Mkpurummiri is huge public mental health issue

By Daniel Kanu

Prof Monday Igwe is the medical director, Federal Neuropsychiatric Hospital, Enugu.

In this exclusive encounter with Sunday Sun, Igwe who also lectures at the Department of Psychological Medicine, Ebonyi State University Abakaliki, speaks on the disturbing stimulant, Mkpurummiri, the danger, the challenge, and what needs to be done to checkmate it.

The erudite scholar also gave President Mohammadu Buhari kudos for the efforts of his government in the health sector, particularly since the emergence of the COVID-19 pandemic. Excerpt:

Let’s have a brief explanation of what Mkpurummiri is all about and why the issue is prevalent in the Southeast?

Mkpurummiri is the local name of amphetamine-like psychostimulants such as amphetamine (also called speed) and methamphetamine (also called Ice). The problem of substance abuse is now recognized as an emerging epidemic and is seen across all communities and cultures with some variations. The commonly abused drug within a community is related to several factors such as availability and cost. From available research evidence in Nigeria, alcohol and cannabis are still the most commonly abused licit and illicit drugs, respectively. However, it appears that the wave of social media is popularizing “mkpurummiri”. Notwithstanding, it is still a huge public mental health issue. I assume it’s everywhere but just more awareness in Southeast.

What are the implications of its use on the health of the user?

The health implications may be classified as immediate or short-term and long-term effects. It is known that following the inhaling or ingestion of the substance, it may produce a number of effects such as euphoria, increase attentiveness and concentration, feelings of high energy and wakefulness, and quicker reaction time. However, after some period of use, the individual may develop paranoia (i.e., being suspicious and distrustful), hallucinations (i.e., a perception in the absence of a stimulus), cravings for the substance, compulsive drug-seeking behaviour, and convulsions. In overdose, severe mental disorders such as psychosis may emerge; dangerously high blood pressure, chest pain, stroke, heart attack etc, may occur. Apart from the medical implications, there are social consequences of dependency on psychoactive substances.

Does Mkpurummiri have medical value?

Clinicians use methamphetamine for medical purposes. For example, psychiatrists commonly prescribe it for the treatment of such conditions like attention deficit hyperactivity disorder, narcolepsy and sometimes for weight loss.

How can its abuse be checkmated?

Prevention of substance use disorders requires a multi-sectorial approach with interventions across lifespan. Addiction is a brain disease and preservation of the brain early in life is a necessary step. Quality obstetric and neonatal care is the bedrock of health neural development. Strengthening family values and resources, good neighborhood with community cohesion, the church, and other institutions of socialization are very important in the prevention of addictive behaviour. Law enforcement must be balanced with a public health approach to substance use problems to achieve the desired results. Emphasis on drug supply reduction without addressing drug demands through evidence-based treatment approaches may be counter-productive.

What type of help does a drug abuser need?

It is good to understand that drug use disorder is a spectrum ranging from use to abuse/harmful use to dependency syndrome. As earlier stated, persons having drug-related problems require humane medical attention at various levels. Various levels of care ranging from counseling to motivational interviewing and to in-patient care depending on the degree of use and other medical and mental health co-occurring conditions.

The current community approach of using punitive measures, is that the correct thing to do?

Well, as stated earlier, a multi-sectorial approach is needed to address indices of social disadvantage such as poverty and unemployment. Punitive measures are oftentimes based on the moral theory of addiction which emphasize that people having problems with psychoactive substances brought it upon themselves and so should not be pitied or even treated. Those who hold this view tend to use punishment as a deterrent. However, it is known that substance use disorder is a disease with recognizable signs and symptoms that has evidence-based treatments that are cost-effective. Treatment of persons with drug use problems has several advantages. One example is that a treated drug user is less likely to recruit another person and this reduces criminality associated with the use of drugs. The use of punitive measures is successful only when it is targeted at the drug producers and dealers, but not users as the current approach to the drug war focuses only on supply reduction which drives increase on demand. To achieve the much-needed supply and demand reduction, punitive measures should be targeted only at the drug producers and distributors and this should be coupled with the treatment of users.

What is the state of healthcare in the country presently?

The current government in Nigeria under the leadership of His Excellency, President Muhammadu Buhari has done marvelously well in the health sector. With the advent of COVID-19 disease two years ago, the Federal Government has done so much to improve the infrastructure in the health sector. In essence COVID-19 is a blessing in disguise. The government has provided and equipped isolation centres, Intensive Care Units, molecular laboratories in all Federal Government tertiary hospitals across the country. Also, personal protective equipment was supplied. Unfortunately, there has been a massive migration of health professionals to other countries for better remuneration, bringing a shortage of manpower in some critical areas. I plead with the relevant agencies to quicken the process of replacement for these staff that have left the system.