Drug and Substance Misuse

Drug and Substance Misuse

Drug and Substance Misuse: Resist the Temptation. 1
What is a drug?
Part IV Section 44 of Nigeria’s National Drug Law Enforcement Agency, Act 1990 described and gave definitions to what constitute drugs and substances.
In this article and to make things simple for us, I will look at drugs from two other definitions. The first definition is one that is within the confine of the professionals:
1) Under the USA Federal Law: A drug is:
a. any substance recognized in the official pharmacopoeia or formulary of the nation.
b. any substance intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease in humans or other animals.
c. any article, other than food, intended to affect the structure or any function of the body of humans or other animals.
d. any substance intended for use as a component of such a drug, but not a device or a part of a device.
2)The American Heritage Science Dictionary defines “drug” as a chemical substance such as a narcotic or a hallucinogen that affects the central nervous system and is used recreationally for perceived desirable effects on personality, perception, or behaviour. Many recreational drugs are used illicitly and can be addictive.
Uses of drugs
From the above definition, we can see that, in fact, drugs actually have their good uses. They are intended to be used in certain ways such as for diagnosis (detecting) diseases, prevention of diseases, treatment of diseases in both human and animals. Drugs are also used to treat plant diseases.
Drugs are chemical substances that are found in different parts of the world. What constitute a drug will also depend on how it’s used. Therefore, drugs can be just any substance. The important thing though is that, apart from food and water, it must affect and make changes to the body of the person taking the drug. These changes can be physical and it can be mental. Drugs are in general supposed to be useful clinically. Examples: cocaine is used for anaesthesia. Morphine and its class is used for relieve of pain.

Alcohol, (methylated spirit) can also be used as a cleansing and disinfectant at home and in hospital. In most mouth washes, there are some alcoholic content. Heroin in prescribed form is used as a pain killer after operation and in people with serious disease conditions with pains. There is probably no tangible use for LSD. Amphetamine and related product can be used for slimming in controlled clinical conditions. So, these substances have their clinical uses. Cannabis in under scientific formulation is now in some conditions prescribed to control some diseases. The problem is that the usefulness of these substances is being manipulated by barons, couriers and users under the shadow of illegality.

What is abuse (ab= abnormal; use hence ab/use)
Abuse simply means, abnormal use, improper use: A use that is a deviation from its intended purpose. You will remember that, all things (please put emphasis: ALL THINGS) and not the least, drugs, have their intended use and purpose. Any departure from such intention is therefore an abuse or misuse.
Why is drug abuse so important?
Every action has its consequences you will remember. Like child abuse or abuse of anything for that matter, drug abuse has its own results. Very often these results are fatal or it may have long term damaging effects on the individual and everyone around the person. Someone may claim that, they are using drugs though it does not cause anyone else any harm. The fact is that they cause many people
some harm, ultimately. In the mind of the drug user who says she or he causes no one else any harm, such user (misuser) should understand, that her or his behaviour is causing unhappiness or even depression to the spouse, parents, children and the community around the drug user. Further, the misuser may constitute a nuisance to the society.

Every one of us in a given society is supposed to be productive and somewhat support each other in that community. If someone steals, the society will punish the person for stealing because stealing is classed as bad. If someone harms another, the law will take its full course if caught because; the person that is harmed may become less productive and may become a burden on the community. Punishing the offender is also a deterrent that causing harm is damaging to the common good. In the same way, someone who takes drugs is cheating on the others or the rest of the community. While he may not directly cause physical harm, he or she may become injured or dies. The injury will cause the person to be less productive against the overall common good of the rest. He or she may become mentally unwell. Someone will have to pay for the gaps in productivity that is opened up by the person. Even if the drug miser is multi-billionaire, his drug habit will have impact on his children, wife, employees with their dependants and fans or the larger society that look up to the drug user. This is why drug misuse if so dangerous.
He, the drug user, will cause others to be unhappy and possibly depressed even if the drug user does not cause these things or agree to be causing the harms directly.

