Abuse of painkillers fueling Nigeria’s growing substance abuse crisis — Michael Okonkwo, pharmacist, doctoral researcher

Michael Chinyem Okonkwo is a Nigerian-born, United States-based pharmacist and a doctoral researcher at the University of Houston, where he researches substance abuse disorders. He is an awardee of the National Merit Award by NAPPSA, the umbrella body of the Nigerian pharmacists and pharmaceutical scientists in the Americas. In this interview by KINGSLEY ALUMONA, he speaks about his work and research in the US, among other issues.

How did you secure admission to a doctoral programme at the University of Houston? Why University of Houston? And, how did you get admission into the doctoral programme without a master’s degree?

In the United States, exceptional applicants can pursue a PhD without a master’s degree, and I qualified under this pathway. Before applying, I had five years of clinical experience as a pharmacist in Nigeria, where I worked directly with patients. I also had a strong research background. I had peer-reviewed research experience as an undergraduate. This combination of clinical work and proven research ability made the transition smooth.

Why University of Houston? The College of Pharmacy at the University of Houston has one of the best Health Economics and Outcomes Research programmes in the US, especially for substance use disorder research, which is exactly my focus. The programme has access to massive healthcare databases for real-world research. The programme wanted me, and I wanted it. It was a great marriage.

What is your doctoral thesis or work about, its possible findings, and its relevance to society?

My doctoral work focuses on patients with substance use disorders who also have comorbid mental health and metabolic conditions. This is critical because these conditions often occur together. For example, many people with opioid use disorder also struggle with depression, anxiety, or diabetes, which complicates their treatment and recovery.

I am studying several key areas. First, medication adherence. How well do patients stick to their treatment when they are managing multiple conditions? Second, treatment effectiveness. Which medications and treatment strategies actually work in real-world settings? Third, cost-effectiveness. Are we getting good value from these treatments given their costs? Fourth, adverse events and safety. What are the risks, and how can we prevent harm while keeping patients in treatment?

The relevance?  Over 105,000 Americans died from drug overdoses in 2023, and the opioid crisis alone cost the US $2.7 trillion. My research generates evidence that helps doctors, policymakers, and insurance companies make better decisions about which treatments to use, how to use them safely, and how to allocate limited healthcare resources to save lives and improve outcomes.

Substance abuse is a big health challenge globally. What kind of perspective does your work and research offer in the study and mitigation of these kinds of problems?

My work answers three critical questions: What works? For whom? And at what cost? Traditional research often focuses on ideal clinical trial conditions, which are very expensive and impractical. In contrast, my work uses real-world data from millions of patients to assess how treatments perform in everyday practice. I analyse large insurance claims databases and electronic health records to track what happens when real patients with complex problems get treatment in real clinics. This perspective is valuable because it identifies which treatments give the best outcomes for the money spent.  With limited healthcare dollars, we need to invest in what actually works.

What are the abused substances you are studying, and how do they affect the body?

I study all major substance use disorders, including opioids, stimulants, alcohol, cannabis, and sedatives. Opioids, for example, include prescription painkillers like oxycodone, hydrocodone, and illegal drugs like heroin and fentanyl.

They alter brain chemistry, leading to dependence, tolerance, and severe withdrawal. An overdose occurs when opioids suppress breathing to the point where oxygen cannot reach the brain, leading to death. Fentanyl is particularly deadly because it is 50 times stronger than heroin.

Beyond physical effects, opioid addiction devastates families and communities. It leads to job loss, homelessness, broken relationships, crime, and enormous healthcare costs. The tragedy is that effective treatments exist, but many patients do not access care or stay in treatment long enough. My research focuses on improving access to treatment, adherence, safety, and outcomes to save lives.

One of your recent co-authored scholarly publications, published in January 2026, is titled ‘Buprenorphine use and the risk of dental adverse events in patients with opioid use disorder’. What inspired this work?

This work was inspired by a US Food and Drug Administration (FDA) safety warning in January 2022. The FDA warned that buprenorphine, particularly the sublingual films and tablets used to treat opioid use disorder, was linked to serious dental problems, including tooth decay, cavities, infections, and even tooth loss.

