Nigeria’s drug system and across the counter sale of drugs

 …as drug resistance remains a major puzzle confronting the globe

Nigeria’s pharmaceutical industry is one sector that has over the years been confronted with several challenges; from the illicit sale of drugs which the National Agency for Food Drug Administration and Control (NAFDAC) has fought headlong to across-the-sale of drugs. And the list is endless.

However, despite Federal Government’s resolve to attain self-sufficiency in local manufacturing of essential drugs, which is in line with the National Drug Policy to make drugs that are safe, effective, efficacious, affordable and available at all times to the Nigerian populace, one dangerous trend which is fast becoming a norm is the unguarded sale of drugs across the counter.

Hence, when people feel ill, without hesitating on the dangers associated with self medication, quickly reach out to any hereby pharmacy to purchase drug(s) of their choice without the prescription of a physician. This practice, more often than not, has led to cases of drug resistance (including antimicrobial resistance) which has become a major source of concern globally giving the health hazards associated with it.

In the light of this, health experts have called on the government and stakeholders in the health sector to put in place strict regulatory control of medicines on the market, strict enforcement of quality standards, diligent pharmacovigilance  as well as policies that would nip these problems in the bud and as well as prevent the emergence of highly resistant microorganisms.

In an interview with BusinessDay, Shilaj Chakravorty, consultant pathologist, BT Health and Diagnostic Centre, Lagos State University Teaching Hospital (LASUTH) described “across-the-counter sale of drugs” as medicines that are sold to a consumer without the prescription of a healthcare professional.

While acknowledging the fact that we live in an era where people depend on antibiotics and other antimicrobial medicines to treat conditions, Chakravorty stated that when antimicrobial resistance-otherwise known as ‘drug resistance occurs’, it renders these medicines ineffective.

Giving this imminent danger, the medical pathologist called for effective regulations which will include what drugs should be sold across the shelves, who is authorized to dispense them and whether a prescription is required is done in view of checkmating drug resistance.

In his words “Drug resistance is facilitated by the inappropriate use of medicines. For instance, when taking substandard doses or not finishing a prescribed course of treatment. Low-quality medicines, wrong prescriptions and poor infection prevention and control also encourage the development and spread of drug resistance.

“Also, poor surveillance and a diminishing arsenal of tools to diagnose, treat and prevent also hinder the control of drug resistance. Don’t forget that when microorganisms become resistant to most antimicrobials, the resistant infection may kill, can spread to others, and imposes huge costs to individuals and society,” Chakravorty concluded.

Lending his view, Wellington Oyibo, consultant medical parasitologist, college of medicine, University of Lagos, Idi-araba, stated that across the shelf purchase of anti-malarial drugs as well as the advertising of various anti malarial drugs in the media has led people to indulge in self medication without undergoing medical examination to examine the real course of the ill health.

Oyibo pointed out that due to this scenario, inappropriate medication leads to development of resistant strains of malaria parasite. One should also be aware that cross-resistance is common which means, a parasite developing resistance to one drug will show resistance to any other drug within that drug family.

There is no gain saying that any medicine, whether good, worthless, or harmful, can be sold in a country that lacks appropriate laws and regulations, administrative procedures for registering medicines, quality control laboratories, and enforcement capacity.

However, with the globe rapidly losing the ability to fight disease because of adversary drug resistance associated with malaria, tuberculosis, etc. human actions is hastening it due to unguarded consumption of drugs.

In an increasingly interconnected world, drug resistance does not stop at a patient’s bedside-it threatens global health. It slows the gains against fatal revenges of childhood illnesses including pneumonia, drastically increased the cost of fighting tuberculosis, and malaria ad imperiled efforts to treat people living with HIV/AIDS.

For Chakravorty “Proper surveillance for drug resistance will be aided if governments at all levels and as well as private clinics and centers submit data with special reference on resistance to anti malaria drug. Anytime issues of anti-malaria drug resistance are reported, such should be reported to the state health authorities. Strengthening drug regulatory capacities is the best way to turn off the tap of bad medicines

“More importantly, Nigerians should be discouraged via media advertisement on the dangers associated with the purchase of drugs counter without the prescription of a physician. Also, there is the need to educate the public on the importance of diagnosis before any administration of drugs to the ailing patient. This is to avoid any likelihood of encountering drug resistance in any form,” the medical pathologist concluded.

 
No doubt, without a global effort to ensure lasting effectiveness of treatment, drug resistance is poised to get worse, raising medicare costs, claiming more lives and making future generations vulnerable that are easily cured today.