The open drug markets in the country have continued to escape shutdown despite efforts by the Federal Government to establish coordinated wholesale centres for drug marketers. DAYO OJERINDE writes From Lagos to Kano, Aba to Onitsha, open drug markets have continued to thrive in the country as many Nigerians rely on them to get their drugs not minding the health implications. Open drug market refers to uncontrolled and undefined buying and selling of medicine with or without proper approval. Researchers, Alex Harocopos and Mike Hough, in a publication, titled, ‘The Problem of Drug Dealing in Open-Air Markets,’ said drug dealing in open-air markets “generates or contributes to a wide range of social disorder and drug-related crime in the surrounding community that can have a marked effect on the local residents’ quality of life.” They wrote, “Open-air markets represent the lowest level of the drug distribution network. Low-level markets need to be tackled effectively not only because of the risks posed to market participants, but also to reduce the harms that illicit drug use can inflict on the local community.”
In Nigeria, an open drug market can be found at Enu Owa Street, Idunmota, Lagos; it can also be found at the Sabon Gari Market in Kano State, as well as Ariara Market in Aba, Abia State, among others. Efforts to shut the open drug markets across the country started on July 1, 2005, when the Federal Government, through its National Drug Distribution Guidelines, directed that all open drug pharmacies in marketplaces should be shut down.
In 2014, the Federal Ministry of Health also issued a June 30, 2014 deadline to the private sector for the establishment of the State Drug Distribution Centres by the state governments and Mega Drug Distribution Centres where drugs should be stored, monitored, distributed and sold under acceptable and ethical conditions. How safe are medicines from the open drug markets? The National Chairman of the Association of Community Pharmacists, Mr Samuel Adekola, in an interview with our correspondent, noted that the open drug markets were not the best for Nigerians.
We know that open drug markets are not the best for Nigeria because of how the drugs are sourced. The government has been coming up with policies to address it, but you know that nature abhors a vacuum, so once there is no alternative, these markets crop up because people must use drugs. “Policies of the government must support alternatives which will make the drug distribution process/system in Nigeria a regulated and sanitised one. The whole essence of this is to save society from fake and adulterated drugs because the burden of fake drugs on citizen’s health and the economy is huge. Today, 70 per cent of deaths in the hospitals arise from drug misuse or fake drugs,” Adekola said
He alleged that many hospitals made money by patronising the open drug markets because it was cheaper. “Some doctors do not care what happens to the patients afterward because if they sell a drug to them and it doesn’t work, they’ll come back for another treatment, and if they die, it doesn’t matter to them. This is the challenge; the patients and the economy suffer where open drug market thrive,” Adekola said.
The ACPN National Chairman urged the Federal Government to guarantee safe drugs for Nigerians. Adekola believes the Federal Government must take deliberate actions to make medicine safe for all Nigerians. Some of the ways to make safe drugs available to Nigerians, according to him, is to make sure that manufacturers and importers have original drugs and distribute it through the proper channels. “The Pharmacy Council of Nigeria decided that since the original plan of disbanding the open drug markets isn’t working, an alternative approach was needed. They came up with the policy of coordinated wholesale centres. Under the proposed system, those in the open drug market who are doing legitimate business will be brought together so they can be regulated. So, before a product comes into and leaves these coordinated wholesale zones, they will be scrutinised by the appropriate regulatory bodies.
Unfortunately, the government has not provided the incentives, like cheap capital, that will encourage the achievement of this plan and the establishment of these centres in all the geo-political zones. In Lagos, for example, the marketers have spent so much money and resources to acquire land to build the coordinated wholesale centre, but the government is not assisting them.” Adekola urged the president, Major General Muhammadu Buhari (retd.), to sign the pharmacy law to address the loopholes in the pharmaceutical industry in the country.
Closing open drugs markers require political will – PMG-MAN The Executive Secretary, Pharmaceutical Manufacturers Group of Manufacturers Association of Nigeria (PMG-MAN), Mr Frank Muonemeh, in an interview with our correspondent advised the Federal Government to implement the policy on open drug markets and also reduce the importation of drugs, pointing out that such would curb the menace of fake and substandard drugs. “The government should do the right thing, they should live up to what they want to do with the open drug markets. If you say this is what you want to do, go ahead and carry all stakeholders along. This thing has so much to do with the political will; it is a systematic problem, but as a businessman you look at how your business will survive. They (open drug marketers) are the biggest influencers in everything. Most of them are the biggest distributors of drugs in the country.
The professional pharmacists don’t have the money to compete with them; unfortunately, the government cannot do the needful because so many things exchange hands. Also, the issue of fake drugs boils down to political will. Except the people of a nation exert sufficient input on the medicines they consume are produced and even the distribution of these medicines, all these English they speak on safe medicines, access to affordable medicine will continue to be rhetorics and a mirage. “The government should pay attention to local pharmaceutical companies, give them funds, set up policies that will encourage them as every other countries do. Our population should not just be an advantage to other countries, let us be the ones to take advantage of it. The reason why we should pay attention to medicine security which can only be guaranteed is if Nigerians are the ones in charge of the drugs we produce in Nigeria,” Muonemeh said.
