By Our reporters
Six years after Nigeria launched the National Drug Distribution Guidelines, NDDG, drugs are still indiscriminately sold, distributed and administered by quacks across open markets in Nigeria with little or no monitoring in sight.
Vanguard investigations show that although in 2018 alone, data from the National Agency for Food and Drug Administration and Control, NAFDAC, revealed that fake drugs worth N4.7 billion were destroyed in four exercises in Abuja; Shagamu, Ogun State; Kaduna and Gombe; the upsurge in fake drugs is presently alarming and has become a major contributor to high death rate and a prolonged period of illness.
It was gathered that activities in these open drug markets had contributed immensely to the growing problem of drug resistance on one hand and substandard and falsified drugs in circulation on the other hand.
The World Health Organisation, WHO, says substandard and falsified medical products cause harm to patients and fail to treat the diseases for which they were intended. They lead to loss of confidence in healthcare providers and health systems.
According to the Pharmaceutical Society of Nigeria, the main sources of fake drugs in Nigeria are India, China, and Pakistan among others.
Recently the NAFDAC admitted that about 17 per cent of pharmaceuticals and medicinal drugs available in Nigeria are substandard and falsified.
Visits to selected open drug markets across major cities of Nigeria revealed a hopeless situation in the pharmaceutical industry. In Idumota, Lagos, one of the largest unregulated open drug markets in the country, professionalism is of no use as medicines are sold in any available space.
There, you do not need to be a pharmacist or a patent medicine dealer to sell drugs. Anybody is qualified and drugs are stored and distributed through any available means. It is difficult for even for the medical experts to differentiate between the fake and the original.
Some of the drug dealers who spoke to Vanguard said genuine drugs can only be properly identified by those who really know the business or through laboratory analysis.
It was also gathered that the commonly faked drugs are the fast-selling brands and they are sold at the same price as the original.
Sore point in drug distribution remains Patent Medicine Vending – PSN, Lagos
In a response, the Pharmaceutical Society of Nigeria, PSN, lamented that Nigeria has made little or no progress in the quest to sanitise the drug distribution channels.
According to the Chairman of the Lagos State branch of the PSN, Pharm Bola Adeniran, one of the sore points in drug distribution remains Patent Medicine Vending.
She said Patent Medicine Vending, which was meant to be a stop-gap-mechanism in service rendition to people in under-served areas has become a huge albatross on the neck of practising Pharmacists because it has become an endless means of easy access to all categories of medicines.
“It is therefore very imperative to call on the Federal Government that the reforms we need with Patent Medicine Vending must focus on allowing Pharmacy Technicians who are part of the global pharmacy workforce to take care of Patent Medicine Vending in rural communities or other areas where service delivery is lacking in Pharmaceutical Services.
“If we decide to call a spade a spade, the Federal government actually needs to call a state of emergency in the drug distribution brackets of our health sector to redress the unending cycle of non-productivity.”
Weak legislation is the problem — ACPN, Lagos
Corroborating her views, the Chairman of the Association of Community Pharmacists, ACPN, Lagos State, Pharm Olabanji Obideyi decried the rate at which Nigerians are exposed to expired, substandard and falsified medicines due to weak legislation on pharmacy matters in Nigeria.
Illegal drug premises run by charlatans on increase in Lagos
Obideyi who said on a daily basis, illegal premises run by charlatans are springing, and the only motivation is to profiteer at the expense of citizen’s lives.
“In these illegal outlets, expired drugs are relabelled for sale to the unsuspecting members of the public, while some other medicines are being falsified at an alarming rate, “if our medicines must be safe and efficacious, the government needs to build the capacity of regulated agencies by providing necessary tools to work.”
He said Nigerians should be wary about where they purchase their medicines and should not be carried away by how cheap the medicines are, “rather be cautious of the quality and service being rendered towards deriving maximum benefit. As a guide, we advise you to patronize any pharmacy premises where you see the emblem signage Rx and green cross.”
Govt has failed to implement its Drug Distribution Policy
The Public Relations Officer, ACPN, Pharm. Jonah Okotie regretted that though Nigeria’s distribution system has remained deficient, the government has not displayed enough commitment and political will to implement its drug distribution policy.
He attributed drug inefficacy to poor or wrong storage conditions such as exposure to heat, light, air, moisture amongst others. “Unfortunately, our people consider first the price not the quality of medicines especially with regards to storage conditions and getting the right information as regards the use and storage of our medicines.”
Blame quackery, greedy importers – NMA, Imo
In Imo State, Chairman of the Nigeria Medical Association, NMA, Dr. Kyrian Duruewuru said substandard drugs are usually purchased from the open drug markets and not hospitals.
“There is no data to know the magnitude of treatment failures and you know that there is a high level of kidney failure. Most of these diseases you should see in the elderly people are now in the younger people are caused by drugs. Kidney failure is found with elderly people but nowadays is more with the young because of drugs. The same applies to all other ailments but the common denomination is that people go to the chemist and buy drugs.
“If a doctor treats you and you go out and buy drugs from open markets, it is no longer the doctor’s faults if that drug does not work and that is the major problem we have now.”
Open drug market major problem affecting drug potency – PSN, Rivers
In Rivers State, the Chairman of the Pharmaceutical Society of Nigeria, PSN, Rivers State branch, Pharm. Chima Ogbu, explained that the sale of drugs in open markets remains the major problem affecting drug potency in Nigeria.
