‘PRESCRIPTION OF MEDICINES IN NIGERIA....ABUSE AND IMPLICATIONS FOR THE HEALTH OF NIGERIANS’

1. ‘PRESCRIPTION OF MEDICINES IN NIGERIA....ABUSE AND IMPLICATIONS FOR THE HEALTH OF NIGERIANS’ A PAPER PRESENTED BY DR. PAUL ORHII. JD,MD,Ph.D,OON DIRECTOR GENERAL (NAFDAC) AT THE PHYSICIANS WEEK 2012 ORGANISED BY NIGERIAN MEDICAL ASSOCIATION (NMA) OYO STATE BRANCH 23rd OCTOBER 2012

2. Definition A drug which can also be referred to as a medicine or medication is any substance of plant, chemical or animal origin or mixture of substances used in diagnosis, prevention, treatment and cure of diseases, abnormal physical state or symptoms of diseases in man or animals.

3. Classes of Medicines • Over The Counter (OTC) medicines which are sold at outlets such as patent medicine stores, supermarkets . • Prescription only medicines (POMs) whichcan only be sold and or supplied with a prescription written by an appropriate medical practitioner . • Pharmacy only medicines which can only be sold or supplied at a registered pharmacy premises or under the supervision of a pharmacist.

4. WHO CAN PRESCRIBE DRUGS? • Drugs should prescribed by authorized personnel such as a medical doctor, dentist, and in certain circumstances, a nurse • Only duly qualified and licensed medical practitioners shall have the authority to prescribe drugs in tertiary and secondary health care institutions. • Government shall designate appropriate health care personnel to prescribe drugs at the primary health care level • Only qualified and licensed medical practitioners shall have the authority to prescribe drugs in the private sector. Source: National Drug Policy 2003

5. WHO CAN PRESCRIBE DRUGS cont’d? • Prescriptions shall be made, using the International Non-Proprietary or Generic Names. • It shall be made in a manner to ensure that proper records are kept at the records and pharmacy departments of health care institutions in both private and public sectors Source: National Drug Policy 2003

6. Situation in Nigeria • Prescription of medicines is an all comers affair in Nigeria. Medicines are prescribed by: • Medical Doctors/ Dentists • Pharmacists • Nurses • Laboratory Technologists • Patent Medicine dealers • Hawkers • Relatives/ Friends • Self Over 50% of medicines are prescribed inappropriately by unauthorized people.

7. Factors That Contribute to Abuse of prescriptions • Ignorance • Poverty • Lack of knowledge and skills • Inadequate Health care providers in rural areas • Inadequate health care facilities • High cost of medical care • Profit • Unrestricted availability of medicines/ chaotic drug distribution system.

8. The prescription of medicines by medical personnel without adequate knowledge or by unauthorized personnel or leads to • Irrational use of drugs:- • Under dosage of medicines • Over dosage in some cases • Wrong medicines are prescribed • Wrong diagnosis of patients condition • Poly pharmacy • Overuse of antibiotics • Antimicrobial resistance • Overuse of injections when other dosage forms can be used • Adverse drug reactions

9. Treatment Failures • Organ Damage • Disability and/ or death • Self-medication • Drug Addiction • Eroded patient confidence in health care system • Loss of resources to both patient and the state These have Health, Social and Economic implications

10. HEALTH IMPLICATIONS Increase in cost of healthcare delivery due to treatment failures Increase in number of previously unknown diseases. Increase in permanent disability and or deaths. Loss of confidence in the healthcare system. Overstretching of the inadequate health care facilities. Increase in the development of new drug resistant strains of viruses, parasites and bacteria.

11. IMPLICATIONS ON THE ECONOMY Increase in number of people falling sick Permanent disability or death leads to reduction in the labour force in the country. Leads to loss of man hours at work ,affects productivity and earning capacity of the individual and nation. It leads to poverty and also perpetuates poverty especially amongst people living below poverty levels. Money needed for critical infrastructure used for treatment of diseases.

12. NAFDAC ACT • NAFDAC was established by Decree 15 of 1993 as amended now NAFDAC Act Cap N1 Laws of the Federation of Nigeria 2004 to amongst other things regulate and control the manufacture, importation, exportation, distribution, advertisement, sale and use of food, drugs, cosmetics, chemicals, detergents, medical devices and packaged water (regulated products).

13. NAFDAC as the National Drug Regulatory Authority in Nigeria promotes the rational use of drugs by • Registration of drug products to ensure the availability of good quality drugs that are safe and efficacious • Ensuring that adequate information is available on the package and information leaflets of drugs. • Bogus advertisement of drugs especially OTC drugs are not allowed.

14. Reclassification of certain drugs- codeine containing cough syrups (cccs)now pharmacy only and tramadol now prescription • Monitoring of adverse drug reactions by the National Pharmacovigillance Centre ( Yellow forms distributed to hospitals) • Collaborating with other regulatory agencies and stakeholders to ensure that a proper drug distribution system is in place in Nigeria. • Advocacy, meetings , workshops and sensitization programmes about rational drug use

15. Way Forward • Qualified medical practitioners should be willing to work in rural areas. • Capacity building through training of professionals to improve their skills • Enforcement of the laws by Government Agencies • Chaotic drug distribution system should be sanitized • Public awareness campaign about rational use of drugs • Collaboration amongst all health care providers

16. CONCLUSION • The prescription of medicines by authorized personnel with adequate knowledge is very critical in the provision of good quality health care . • It promotes rational drug use so that the appropriate drugs are given to patients in the appropriate dose and dosage form for the appropriate duration or time. • NAFDAC is always ready to collaborate with all stakeholders in ensuring the rational use of medicines in order to safeguard the health of the Nation.

17. THANK YOU