Drug abuse in Nigeria: a review of epidemiological studies
Other epidemiological evidence
Author: A. O. PELA, J. C. EBIE
Pages: 91 to 99
Creation Date: 1982/01/01
J. C. EBIE
Department of Mental Health, University of Benin, Benin City, Nigeria
There is no universal agreement on the definition of the term "drug abuse'". For example, Edwards and Arif [ 12] defined it as "the use of a drug which is viewed as posing a problem by the society concerned". Other authors have defined it as the unspecified use of a drug other than for legitimate purposes. Using this latter definition, substances reported to have been abused in Nigeria include, among others, antibiotics, antidiarrhoeals, laxatives and pain-relieving drugs [ [ 9] , [ 23] ]. Most societies do not usually disapprove of the abuse of drugs which do not produce overt behavioural changes, and as a result this presentation is restricted to the abuse of drugs which affect behaviour.
* Paper delivered at the Nigerian Training Course on Drug Dependence, organized by the International Council on Alcohol and Addictions and the Addiction Research Foundation of Ontario, Canada, in co-operation with the Department of Mental Health, University of Benin, Benin City, Nigeria.
Some dependence-producing drugs such as sedative-hypnotics which have been accepted for medical use and are known to be widely abused do not carry the same amount of adverse publicity as amphetamines, which have also been accepted for medical use. This is either because sedative-hypnotics do not frequently produce bizarre overt behavioural changes or because import restrictions on these substances are lax. In contrast, the importation of amphetamines and narcotics into Nigeria is prohibited except through the Federal Ministry of Health. There is, however, need for concern about the use of sedatives since these drugs are, to a large extent, imported both legally and illegally. "The cost of importing sedative-hypnotics into Nigeria legally in 1977 was twice the cost of all other drugs imported into Nigeria" [ 25] . The increasing number of reports of attempted suicides by ingesting sedatives in combination with tranquillizers is also a reason for concern about the abuse of these drugs.
In Nigeria, emphasis is placed on cannabis abuse since it is frequently reported to be associated with drug-induced psychosis [ [ 5] , [ 19] , [ 20] , [ 21] , [ 22] ]. As far as the authors know, however, there is little evidence about the cause and effect relationship between abuse of cannabis and the occurrence of psychosis in drug abusers in Nigeria.
What is known about drug abuse in Nigeria is as a result of research with little or no financial support, and from a public outcry through the mass media about "deviant behaviour" of adolescents because of drug abuse. Although these reports all seem to agree on the classes of drugs abused, the changing patterns in drug use and other epidemiological data, the lack of a uniform reporting system has tended to mask the increasing danger posed by the abusers of drugs such as narcotics [ 11] . The authors are of the opinion that this state of affairs is due to the fact that abuse of substances such as cocaine, heroin and lysergic acid diethylamide (LSD) has not yet permeated the adolescent population. Research findings, for example those of Anumonye [ 5] , Ebie and Pela [ 10] , and Nevadomsky [ 17] , supported this view in that some students in their surveys who had heard of these substances claimed not having seen or used them. Ebie and Pela [ 11] , however, reported the organization of "cocaine parties" by some well-placed Nigerians in collaboration with non-Nigerians in Benin City. Ahmed [ 1] also reported the use of cocaine in Kaduna. These separate observations raise serious questions about security measures at the various ports of entry into Nigeria.
What has consistently emerged from work done in Nigeria is that substances of abuse of any major importance are cannabis, benzodiazepines, barbiturates, amphetamines and alcohol. A brief review of the abuse of these drugs is as follows:
In Nigeria cannabis is known by various names including "pot", "igbo", "wee wee", "marijuana", "ganja" and "Morocco". The active ingredient in all of these is tetrahydrocannabinol (THC). The mode of consumption in Nigeria is by smoking the prepared leaves and flowering seeds. There has been no reported use of other preparations.
There are no known medical uses of the drug in Nigeria. The effects, which appear to depend on the potency of the preparation and the amount consumed, are both physiological and behavioural. Although some authors have associated smoking of cannabis with the genesis of mental illness, we shall not enter into the controversy over the degree of harmfulness, since relevant data on this issue are scanty in Nigeria.
Since the use of barbiturates and non-barbiturate sedatives poses similar problems and since these substances are used for medical purposes, they are discussed as sedatives in this paper. Research findings in Nigeria [ [ 5] , [ 17] ] are in agreement with the fact that the extent of dependence on sedatives is second in rank only to dependence on alcohol [ 4] .
