Codeine Ban: Is Tramadol Next?, By Kayode Ojewale
This is…calling on the government through its appropriate authorities, ministries and enforcement agencies to take drastic actions by arresting this increasing ugly trend of some OTC and ‘Behind-the-counter’ drugs being abused in the country.
The misuse, abuse of, and overindulgence in drugs have become common occurrences in all age groups but are more prevalent in adolescents and adults. Some become addicted to certain drugs unconsciously and others consciously. To abuse a drug simply means to use the drug for non-medical purposes. For example, taking a drug only for the effect it produces is an outright abuse of such drug and can eventually lead to addiction with time. One, however, can become addicted unknowingly by administering such drug without a resultant cure for the intended illness. Since it has been established that drug addiction is a substance use disorder (SUD), then it is important to state and make some clarifications on such substances, which can potentially cause disorders when misused or abused.
Drugs can be classified on the basis of addiction, treatment and rehabilitation, into five categories: narcotics, depressants, stimulants, hallucinogenics and anabolic steroids. Narcotics are pain relieving drugs which work by inducing sleep, numbing, deadening and dulling the senses. Hence these drug category is said to comprise controlled substances. Drugs can also be categorised into two on the basis of prescription: Over-the-Counter drugs and ‘Behind-the-Counter’ drugs. OTC drugs are those that are available to people without a prescription. Illnesses associated with certain symptoms like colds, diarrhoea, acne and others can be treated with OTC medicines. However, some OTC drugs have potential for misuse when overdosed on. ‘Behind-the-counter’ drugs are available for sale only and strictly by prescription. The commonly misused OTC drugs are dextromethorphan (a cough suppressant and active ingredient in cough syrup) and loperamide (an anti-diarrhreal ingredient).
Three types of OTC cough medicines exist – expectorants (with guaifenesin-active ingredient), suppressants (comprising dextromethorphan, camphor, menthol and eucalyptus oil as ingredients), and combination cough syrup products, which contain both guaifenesin and dextromethorphan. However, codeine (a narcotic pain-reliever and cough suppressant) is also added to cough medicine preparations. It is used as anti-tussive (to relieve cough) and as analgesic (to relieve pain) and sometimes mixed with aspirin. But this codeine-containing cough syrup is usually abused and misused because of its high addictive and habit-forming potential, inducing psychosis, which is a severe mental disorder involving physical damage to the brain, and marked by a deranged personality and distorted view of reality. Teens take large doses of codeine-containing cough syrup to make them go ‘high’ and experience states of hallucination, delusion and paranoia. Experts also say that codeine causes sedation and drowsiness. The excessive intake of codeine can cause organ failure and brain impairment. Dextromethorphan suppresses cough about half as effectively as codeine does but with little addictive potential, due to its low narcotic activity.
Tramadol may be habit-forming even at normal dose, how much more its dangers when abused and overdosed, as the fatal side effect of misused or overdosed Tramadol, like any other narcotic, may lead to reduced breathing, seizure (convulsion) and eventual death.
Another drug that is alarmingly being abused is Tramadol – a synthetic analgesic opiate used for the relief of pain. Tramadol is said to be a narcotic analgesic because it works in the body to change how it feels and responds to pain. Analgesics are pain relieving drugs, e.g paracetamol and aspirin, while narcotics are drugs that work by affecting (dulling) the user’s sense of pain, and are called brain receptors e.g codeine and morphine. No narcotic pain medication (e.g. Tramadol) should be sold over-the-counter by pharmacists but it is unfortunate that Tramadol can readily and easily be purchased without a prescription in most pharmacies in Nigeria. A friend once told me that some teens take high doses of Tramadol to numb and deaden their appetite for food. Those teenagers, as reported, when they take excess doses of tramadol, may not go hungry for the next 24 hours or more, which is quite shocking! Another close contact once reported having no appetite for food all day after taking the recommended dose of Tramadol. It is recommended that Tramadol should not be given to children under the age 12, pregnant women, breast-feeding mothers and people allergic to it or people with severe asthma or breathing problems. Tramadol may be habit-forming even at normal dose, how much more its dangers when abused and overdosed, as the fatal side effect of misused or overdosed Tramadol, like any other narcotic, may lead to reduced breathing, seizure (convulsion) and eventual death.
This is therefore calling on the government through its appropriate authorities, ministries and enforcement agencies to take drastic actions by arresting this increasing ugly trend of some OTC and ‘Behind-the-counter’ drugs being abused in the country. As done in the case of codeine, when a BBC documentary aired on April 30, 2018 allegedly implicated an official of the Emzor Pharmaceutical company selling quantities of a codeine-based cough syrup without prescription, leading the federal government to act swiftly with a ban on the production and importation of codeine on May 1, 2018. This directive by the government was subsequently followed by some findings, investigations and inspections carried out by officials of the National Agency for Food and Drug Administration and Control (NAFDAC) at the pharmaceutical firms which were implicated in the BBC documentary on the codeine abuse crisis.
We should recall that on Tuesday May 8, 2018, the Nigeria Customs Service at Tincan Island port said it intercepted and seized two containers laden with 225mg of Tramadol Hydrochloride valued at N124 million packaged as electrical materials – revealing the height of human desperation!
On May 7, 2018, NAFDAC shut down all the product lines of three companies – Peace Standard Pharmaceutical Limited and Bioraj Pharmaceutical Limited (both in Kwara State) and Emzor Pharmaceutical industries Limited (Lagos State). Embargo was placed on these three companies because they could not provide the required documents to NAFDAC officials during an inspection of their facilities. However, on May 12, 2018, the shutdown order by NAFDAC was lifted on the affected three companies but they were penalised with administrative fines for their respective violations. However, the ban by Federal Ministry of Health on the production and importation of codeine-containing cough syrup still stands.
We should recall that on Tuesday May 8, 2018, the Nigeria Customs Service at Tincan Island port said it intercepted and seized two containers laden with 225mg of Tramadol Hydrochloride valued at N124 million packaged as electrical materials – revealing the height of human desperation! Government agencies like the National Institute On Drug Abuse (NIDA), National Institute of Health (NIH), National Agency for Food and Drug, Administration and Control (NAFDAC), National Drug Law Enforcement Agency (NDLEA) and, of course, the Federal Ministry of Health should do more by putting mechanisms in place to regulate the production, distribution, Sale and use of drugs nationwide.
Kayode Ojewale, an industrial chemist wrote from Idimu, Lagos; Email: email@example.com.