

“Addiction to painkillers often starts with pain management. A doctor prescribes codeine to manage a patient’s pain for a number of days. Later, the patient is gobbling up the pills to get high,” said Dr Peter Njagi, a psychiatrist and addiction expert who runs a rehab in Nairobi.

A recent exposé by the BBC highlighted the magnitude of codeine cough syrup abuse in Nigeria. The Nigerian Government banned the import and production of cough syrup.

Whereas the burden of substance abuse disproportionately affects the poor, studies and experts say opioids are creating a new crop of addicts.

While the International Narcotics Board provides data on the amount of legally required opioids by Kenya, there is less information on who is taking the drugs.

Pharmaceutical firms have been accused of helping spark addiction by aggressively marketing opioids as low-risk solutions for chronic pain.

However, they are anything but low-risk. Taken in excess, codeine can cause organ failure and trigger schizophrenia.

Silently addicted

Dr Njagi says the number of people seeking treatment to wean off the habit is nowhere close to the number silently addicted.

Codeine and Tramadol are not the only opioids scourge spreading across the continent.

Dr Peter Njagi, a psychiatrist and addiction expert who runs a rehab centre. PHOTO | COURTESY 

Other painkillers such as pethidine and morphine are also contributing to addiction.

Morphine and Pethidine are opioids used in managing chronic pain. Overdose of the two drugs can be fatal.

These drugs cause sedation, dizziness, nausea, vomiting, constipation and difficulty in breathing.
Morphine and pethidine are available in hospitals and are used in orthopaedic, surgical, cancer and obstetrics patients.

Because of their addictive nature, they are classified under the Dangerous Drug Act (DDA).

DDA regulates the import, export, manufacture, cultivation, sale and use of opium and other dangerous drugs. The drugs are always under lock and key.

Some of the biggest abusers of these drugs are health workers. “Since they (health professionals) are allowed by law to keep these drugs, one will never tell whether they will use it on the patient or not. After all, the law already allows them to have custody of the products,” says an expert who works with a pharmaceutical company who sort to remain anonymous.
The person taking a vial from the DDA box must sign a record book. Custodians of these drugs have been accused of forging patient records.

According to the Narcotic Drugs and Psychotropic Substances (Control) Act 1994, a person found in possession of a narcotic drug or psychotropic substance, intended solely for their own consumption, will be found guilty of an offence, imprisonment for 20 years and slapped with a fine of not less than one million shillings or three times the market value of the drugs seized.

Prof Lukoye Atwoli, a psychiatrist, says the abuse of prescription medicines is as a bad an addiction to illegal drugs. “It is not a matter of whether you have the knowledge of the side effects or not. Addiction affects health workers the same way it does the rest of the population. It is a mental illness,” he says

Many health workers including doctors have died from Pethidine overdose.

Morphine and pethidine are also finding their way into the illegal market. PPB says it is fighting the epidemic of addiction. “We have intensified campaigns on the dangers and misuse of codeine containing medication in liaison with National Authority for the Campaign Against Drug Abuse and other agencies," says Dr James Owuor, who oversees good distribution practice.
He says the board has partnered with the police and other law enforcement agencies to organise swoops which will restrict influx and arrest drug peddlers of unregistered products.
Commonly abused prescription only medicines according to PPB include:

  • Daizepam
  • Betapyn
  • Syndol
  • Syndol
  • Rohypnol
  • Ketamine
  • Codeine-containing cough syrups
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