It is interesting to note that there are changing patterns in the abuse of sedative-hypnotics. Earlier reports from Nigeria, notably by Olatawura and Odejide [ 23] and Akindele [ 3] , indicated widespread abuse of methaqualone in combination with diphenhydramine (Mandrax) by secondary school students. Recent reports, particularly those from clinical settings, indicate that the abuse of benzodiazepines and barbiturates is widespread. The abuse of a barbiturate referred to by the drug-using culture as a "Chinese capsule" has been widely reported. A preliminary sample analysis indicated that it was either secobarbital or quinobarbital.
Medically, these drugs are prescribed to induce sleep, relaxation and relief from tension or anxiety. Interestingly, those who abuse them do so not only for these reasons but also to increase intoxication when used together with alcohol. These drugs have been associated with cases of attempted suicide in Nigeria [ [ 6] , [ 7] ].
Although not an amphetamine, Proplus 1 is a preparation marketed for alertness and revitalization. The amphetamines which are available in Nigeria are dextroamphetamine sulfate (Dexedrine) and methamphetamine hydrochloride (Methedrine). The abuse of methylphenidate hydrochloride (Ritalin) has also been reported.1
A preparation containing 50 mg caffeine per tablet.
The legal importation of amphetamines is controlled by the Ministry of Health. Although the medical use of such drugs is not approved, they are prescribed and dispensed by medical doctors and pharmacists to patients for weight-control purposes. Because of the poor enforcement of unclear drug laws, these drugs have found their way into Nigeria via illegal routes and are widely marketed by patent medicine dealers.
Eferakeya [ 13] observed in 1980 that the Narcotics Division of the Federal Ministry of Health asserted that information from a World Health Organization (WHO) committee on drug dependence showed that the volume of amphetamines entering Nigeria had increased by 100 per cent since 1971. Most reports [ 5] , [ 10] from Nigeria claim a fairly low use of this drug by the sampled population, thus it is difficult to explain where the bulk of the users are. It is possible that the section of the population which uses amphetamines has never been studied. Apart from reports from clinical practice implicating truck drivers, farmers and other adults, no attempt has been made to study samples of the general population in order to determine the extent of amphetamine abuse.
The astronomical increase in the number of breweries in Nigeria (over 16 at the last count), has brought, on the one hand, considerable economic rewards to Government and investors, while, on the other, it is beginning to cause concern over alcohol-related problems and their attendant economic, social and medical adverse effects upon the individual, family and community.
The abuse of cocaine, volatile solvents, heroin and LSD is not widespread. Few authors have mentioned the use of some of these drugs in adult populations [ 1] , [ 3] , [ 11] . The likelihood that large-scale abuse of these substances will spread to the adolescent population cannot be overlooked, however, considering the influx of semi-skilled expatriate workers and the desire of the young to experiment.
The potential abuse of volatile solvents in some occupational groups such as car mechanics, welders, artisans and petrol station attendants cannot be ruled out in view of their close contact with such substances and poor emission control regulations. The spread of volatile substances to the schools is a logical sequence, bearing in mind the fact that a sizeable number of the skilled labour force are young adults and adolescents.
Findings from hospital statistics and the few available epidemiological surveys show that the abuse of drugs, especially of the cannabis and stimulant types, have involved adult populations [ 8] , [ 16] , young adults between 21 and 25 years of age [ 19] and children of school age [ 5] . Reports on drug experimentation have shown that children as young as 11 years of age have experimented with one form of drug or another [ 1] , [ 17] .
Young men are usually more prone to drug abuse, particularly cannabis, than women [ 9] , [ 17] , although there have been reports that an increasing number of young women are using cannabis. The abuse of stimulants has been largely reported among students [ 5] , [ 15] , [ 21] , farmers [ 24] and labourers [ 24] . The proportion of women reportedly abusing sedative-hypnotics is higher than men [ 9] , [ 17] . Earlier findings on the problem of alcohol abuse showed that it was a problem of middle-aged people [ 7] , [ 18] ]. Recent epidemiological data have revealed, however, that alcohol abuse is becoming a problem in the adolescent and young adult group as well, with a narrowing of the sex differential [ 9] , [ 17] .
Studies carried out in the east [ 14] , west [ 5] , [ 10] , [ 17] , [ 19] , [ 21] , and north of Nigeria [ 2] , [ 24] , have shown that there is apparently no relation either between ethnicity and the type of drugs abused or the reason for, or patterns of abuse in Nigeria. Religion has also not been found to be a factor in drug abuse.
Studies on the influence of socio-economic status and the abuse of substances have been contradictory. In 1974, Akindele found that drug abuse, mainly of cannabis and amphetamines, was more prevalent among privileged youths [ 3] . Two years later, Odejide and Sanda [ 19] reported from the same geographical location a relationship between social class and drug use, and parental deprivation and drug use. In his study of a different geographical area, however, Nevadomsky [ 17] did not find social class to be a factor in drug use. Thus, the abuse of drugs has been reported among children of the rich and poor alike, among urban and rural adolescents and among highly literate and illiterate individuals. While the widespread belief is that the abuse of drugs, mainly of cannabis, is restricted to the poor and illiterate, findings by Akindele [ 3] and Asuni [ 7] and the more recent clinical observation that approximately 70 per cent of cases of toxic psychosis are from wealthy homes, indicate that apart from what is termed a "vulnerability" factor in predisposition to psychosis resulting from drug abuse, there are factors referred to as the "set" and "setting" of the potential user.