Drug and Substance Misuse: Resist the Temptation. 2
As we shall see below, there are lots of impacts of drug misuse on the society, friends and not the least the individual drug miser. In the least, it gives a certain community and nation a bad name and image. In neighbourhood where drug misuse is common, the image projected by the drug usage is clear for everyone to see. For example, the community is branded as drug misuser, crime rates are higher, unemployment is high, property and social development is such community are low. Drug misuse has serious impacts on the said community not to mention the serious implication on mental health.
Drugs that are commonly misused/abused
Strictly speaking, anything and any chemical can be abused. They range from tobacco (nicotine), alcohol, smoking tea (!), petrochemicals, paint, kerosene, to cannabis and to more serious ones like cocaine, heroin, LSD, ecstasy, magic mushrooms and many more. Just anything can be a drug. It may be common plants or cultural plants such as khat commonly used in Somalia and now used in the Western World. Probably the commonest drug of abuse is alcohol and nicotine (cigarette) and marijuana.
Why do people abuse drugs?
1) Lack of knowledge / Ignorance. The old saying that ignorance is a disease and that ignorance kills is ever so perfectly true as in drug misuse. Most innocent people especially adolescents and children are introduced to drugs without them ever being aware of what they are getting into. The reasons are that:
a) Some parents do abuse their children: Parents who are on drugs (see above list of drugs but especially alcohol and nicotine) will most tacitly or directly introduce the drugs to their children. Children of course learn from parental habits or learn from the habits of guardian. They will simply pick up the behaviour.
b) The “mates” and friends effect: Hardly does it ever occur that anyone, for the first time and without prior knowledge of drugs, could walk along the street looking to buy heroin, cocaine or even alcohol. Someone must have first, introduced the substance to the person. This is where “mates” and friends come in. Pressure groups, in schools, streets, rave parties’ gives the drugs to the unwary, the easily led and innocent person who wants to “belong” to his mates or “be like them”. In my clinical experience, this is how teenagers get into drugs. The “mates” often “market” the drugs as “happy” substance and asking the innocent person to try it. On the other hands, the drugs may be marketed as helping users to be bold and less shy especially in approaching the opposite gender.
c) Illegal administration/ criminal acts: Sometimes in parties and to the unwary, drugs may be put in drinks and food belonging to the victim who innocently takes the drugs. On other occasions, the drug may be presented as sweats or something pleasant that the victim may benefit from. Actually, in law, this is both an illegal administration of drugs and this act is seen as poisoning the victim. This is what happens, sometimes between children and parents. It also occurs between “mates” or between opposite genders. Males may put rape drugs in drinks of a female whom the male intended to subdue for the purpose of rape when the drug had taken full effect. The victim being unaware takes the drink and subsequently get attacked.

2) Supposed pressure of life/ Desire to excel in life: There is a false belief that, using recreational drugs can give relief of some sort such as “stepping down” from a pressure of unemployment, family issues, pressurising job positions, career and school pressures: Relieve may indeed last for a while. Once it becomes a habit, the damage may have gone too far and beyond repair. So, taking illegal drugs is an escapist method of dealing with failures and pressures of life. The desire to excel is linked to success. As I mentioned earlier, drug taking is almost always an act of cheating the rest of the society. This is the situation that occurs in sports and games. In the end, it does not pay to take performance enhancing drugs as we have witnessed with so many lives cut short, sport career banished, athletes are banned from games and money in the hands of drug misuser is filtered away.
3) Duress: If you are poor and you are looking for way out of it and you happen to fall into the wrong hands, you may be forced into the drug ring. In the first, you may actively be looking for the way out of your poverty. This can be by your voluntary action in which case you choose to be part of the drug team as either a courier and or a user. Of course, it makes loyalty sense that if you are going to be part of a team, you should show your commitment to the leadership by taking the drugs, somehow. The loyalty factor ties the drug courier and user to the baron. On the other hand, you may be actively recruited and be forced to take or carry drugs under the threat of death or any other harm In return couriers and users are promised a handsome reward. In the end, your action may lead to your mental health breakdown or you end up in prison or both.