Buprenorphine is an effective medication for treating opioid use disorder. But if it causes severe dental problems, patients might stop taking it, which could be life-threatening. We needed current, real-world evidence to understand the actual risk. Using large insurance claims databases, we found that buprenorphine users had a 36 per cent higher risk of dental problems compared to non-users. This confirmed the FDA’s concerns with robust data.

The goal was not to discourage buprenorphine use but to inform better patient care. Our findings help clinicians counsel patients about dental hygiene, encourage regular dental visits, and implement preventive strategies. The key message is to stay on your life-saving medication while protecting your teeth through proper oral care and monitoring.

As a big data analyst, researcher, and pharmacist, how do you think artificial intelligence (AI) can help in the management of substance use abuse, especially from the public health perspective?

I was recently awarded the National Merit Award by NAPPSA, the umbrella body of Nigerian pharmacists and pharmaceutical scientists in the Americas, and selected to co-moderate a session on ‘AI and Clinical Therapeutics’ alongside an FDA senior pharmacologist at their 2025 conference. My stance has been clear: AI is here to help but must be ethically deployed.

AI can revolutionise substance abuse management in several ways. First, predictive analytics can identify high-risk patients before overdose by analysing prescription patterns and medical records. Second, AI can personalise treatment by predicting which therapy will work best for each individual.

However, AI should augment, not replace, human judgment and compassion.

If you were to solve three national problems facing Nigeria with your pharmacy expertise, which problems would they be, and how would you go about solving them?

First, Nigeria’s growing substance abuse crisis, particularly tramadol and codeine misuse. During my clinical practice in Nigeria, I saw firsthand how painkillers were being abused. We need evidence-based treatment programmes modelled after what works in the US, but adapted to the Nigerian context. This means establishing medication-assisted treatment programmes, training healthcare workers on addiction medicine, and creating public awareness campaigns that destigmatise seeking help.

Second, the data infrastructure problem. It is tough to conduct health outcomes research in Nigeria because we lack the large-scale electronic health records and insurance claims databases that enable my current work. Nigeria needs investment in health information technology and interoperable data systems.

Third, the insurance and access crisis. Only about three per cent of Nigerians have health insurance coverage, which is a massive barrier to care. Of course, there are macro-level issues, such as problems with the pharmaceutical supply chain.

You studied pharmacy in Nigeria and are now studying it in the US. What two things can Nigerian pharmacy departments learn from their US counterparts to make pharmacy learning and research more innovative?

Let me start by saying the Nigerian pharmacy programme is excellent. Nigerian pharmacists integrate seamlessly into the US healthcare system and routinely pass the NAPLEX licensure exam even on their first attempt. As a teaching assistant in my first year here, I have worked closely with the pharmacy programme, and I can confirm we are not far off at all. However, there are two areas for improvement.

First, universal adoption of the PharmD programme and phasing out the B.Pharm degree. The PharmD is now the global standard for clinical pharmacy practice, and Nigeria should complete this transition to ensure our graduates meet international benchmarks.

Second, better research infrastructure. US pharmacy schools have state-of-the-art laboratories, advanced analytical equipment, and access to massive healthcare databases for research. Nigerian institutions need significant investment in lab facilities, equipment, and data infrastructure to enable cutting-edge research.

What is next for you after your doctoral programme? And where do you see yourself and your career in five years?

I plan to continue my research career in the United States, where the data infrastructure and federal funding enable the large-scale health outcomes research that drives policy change.

In five years, I see myself as an independent researcher, possibly in academia or a research institution, leading my own projects that directly improve patient outcomes. My expertise is globally relevant, but the foundation of my work will remain in the US.

So far, what is your American dream, and are you living that dream?

The United States is a great country that pushes you to a level of excellence you did not know existed in you, no matter how good you think you are. The academic rigour, the research opportunities, the mentorship, and the resources available here challenge you to reach heights you never imagined.

Yes, I am living my American dream. I am affecting lives with my research, publishing work that influences clinical practice, and contributing evidence that shapes healthcare policy. My dream is to scale this impact, primarily serving Americans facing the substance abuse crisis, then extending to global health, including Nigeria.

How would you advise Nigerians hoping to live or study in the US?

My advice to Nigerians hoping to study or live in the US? Your dreams are valid, solid, and worth pursuing. But come prepared to work harder than you have ever worked. Excellence in the US is not negotiable. Come with clear goals, intense preparation, and resilience. The opportunities are real, but you must be ready to seize them.