Anumonye [ 5] , Ebie and Pela [ 10] , Nevadomsky [ 17] and Ogunremi and Rotimi [ 22] investigated the patterns of drug use. These studies did not reveal any degree of consistency in the pattern of abuse of specific drugs for a protracted period of time. Most of the research, particularly the surveys of student populations, showed that the majority of the subjects were occasional drug users [ 17] . Obviously, survey data provide a different type of information from clinical data, which focus only on a highly selected population. It appears, however, that the trend in substance abuse is shifting from single-substance use to the use of two or more substances in combination. Reports from patients suggest that alcohol is used more frequently than any other drug, and is combined with other substances (mostly with cannabis and sedative-hypnotics) to enhance the euphoric effect of the substance.
Looking at the source of initial drug contact and use and the reason for first drug use, Anumonye [ 5] , Ebie and Pela [ 10] , Nevadomsky [ 17] and Ogunremi and Rotimi [ 22] showed that the source of drugs were clandestine agents, home medicine chests at home, open markets, chemist shops and cannabis farms. Factors predisposing to initial drug use included curiosity, enjoyment, peer group pressure, conflicts with parents (anti-establishment revolt), academic pressure, loneliness and, to a minor extent, fatigue. Apart from these reasons, the authors shared Anumoye's [ 5] and Nevadomsky's [ 17] views that the period of integrating the physiological with the psychological self was an important factor. Thus, the period from 10 to 12 years of age and from 15 to 17 years of age are extremely important in adolescent psychology. These are periods when Nigerian children make the transition from primary to secondary education and from secondary education to post-secondary education. In addition to the anxieties of academic success, it is a time when they are exposed to numerous pressures from parents and peers and when they undergo considerable physiological changes. Nevadomsky [ 17] advanced a theory to explain how this change could contribute to the development of the drug-use habit in a psychologically vulnerable individual. He stated, "Small-scale societies have normally been adept at coping with transitional statuses, through rites of passage or age grading, by arranging marriages and delimiting friendship cliques, and providing that sense of security that comes through adherence to age-old principles and regulations. In modern society, on the other hand, stratification, individualism, intergroup tension, uncertainty and inhibitions predominate. Such factors make difficult the attainment of an easy, non-competitive friendship situation based on trust which is a pre-requisite for interpersonal relaxation. People Caught in this situation thus resort to drugs to achieve their aims."
Although there are no studies establishing a direct cause and effect relationship between drug abuse and criminality in Nigeria, some authors [ 15] , [ 24] have shown that cannabis abuse is associated with cases of murder and sexual abuse.
With respect to treatment modalities in drug abuse victims, there is little available information. Management of the victims of drug abuse is patterned after the medical model and little attempt is made at rehabilitation or in promoting "serious" attempts at stopping the habit. The literature revealed that there had been no studies in the treatment and problem of relapse m toxic psychosis except for Pela's paper on a behaviour modification approach to rehabilitation and management [ 26] .
In conclusion, the abuse of narcotic drugs does not appear to be as serious a problem in Nigeria as it is in some other countries. In a clinical setting a great deal of psychosis associated with the use of cannabis and amphetamines is seen. The extent of the use of these substances in the entire population is not known. Sedative-hypnotics and alcohol are freely available and are used. There is a trend towards a gradual decrease in the age of initial exposure to drugs, and multiple drug abuse is becoming common.
The epidemiological information provided in this report has been put together from various fragmented researches. There is the need to organize epidemiological surveys that will incorporate most of the core items in any epidemiological study on substance abuse. While the authors seem to be preoccupied with the prevention of drug abuse in Nigeria, there is no reporting system in the country by which trends in drug abuse can be monitored. There is a need to set up a drug abuse information centre which should co-ordinate not only the collection of epidemiological data but also be charged with implementing a reporting system and applying a timely multi-disciplinary approach in the control of substance abuse.