The PMG-MAN Executive Secretary opined that at least 70 per cent of drug consumed by Nigerians should be manufactured locally while 30 per cent of those drugs could be imported.
The Director, Public Affairs, NAFDAC, Dr Abubakar Jimoh, in an interview with our correspondent, said successive administrations in the country had tried to close the open drug markets, but they had not been able to achieve the desired result.
He said, “The open drug market as we have it now in the country is chaotic to some extent, especially the distribution system. It is something Nigeria has been battling with from one administration to another. It didn’t just occur now, it’s a recurring decimal. Before now, many administration has promised to destroy the market and they failed to. But in recent times, there has been a paradigm shift in the government approach towards dismantling the market. “The government believes in its wisdom that as chaotic as the open markets are, they are also serving a purpose and before we dismantle them, there must be a viable alternative so that we don’t cause scarcity that will be detrimental to our public health care system in Nigeria. If we close up the open drug markets in Nigeria, which is also serving the West Africa Sub-Region, then we are going to cause havoc.
Coordinated wholesale centres under construction nationwide’ Jimoh added that the coordinated wholesale centres that would replace the open drug markets were under construction nationwide. “What the current administration is embarking on is a gradualist approach towards annihilating the market. We don’t want to take a military approach and suddenly shut down the market, the government is very conscious of the effect on the health care delivery system. That is why the government is making a conscious approach. That conscious and gradualist approach is to ensure that we set up the coordinated wholesale centres which have commenced by bringing in the private sector partnership so that they take ownership of that. We have in Kano, Anambra and some other places; they are still under construction and even the current Director-General of NAFDAC, Prof. Mojisola Adeyeye, has opened up the discussion with the Kano State Government and they took us to the site of the centre which is under construction
These markets, particularly that of Kano, have their challenges; the funding and the contractor challenges that are hindering them from meeting the target date of completing the market. It is only when the market is completed that you can dismantle the current chaotic market that we have. That is why the Federal Ministry of Health has continued to shift the terminal date often to ensure they comply. It does not just lie squarely with the Ministry of Health, there are so many other interests that are also participants with the whole process of getting everything right,” Jimoh said.
One in 10 drugs sold in developing countries is fake or substandard – WHO According to statistics released by the World Health Organisation in 2017, one in 10 drugs sold in developing countries is fake or substandard, leading to tens of thousands of deaths. The WHO, according to research published on its website said fake or substandard drugs are growing threats as increased pharmaceutical trade, including internet sales, open the door to sometimes toxic products.
Some pharmacists in Africa, for example, say that they are compelled to buy from the cheapest but not necessarily the safest suppliers to compete with illegal street traders. “Fake drugs could contain incorrect doses, wrong ingredients or no active ingredients at all. At the same time, a worrying number of authorised medicines fail to meet quality standards because of improper storage and other issues,” WHO said. The WHO Director-General, Dr Tedros Adhanom Ghebreyesus, said on the website of the world health governing that substandard and falsified medicines particularly affect the most vulnerable communities.
He said, “Imagine a mother who gives up food or other basic needs to pay for her child’s treatment, unaware that the medicines are substandard or falsified, and then that treatment causes her child to die. This is unacceptable. Countries have agreed on measures at the global level – it is time to translate them into tangible action.” Fake, substandard drugs extremely dangerous, says Expert A professor of public health at the University of Ilorin, Tanimola Akande, in an interview with our correspondent said fake and substandard drugs are extremely dangerous to individuals who take them and have serious effects on the health system.
“The ailment that is being treated will worsen because the drug is not treating the disease and in a number of cases lead to death. The fake and substandard drugs in themselves are hazardous to the body and may lead to other ailments like affecting other organs of the body like the kidney, heart, liver, etc. “Patients who are on such fake and substandard drugs often do not know and they keep thinking they will be well while the disease will be worsening. Unfortunately, these fake and substandard drugs are very common in Nigeria. If the disease can be transmitted to another person, the spread will be worse. Often it leads to patients reporting back when their condition is already bad
“Fake and substandard drugs contribute immensely to drug resistance. This is well known. The microbes because they are not killed by substandard drugs become even resistant to the same drugs and it will require much stronger drugs to kill those microbes. The stronger antibiotics are often costly. Some popular antibiotics used over the years are no longer effective these days because of the preponderance of fake and substandard drugs,” Akande said. The public health expert added that it might be difficult to identify fake medicine, but warned people to pay close attention to the drug they use whenever they are sick.
He said, “It is difficult for ordinary Nigerians to recognise these drugs. Some analysis of the content of the drug is required to confirm that a drug is fake or substandard. However, one can suspect fake and substandard drugs; they are usually sold by quacks, patent medicine stores, sometimes in markets and buses. They may not have NAFDAC number or are labelled with fake NAFDAC number. They are often cheaper than standard drugs. “One can also suspect when with the use of such drugs the condition doesn’t appear to be better or other symptoms are coming up. There are some trusted pharmaceutical products that can hardly be substandard because the manufacturers are well known reputable pharmaceutical companies. Most of the fake and substandard drugs are often from some Asian countries.”