By Olu Akinyanju
The treatment of severe pain crisis in patients with Sickle Cell Disorder, SCD, often requires the injection of an opioid drug. The preferred opioid analgesic (pain killer) drug is morphine, which unlike pentazocine, is not available over-the-counter in our pharmacies and is only supplied directly, to genuinely registered hospitals and clinics.
Pethidine, another opioid analgesic, is no longer recommended, because it can be toxic to nerves and can lead to seizures, especially in persons with poor kidney function. On the other hand, pentazocine is available in most Nigerian pharmacies and is widely used in Nigeria and has led to severe addiction in several cases.
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Case 1: Many years ago, a friend introduced to me his son who had SCD. Despite his HbSS status, his son’s health soon stabilised, with his use of modern treatment and he was able to run a profitable business.
A while later, I was pleased to attend his son’s wedding and happy to meet his charming wife. Less than a year later, I met his wife and asked how their business was progressing, only to be informed that her husband was spending all available money on himself and neither on his home or business. On making a further enquiry, I discovered that he had become addicted to pentazocine, which he regularly injected into his thigh, several times a day. Several efforts made to assist him in overcoming the addiction failed, thus destabilising his marriage as well as his business until he later succumbed and died.
Case 2: A few years ago, a young man with SCD was referred to me. He had no job and was dependent on friends, relatives and whoever, for financial assistance. On examination, I found several skin disruptive signs on his thighs, which he admitted were from repeated self-administered injections of pentazocine. What he expected was my funding and not my criticism. Consequently, I soon lost his contact.
Case 3: She was a good looking married lady who had sickle cell anaemia and a fairly long history of addiction to pentazocine. The latter had apparently ruined her marriage. She was referred to me on account of her SCD. I went to see her in a hospital in Lekki under the care of a consultant psychiatrist. Unfortunately, I did not receive a pertinent medical report, which I had expected and have lost touch with her.
Sadly, once a patient becomes addicted, he/she does not need to have any pain before seeking the drug for use. Thus, addicted persons spend most or all of their money and time on the acquisition of the drug. Apparently, many of the pentazocine- addicted SCD patients are being cared for at Yaba Psychiatric Hospital in Lagos and probably also in other Psychiatric Hospitals in Nigeria.
It would be best for the Federal and State Health Ministries to rapidly look into limiting the accessibility of this medication and for all medical and nursing personnel to be aware of the dangerous consequences of its use.