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Known among the rich and affluent is something Dr John Omole-Matthew wears effortlessly on his sleeve. He is one of the lead characters in medical sector in Nigeria. He graduated from the University of Ibadan (UI). The articulate and proactive who combines both professional and confident approach with excellent in an interview with OPEYEMI SAMUEL talked on how to reduce Opioid Use Disorders (OUDs) in Nigeria.
Why do you think we need to talk about Opioid Use Disorders while the world grapples with the COVID pandemic?
Opioid Use Disorders also known as OUDs are equally a public health crisis like the COVID pandemic. Worse, with the shutdown, younger Nigerians now have to contend with boredom and this has caused an increase in illicit drug use and by proxy, OUDs. Furthermore, drug seeking behavior during periods of withdrawal has caused many addicted to opioids to flaunt the government shutdown mandates thereby causing the spread of COVID. Finally, OUDs can be fatal and that puts it up there in the hierarchy of importance.
What are Opioids?
Opioids are a diverse group of naturally occurring and laboratory synthesized chemicals which affect the brain by removing the sensation of pain. Morphine and codeine are naturally occurring while fentanyl, tramadol and others are synthetically designed in the laboratory.
Opioids are used medically to treat pain. Hence, why is a public health concern?
Though these drugs have been beneficial to patients who need them for the management of various chronic conditions causing pain e.g. cancer, chronic back pain, they have a euphoric effect on the central nervous system thus have the potential of addiction and abuse. This frequently occurs in non-medical usage. The recent COVID -19 epidemics have further exacerbated global rates of opioid and other substance use disorders.
I am trying to play the devil’s advocate here? Are OUDs a true problem in Nigeria?
The rising abuse of opioid abuse in Nigeria has constituted a public health emergency that requires concerted effort by various stakeholders to stem the increasing rates of abuse. A 2018 survey by the National Drug Law Enforcement Agency (NDLEA) reported that approximately 4.6 million Nigerians had used opioids non-medically in the previous year. This high prevalence of nonmedical use of opioids – 4.7 of the Nigerian adult population- puts Nigeria among the countries with high estimates of non-medical opioid use globally. Digging further into the demographics of the population most affected, the mean age of initiation of non-medically indicated opioid use was 21 years, with 80 % of those reporting usage in the study having used the drug for at least 12 years.
Can you educate us, the average Nigerian, about the group most affected by illicit use and the common opioids that are used in Nigeria?
The rates I alluded to in my last answer underscore the magnitude of the problem affecting the youthful population of Nigeria. The most abused opioids are tramadol, codeine and morphine. The availability of opioids through both legal and illicit channels has contributed to their widespread misuse. Over-the-counter availability and the black market exacerbate the problem.
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You talked earlier about the effect of COVID and boredom, are there other factors that have contributed or are contributing to this emerging epidemic?
Contributing factors to this problem include economic hardships and high unemployment rate may lead young adults to abuse these drugs as a form of escapism. Also, there is a lack of awareness and education as most users don’t know the dangers associated with its abuse including overdose related deaths, healthcare system challenges such as inadequate regulation and monitoring of prescription practices, as well as insufficient resources for addiction treatment and mental health support. These factors in combination hinder efforts to combat OUD.
What are steps that can be taken to curb the rise in opioid abuse in Nigeria?
Various steps have been taken by the Nigerian Government to reduce the rising prevalence of opioids abuse in the country, actions such as the banning the production and importation of certain opioid-containing medications like codeine syrup and tramadol while increasing public health education using different media. However, more needs to be done.
An important yet overlooked step in finding a lasting solution is the establishment of dedicated treatment facilities with the full complement of health professionals to provide healthcare services to individuals suffering from substance abuse but this must not be done in isolation as there has to be a community component to it for it to stand any chance of success. Enrolling individuals with opioid use disorder into treatment is a critical step in dealing with this wicked problem and reducing the demand for opioids. This requires multi-level collaboration and commitment from the three tiers of government. The smaller community mental health workers at the local level can serve as a link to these centers of excellence.
But many Nigerians would say that our healthcare system and infrastructure are still in the 20th century, how can we keep up with the developed nations so that these steps you have highlighted are brought to fruition?
I was just about to say there is a need to upscale the healthcare record infrastructure in the country, switching from a paper based medical record system to an electronic medical record system can lead to the institution of prescription monitoring drug programs as it is done in other parts of the world affected by the opioid crisis. This would help the tracking of opiates prescription and abuse pattern detection in real time by the attending health care practitioner. The danger of a blanket ban of opiates like tramadol is that it would fuel a black-market form of opiates like tramadol. Also, a significant effect of the ban is the lack of access to these drugs by patients who need them to improve their medical conditions.
What do you say to your fellow Nigerians?
Given the magnitude of this problem, not only in the present but for the future as the young population are one of the greatest asset any country can boast of, it is not only necessary but imperative for government at the federal, state and local levels to collaborate with relevant stakeholders to institute measures to stem the tide of opioid and by extension substance abuse in our country by adopting a holistic approach instead of focusing on the symptoms. This is not only necessary but imperative to safeguard the future of the country.
Out of curiosity, why has this topic become your passion?
I am a physician specializing in Obstetrics and Gynecology. During the pandemic, we have seen a surge in pregnancies and an accompanying increase in prenatal visits. Many of the pregnant women are brought to the clinic by their husbands and family members, and I observed an unusually high number of these accompanying visitors showing signs of opioid abuse. Even amongst our patients, there is an increase in prevalence rates of current and past abuse of opioids. That is why I am putting this out there. A stitch in time saves nine.