Drug and Substance Misuse: Resist the Temptation. 3
4) Poverty (and ignorance): As in (3) above, with unguided individuals who is poor, there is greater likelihood of alcohol misuse, nicotine misuse and cannabis. Heroin and cocaine appears to be the preserve of the rich though not exclusively.
5) Abuse of Prescription Drugs. As our definition clearly stated, any chemical can be abused be it prescription drugs or recreational drugs. Some individuals do suffer long standing and painful conditions. In such a state, some believes that taking more than what the doctor has prescribed would provide corresponding greater healing effect. In fact, the opposite may be true. It may cause considerable damage beyond what the user had ever contemplated. Yet, there are many people who out of ignorance, poverty or both refused to attend a medical consultation. Instead, they prefer going to the local chemist or pharmacy to get over the counter medications. Paracetamol or other pain killer as well as sleeping tablets belong to drugs that are frequently abused by the public. Abuse of over the counter drugs and prescribed medications are extremely dangerous. Illnesses are better handled by clinician and trained professionals.

In similar situations, there are individuals who use drugs to “suppress” the effect of a disease. Cannabis, illegal as it is for example, is used by some in the belief that it helps the pain of chronic diseases. To be truthful, it is to this end that a prescribe-able form of cannabis has now developed. Cannabis causes, depression and paranoia. Some mental health patients who ironically developed paranoia tend to believe that their depression and paranoia could get better by use of cannabis. The opposite is in fact true. It could and does get worse.
Ways of using drugs?
The ultimate aim of drug user is to get the drug to the brain: however it gets there.
Therefore, the common routes are:
a) The mouth as in tablets such as ecstasy, various forms of preparation as in chewing of some of our traditional medicines. Some is taken as liquid as in alcohol and gas as in cigarette and cannabis (also known as marijuana, skunk).

b) Through the nose as in cocaine sniffing.

c)Through the blood vessels (injection) as in heroin

d) It may also be through the vagina or anus as in drug courier and other shrewd users.
How is drug presented? What does some of these drugs look like?
a) It can be in its natural form of leaves as in cannabis or heroin or cocaine as in coca
b) It can be in tablet forms as in LSD or ecstasy. It may look very innocent in presentation.
c) It may be in powder form as in cocaine powder which is often “white” in colour.
d) It may be in liquid form as in paint, petrochemicals and alcohol (ethanol). Some drugs such as cocaine and heroin may also be dissolved chemicals as a way to conceal their usage and carriage.
e) It may have been transformed by the barons in which case they may mix it with other products to disguise the real content of it.
Effects of drug abuse
I will not be detailing the effects of each of these drugs. To do so will undoubtedly complicate the discussion. Suffice to say that the principal effect is that drugs of all classes interfere with the way the brain works. Drugs interfere with the thinking process, the data processing by the brain and the way the person perceives things from the environment and the way the person reacts to the environment.
Drugs such as alcohol do also cause real and tangible damage to the substance of the brain which may lead to mental health diseases such as dementia.
Ultimately, drugs can contribute to or lead to psychosis, schizophrenia, paranoia (undue suspicions), delusions, hallucinations (hearing of voices, seeing strange things, and feelings of unrealistic sensations on the body, smelling things that feel abnormal or unreal), mania and unreasonable euphoria. It may lead to distortion of reality. Drugs may cause or contribute to depression, panic attacks and anxiety and sleeplessness. The list is endless.
Physical effects: The person abusing drugs may not now be well without the drugs (called addiction). He or she depends on it for daily “boost” (called dependence). If the person is injecting the drugs, it may leave marks on the skin. In fact this is probably the simplest effect.
The person may contact infection such as AIDS/HIV/hepatitis especially if needles are being shared between drug users. Substance misuse may also lead to other forms of less known infection that may kill the individual. Septicaemia or blood poisoning may be what will ultimately kill the person. I have seen someone, a drug user who developed abscess of the groin and had to have his leg and hip amputated as a result of what is known as osteomyelitis. If death or other severe damage has not occurred, organ damage may occur such as liver disease for example: cirrhosis of the liver as in chronic alcohol misuse.