“Rivers pharmacists will continue to ensure availability of safe and effective medicines in the state the communities, hospitals and in all health facilities in line with our professional training, ethics, relevant law and regulations in Nigeria.”
Only coordinated distribution will end poor treatment outcomes – ACPN, Rivers
The Chairman, ACPN, Rivers State, Agboma Esom-Ibe said only a well-coordinated distribution chain will end poor treatment outcomes. She called for the right political will to sanitise the nation’s drug distribution network.
Esom – Ibe also demanded that regulatory bodies should do what they were established to do which includes, regulation of the drug distribution network, ensure that professionals handle drugs, and prosecute offenders.
Most substandard drugs are imported – MAN, Ebonyi
Speaking to Vanguard, the Chairman of Manufacturers Association of Nigeria, MAN, for Anambra, Enugu, Ebonyi Chapter, Phram. Chuzi Igweobi said that most substandard drugs in Nigeria were imported.
Igweobi said that most Nigerian drugs were more costly than the imported ones because of the standardisation and effective regulation of drugs production in Nigeria.
“If you are in Nigeria and have been buying drugs, you will know that most people, perhaps 80 per cent of Nigerians, buy Nigerian drugs. Remember that late Prof Dora Akunyili was against the importation of drugs from India and China.
“Do you know why? Our people go there, buy 500 milligrams of products and write another thing on them. They clear the drugs and distribute to people. Most of the drugs manufactured in Nigeria have scratch cards on them. In the scratch card, you will find the phone numbers of NAFDAC and that of the manufacturing company. The reason is that if anything goes wrong you call the numbers.
Doctors in S/East, S/South buy drugs from Onitsha market – Union
In Onitsha, Anambra State, although there were divergent views on effects of fake drugs by the leadership of the Ogbogwu International Market Onitsha (formerly Onitsha Patient and Proprietary Medicine Union, OPPMDU), one of the leaders in the market, Hon. Eziobi, however, admitted that they are still combating a the illicit business of fake, adulterated and substandard drug dealers operating outside the Onitsha Bridge Head drug market.
He affirmed that almost all the hospitals and doctors in theSouth-East and South-South go to Onitsha to purchase drugs, but have not complained negatively about the efficacy of such drugs.
“We are very strict with traders and the drug they deal in; we from time to time lunch onslaught against fake, adulterated and substandard drug dealers in this market, you will hardly see any of them in this market, but we cannot guarantee those operating outside this market.”
FG lacks political will to check menace – PSN, Edo
The Vice Chairman, PSN in Edo State, Pharm Uyi Oriakhi expressed worry that Nigeria lacks the political will to enforce regulations in the drug sector. He called for the closure of open drug markets and replacement with viable alternatives strictly manned by professionals.
“If you want to go and purchase drugs in Onitsha, there is no barrier, just go and purchase and that is how it is in several other places across Nigeria. Even though you are not schooled in the art and science of drug manufacturing and drug use, you just carry it and you sell to anyone.”
He said the PSN at the national level has complained about the development and even drawn up a Masterplan on how these things can be contained.
“Even as we speak, there is a pharmacy law pending in the National Assembly where some of these reforms are part of it to check the menace but we don’t know what is happening to that Bill. If that Bill is passed into law, some of these things like the open drug market can be checked and once this is checked, it means every drug will pass through a process that will ensure that the end users would not be having access to some these counterfeit and substandard drugs.”
Oriakhi said in Edo state, they have discovered certain tricks about counterfeiters of drugs. “Sometimes, they have warehouses or stores somewhere close to their outlet. When you go to there as a regulator, you will only find what you are expected to find there but there have been occasions where we are able to identify some of them, and they are sanctioned. But the law as it is today does not give room for prosecution so sometimes we seize the products.”
Some government officials have interest in open drug markets
“Government has its presence in the ports but the Nigerian system gives room for cartels to spring up easily. For instance, we have SON, NAFDAC and others to ensure these drugs don’t get in but government needs to be more scientific in its approach, there should be the use of technology to trace these things at every point so that even if they succeed in getting them into the open drug market, there should be technology and strategy to detect them.
“There are some interests that are involved in the open market; some of them are in government they just want to make their profit. The government had since 2013 been giving deadlines to close down the open drug market but before they do that there is a need for an alternative, they have been giving deadlines – 2014, 2015 even January this year, another deadline was given but government cannot muster the will to do it.”
Treatment failures, substandard drugs at alarming rate—NMA, Akwa Ibom
The State Chairman, Nigerian Medical Association, NMA, Akwa Ibom state branch, Dr. Nsikak Nyoyoko said that the incidences of treatment failures from substandard drugs in the state and the country at large was at an alarming rate.
Nyoyoko, attributed the menace to untested imported drugs and poorly identified sources, however, suggested that the regulatory agencies should be provided with armed security financial empowerment to enable them arrest the situation.
“The incidences of treatment failures from poor safety, substandard drugs are at an alarming rate in the state and the nation at large. And the reasons for this is, of course we all know that corruption is rife in our environment. A lot of drugs that are imported into the country are imported from untested and poorly identified sources. Ideally, all drugs should pass through NAFDAC, get NAFDAC certification; unfortunately, some drugs still find their way into the market without NAFDAC certification. Some have false NAFDAC stamps on them. And those are very cheap.
“Some pharmacists are also guilty of selling these drugs, but mainly the problem is with the Chemists who source their drugs from anywhere in society. They don’t care if the drugs are effective or not, they are just interested in making money. Most pharmacists are mindful of their reputation, so they will not delve into such act.”