Ahmed, M. Personal communication, 1981.002
Ahmed, M. and M. O. Akindele. Drug abuse as seen in the psychiatric unit of Ahmadu Bello University Hospital, Kaduna. In Proceedings of the Workshop of Association of Psychiatrists in Africa, held in Nairobi, Kenya, 1974. By Eva Tongue, ed. Lausanne, International Council on Alcohol and Addictions, 1974, pp. 102 - 104.003
Akindele, M. O. Students and drugs: a study of 39 problem cases. Paper presented at the Nigerian Medical Association Annual Conference, Enugu, Nigeria, 25 April 1974.004
Anderson, D. and P. Solomon. Drug dependence. In Handbook of psychiatry. By P. Solomon and V. D. Patch, eds. Los Altos, California, Lange Medical Publishers, 1974, pp. 314 - 332.005
Anumonye, A. Drug use among young people in Lagos, Nigeria. Bulletin on narcotics (United Nations publication), 32:4:39 - 45, 1980.006
- Patterns of suicidal behaviour in Lagos. Proceedings of 6th Annual Scientific Conference of Association of Psychiatrists in Nigeria, Ibadan, 1975.007
Asuni, T. Pattern of alcohol problems as seen in the Neuro-Psychiatric Hospital, Aro. Abeokuta: 1964 - 1973. In Proceedings of the Workshop on Alcoholism and Drug Addiction in Africa, held in Nairobi, Kenya in 1974. By Eva Tongue, ed. International Council on Alcohol and Addictions (Lausanne), 1974, pp. 66 - 70.008
Boroffka, A. Mental illness and Indian hemp in Lagos, Nigeria. East African medical Journal (Nairobi) 43:377 - 381, 1966.009
Drug habits of teenagers and young people in tropical Africa, compared with other developing and developed countries. By A. Olatunde and others . In Selfmedication: benefits, precautions and dangers. London, Macmillan Press, 1979, pp. 24 - 41.010
Ebie, J. C. and O. A. Pela. Some aspects of drug use among students in Benin City, Nigeria. Drug and alcohol dependence (Lausanne) 8:265 - 270, 1981.011
- Some socio-cultural aspects of the problem of drug abuse in Nigeria. Drug and alcohol dependence (Lausanne) 8:301 - 306, 1981.012
Edwards, G. and A. Arif, eds. Introduction to: drug problems in the socio-cultural context: a basis for policies and programme planning. World Health Organization Offset Publication No. 73. Geneva, 1980, p. 18.013
Eferakeya, A. E. Drug abuse. Paper presented at the symposium of the Pharmaceutical Society of Nigeria, Bendel State Branch, 1980.014
Ilo, M. O. Drug dependence: a personal view from Enugu. Journal of the society of health (Lagos) 10:2:57 - 59, 1975.015
Lambo, T. A. Economic and social aspects of drug abuse in Africa. Unpublished mimeographed report, 1964.016
- Schizophrenic-like psychoses associated with amphetamine intoxication in African students. Dokita (Ibadan) 2:33-37, 1961.017
Nevadomsky, J. Patterns of self-reported drug use among secondary school students in Bendel State, Nigeria. Bulletin on narcotics (United Nations publication) 33:1:9 - 19, 1981.018
Odejide, A. O. Alcoholism: a major health hazard in Nigeria. Nigerian medical Journal (Ibadan) 8:230, 1978.019
Odejide, A. O. and A. O. Sanda. Observations on drug abuse in western Nigeria. African journal of psychiatry (Lagos) 2:2:303 - 309, 1976.020
Odiase, G. I. Marital status and mental illness among psychiatric inpatients treated at University of Benin Teaching Hospital over a six-year period (1973 - 1979). Paper presented at the 1st Annual Conference of the Nigerian Association of Clinical Psychologists, Benin City, Nigeria, 18 - 19 April 1980.021
Ogunremi, O. O. and F. E. Okonofua. Abuse of drugs among Nigerian youths: a university experience. African journal of psychiatry (Lagos) 3:314:107 - 122, 1977.022
Ogunremi, O. O. and D. O. Rotimi. The Nigerian teenager and the use of drugs. African journal of psychiatry (Lagos) 5:1 - 2:21 - 29, 1979.023
Olatawura, M. O. and A. O. Odejide. Prevalence of drug taking among secondary school students: a pilot study. In Proceedings of the Workshop on Alcoholism and Drug Addiction in Africa, held in Nairobi, Kenya, 1974. By Eva Tongue, ed. Lausanne, International Council on Alcohol and Addictions 1975, pp. 71 - 77.024
Oshodi, C. O. Drug dependence and addiction in Kaduna 1970 - 1972. Paper presented at the Annual Conference of the Association of Psychiatrists in Nigeria, Benin City, 1973.025
Pela, O. A. Drug use: a socialization process. Paper presented on children's day celebration. Benin City, Nigeria, Anglican Women's Teachers' College, 22 May 1980.026
- Relaxation-subliminal stimulation - encountering with drug abuse: a behavioural approach. Paper presented at the 1st Annual Conference of the Nigerian Association of Clinical Psychologists, Benin City, Nigeria, 18 - 19 April 1980.