Drug and Substance Misuse: Resist the Temptation. 4
Kidney may also fail in case of septicaemia. Brain damage may occur as I mentioned above. It may or may not be reversible.
The person may become disfigured. Drug may affect a person’s fertility and ability to have children
In women who are pregnant, the child may be severely affected and may present as a “drug addict” at birth with craving or withdrawal symptoms. That may affect the child for life. This is commonly seen in alcoholic pregnant mothers. Some drugs my stiffen life out of the unborn child especially in early pregnancy. Cigarette do damage the lungs of the new born.
Nicotine in cigarette has been linked to cancers of the lungs and bladder and it has effect on other cancers such as breast cancer especially in women. Alcohol is known to cause or be associated with cancers and also contributing to many of such diseases in women and men. In short, alcohol misuse causes cancers.
a) General Effects
Economic: Someone suffering any of the above clinical effects cannot be described as being healthy. Certainly, productivity may be diminished due to diseased state. Business and work may suffer as a result. Cost of caring for the user and the loss in productivity will affect incomes. It may as a result affect, career. Many political aspirants who took drugs in teenage years have fallen by the way side later on in their political career. In the least, they have had to explain to the public and possibly apologise for ever taking drugs in ignorance. Thus, drugs can affect future ambitions.
School and education may suffer considerably. Many individuals have had their schooling cut short on the account of drugs misuse. I have clients now and in the past who had been impaired by alcohol, prescription drugs, cannabis and heroin with serious effects on their academic performance.
Social and family: The impact of drug is widespread. First, it may affect the children who may copy the user. I have seen many spouses and relationship ruined because a partner introduced drug into the family and relationship. This may lead to disease states and fragmentation of the family.
Legal effects and crimes: It has been proven beyond doubt that drugs misuse from alcohol to heroin and cocaine and indeed any form of drugs that distorts reality may aid commission of offence. Commission of offence may lead to imprisonment and or detention in mental health institution. The person may begin to act out of character. This may be the start of a trend in which there is drug use leading to crime and the beginning of the ruining of a life that started as a bright star.
The Situation of Drug Misuse in Nigeria.
Let us face it: with a lax rule of law in practice, poor infrastructure to support economic development, no social welfare benefits, wide disparity between the rich and poor and with 62 % of her people living below poverty line and per capital income recently risen to about $1200 (UNDP) and a teeming population of over N160M, Nigeria is essentially a drug consuming and producing country. Nigeria is also a significant transit and courier country.
According to available public records,” former Chairman of NDLEA (National Drug Law Enforcement Agency), Alhaji Ahmadu Giade, described illicit drugs as “alien” to Nigeria. Cannabis, now locally grown in most states of the federation, was introduced to the country by foreigners. Ms Dagmar Thomas, the Country Representative of United Nations Office on Drugs and Crime (UNODC), says Nigeria was one of the largest cannabis growers in Africa, with over 8% of the population abusing cannabis. Annual cannabis seizures increased from 126 metric tones in 2005 to 210 metric tones in 2007.
The NDLEA describes the South West region of Nigeria as one of the main centers of illicit drug production in the country. 196.5 acres (0.795 km2) of cannabis farmland was discovered and destroyed in the region in 2008. In particular, Edo State has the highest rate of seizure of cannabis in the country. In April 2009, the NDLEA confiscated 6.5 tones of marijuana from the home of a man in Ogun State who claimed to be 114 years old. In September 2009 the NDLEA reported destroying a 24 hectare Cannabis Plantation in a forest reserve in Osun State.
In January 2009, the NDLEA publicly burned 5,605.45 kilograms of drugs seized from traffickers in the historic town of Badagry, Lagos. The bonfire included 376.45 kilograms of cocaine, 71.46 kilograms of heroin and 5,157.56 tonnes of cannabis in 2015…. Between 2006 and June 2008 over 12,663 suspected drug dealers were arrested, with seizure of over 418.8 metric tonnes of various hard drugs. For example, in July 2009 a woman about to board a KLM flight at the Mallam Aminu Kano International Airport was arrested by NDLEA officers and later excreted 42 wraps of cocaine, weighing 585 grams. In September 2009, the NDLEA arrested a Guinean woman en route from Brazil to Europe with 6.350 kg of pure cocaine at the Murtala Mohammed International Airport in Lagos.” (Wikipedia).
Yet, about 20% of Nigerians are mentally unwell with drugs misuse contributing a significant proportion to the scourge of mental illness.

