Codeine ban: Is tramadol next?

The misuse and abuse of, and overindulgence in drugs have become a common occurrence in all age groups but more prevalent in adolescents and adults. Some become addicted to certain drugs unconsciously and some consciously. To abuse a drug simply means to use a drug for non-medical purposes. For example taking a drug only for the effect it produces is an outright abuse of such drug and it eventually leads to addiction with time. One however can become addicted unknowingly by administering such drug without resultant cure for the intended illness. The five categories of drugs with respect to addiction treatment and rehabilitation are Narcotics, Depressants, Stimulants, Hallucinogens and anabolic Steroids. It is important to state and make some clarifications oncertain  substances (drugs) which can potentially cause disorder when misused or abused.

Three types of over-the-counter (OTC) cough medicines exist: Expectorants(Guaifenesin-active ingredient), Suppressants(Dextromethorphan, camphor, menthol and eucalyptus oil as ingredients), and a combination cough syrup products which contain both Guaifenesin and Dextromethorphan. However, codeine (a narcotic pain-reliever and cough suppressant) is added to cough medicine preparation. Codeine is used as antitussive (to relieve cough) and as analgesic (to relieve pain) and sometimes mixed with aspirin. But this codeine-containing cough syrup is usually abused and misused because of its high addictive and habit-forming potential thereby inducing a state of Psychosis-a severe mental disorder with physical damage to the brain, marked by a deranged personality and distorted view of reality. Teens take large doses of codeine-containing cough syrup to make them go ‘high’ with symptoms including hallucinations, delusions and paranoia.

Excessive intake of codeine can cause organ failure and brain impairment. Dextromethorphan suppresses cough about half as effectively as codeine but with little addictive potential due to its low narcotic activity. Another drug that is alarmingly being abused is Tramadol- a synthetic analgesic opiate used for the relief of pain. Tramadol is said to be a narcotic analgesic because it works in the body to change how the body feels and responds to pain. No narcotic pain medication (e.g. tramadol) should be sold over-the-counter by pharmacists but it’s unfortunate that tramadol can readily and easily be purchased without a prescription in most pharmacies in Nigeria. A friend once said that some teens take high dose of tramadol to numb and deaden their appetite for food. Those teenagers, as reported, when they take excess doses of tramadol, may not go hungry for the next 24 hours or more-shocking! Another close contact once said after taking a recommended dose of tramadol, he had no appetite for food all day. It implies that some people are allergic to tramadol.

Misused or overdosed tramadol, like any other narcotic may lead to reduced breathing, seizure (convulsion) and eventual death. This is therefore calling on the government through its appropriate authorities, ministries and enforcement agencies to take drastic actions by arresting this increasing ugly trend of some OTC and ‘behind-the-counter’ drugs being abused in the country. As done in the case of codeine, when a BBC documentary aired on April 30, 2018 allegedly implicated an official of Emzor Pharmaceutical company selling a codeine cough syrup without prescription, the federal government acted swiftly with a ban on the production and importation of codeine on the 1st of May, 2018. This directive by the government was subsequently followed by some investigations and inspections carried out by officials of National Agency for Food and Drug Administration and Control (NAFDAC) at the pharmaceutical firms which were implicated in the BBC documentary on the codeine abuse crisis. On May 7, 2018, NAFDAC shut down all the product lines of three companies- Peace Standard pharmaceutical Limited and Bioraj Pharmaceutical Limited (both in Kwara State) and Emzor Pharmaceutical industries Limited (Lagos State). Embargo was placed on these three companies because they could not provide required documents for NAFDAC officials during an inspection of the facilities.

On 12th May, the shutdown order was lifted by NAFDAC on the affected three companies but fined with administrative fees for their respective violations. However, the ban by Federal Ministry of Health on the production and importation of codeine-containing cough syrup still stands. Recall that on Tuesday 8th May, 2018, the Nigeria Customs Service at Tincan Island port said it intercepted and seized two containers laden with 225mg of Tramadol Hydrochloride valued at N124M packaged as electrical materials- that’s the height of human desperation! Government agencies like National Institute on Drug Abuse (NIDA), National Institute of Health (NIH), National Agency for Food and Drug, Administration and Control (NAFDAC), National Drug Law Enforcement Agency(NDLEA) and of course the Federal Ministry of Health to do more by putting mechanisms in place to regulate the production, distribution, sale and use of drugs nationwide.

• Ojewale, an industrial chemist, writes in via [email protected]