Drug and Substance Misuse: Resist the Temptation. 5
Prevention and Treatment.
As a clinician, my major concern is both the effects of drugs on the individual and the society. I have earlier discussed the clinical implications of misusing drugs.
In prevention terms, adult individuals just need to say “no to drugs” with strong and persistent determination notwithstanding the pressure from wherever the pressure to give in may be coming from. Adults who are at risk of drug misuse should take steps to avoid coming in contact with peers or couriers or kingpins pressuring one into drugs. Change of mobile number, emails, contact address or completely relocating may help: such should also be done with strong will and determination. Avoid swearing on oath. Avoid secret pacts with underling threat of deaths or harm befalling the oath-taking if the oath is breached. Stay and be satisfied with your earnings no matter how little. Greed kills.
Teenagers need to be very careful with whom they befriend and move with. Do not agree to try anything no matter the pressure or need to belong. Once you try, you are hooked on drug.
Children and babies in the womb are vulnerable. Their care and life depends on the parents, guardians and the government as neighbours. Neighbours has a civic duty to report abuse to the government. Government has a duty to protect the citizens.
A word on abuse of prescription and over the counter drugs: Every decent and law abiding society sets the rules for the orderly behaviour of its citizens. The problem in Nigeria is actual enforcement of laid down rules. The Pharmaceutical Society of Nigeria in concert with the respective government agencies as well as the medical profession must adhere to the laid down rule of restricting the sourcing and distribution of controlled drugs. Certain drugs must not be made available to the members of the public without credible prescriptions. As it currently stands, this is not the case, thus leaving a leaking and big gap for potential abusers to lay their hands on controlled substances. The healthcare professionals and the government need to do more to seal this gap.
In term of treatment, detoxification and or weaning off drugs therapy with counselling are available to individuals or groups with insight. No law is as yet exist in Nigeria to compel individuals to undergo treatment for any illness not the least mental health and drug abuse. Therefore, concerned individuals and families may bring their friends or family members to care centres and hospitals for assessment and treatment. In my view, drug misuse is avoidable and treatable as taking of drugs is both a matter of personal choice and the unfortunate administration of substances to unwilling victims.
To avoid misconception, mental health treatment does not have to take place in “asylums” or massive institutions as its in popular mind. To a determined person, recovery from mental health or drug misuse can take place in the person’s comfortable home environment. If however, there is risk of lapsing into drug retake or peers might influence treatment, then it may be better that, the sufferer be taken to a care centre. There are many private and decent hospitals in Nigeria with specialist staff to look after their clients. Most detoxification treatments may take one or two weeks on the average. Nonetheless, associated mental health deterioration such as psychosis and depression may take longer to deal with. Once the acute or emergent phase is over, further recovery may take place at the home of the patient.
Irrespective of where the treatment takes place however, the most crucial factor is the insight of the patient to admit to his or her vulnerability and illness as well as to have a very strong will to resist the temptation to abuse drugs during treatment and after.
This will to get well could also be reinforced by support from spouse, family and friends of the drug misuser with strong ground rule that bad influences from co-drug misuser should not get in contact with the person who is recovering from substance misuse.
In all, help is available if you look for it.

/ Health Info for Patients

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