Introduction

Drug abuse is both a global health and social problem with distinct conditions and problems that vary from place to place (WHO, 1987). According to the diagnostic and statistical manual of mental edition (5th ed.) of the american psychiatric association, drug or substance use disorder is a pattern of symptoms resulting from the use of drugs, despite the clear problems associated with using them. The continuous use of psychoactive substances among adolescents and youths has become a public concern worldwide because it potentially causes deliberate or indeliberate harm or injury (Whichstrom & Hegna, 2003; Daane, 2003).

Drug abuse, including drug addiction and trafficking, has a universal ramification that transverses socioeconomic, religious, cultural and ethnic boundaries (Oyakhilome, 1990). The Nigerian Government and the National Drug Law Enforcement Agency (NDLEA), through policies, have tried to stem its tide in the country but despite these efforts, there has been a consistent rise in the number of cases especially among adolescents (10-25 years of age) (NDLEA, 2012). During adolescence, experimentation with drugs is quite common in Nigeria because at this age, these young people desire to explore due to curiosity, pressure from peers and to “relieve” stress. The use of gateway drugs such as alcohol and tobacco from an early age increases the risk of using other hard drugs later. Some adolescents may experiment with drugs and stop (or continue to use them occasionally) without having negative complications while others develop an addiction that makes them susceptible to other dangerous drugs and cause significant harm to themselves and possibly family/community members (National Institute on Drug Abuse, 2003).

Burden of Drug Abuse

Image 1: Number of deaths from substance disorders in the world (IHME, 2017)

Image 1 shows the number of deaths worldwide from substance use in the year 2017. Alcohol abuse was the leading cause of death (184,934 deaths), followed by opioid use (109,520 deaths) and other illicit drugs (46,270 deaths).

Image 2: Prevalence of drug use in Nigeria by geopolitical zones and states (UNODC, 2017)

Image 2 shows the distribution of drug use in Nigeria. States like Oyo, Lagos, and Gombe have a high prevalence. The south west zone has the highest prevalence of drug use with approximately 22% compared to the North-Central zone at about 10% prevalence rate.
The UNODC reported that in 2013, over 246 million people used drugs illicitly, with 27 million people having drug use disorders and about 400,000 deaths resulting from drug use. Furthermore, there has been an unprecedented increase in the number and non-medical use of synthetic psychoactive substances between 2005 and 2015 (UNODC, 2015). The problem of drug abuse poses a significant threat to the social, health, economic status of the families, society and the entire nations (Giade, 2012; Oshodi, Aina & Onajole, 2010). Almost every country in the world is affected by one or more drugs being abused by citizens (UNODC, 2007). Drug abuse globally has resulted in increased violence and crimes, higher prevalence in Hepatitis B and C virus, HIV/AIDS, and collapse in the social structure (UNODC, 2007; Oshodi, Aina, & Onajole, 2010). A report in 2010 established a link between cultism/violent behavior and drug abuse in secondary schools and tertiary institutions in Nigeria (Abudu, 2008; Oshodi, Aina, & Onajole, 2010).

Examples of drugs include: tobacco, Indian hemp, cocaine, morphine, heroin, alcohol, ephedrine, caffeine, barbiturates, and amphetamines (see image below). A study on perception of drug abuse amongst Nigerian undergraduates, identified dependence and addiction as some of the major consequences of drug abuse, characterized by compulsive drug craving seeking behaviours that persist even in the face of negative consequences (Oshikoya and Alli, 2006;Oshodi, Aina, Onajole, 2010). These changes are maladaptive and inappropriate to the social or environmental setting, therefore may place the individual at risk of harm. In the image below, it is quite evident that young adults between the ages of 25 – 39 constitute the bulk of drug abusers in Nigeria with cannabis, pharmaceutical opioids and cough syrups being the highest abused substances.

Image 3: annual prevalence of drug use by age group in Nigeria (UNODC, 2017)

Image 4: infographic of drug use in Nigeria (UNODC, 2017)

The above infographic shows the estimated number of drug users in Nigeria. The singular most abused drug was cannabis followed closely by opioids and then cough syrups. An estimated 14.3 million people reported the use of any drug within the past year prior to the research while the least abused drug was cocaine.

Prevalence of Drug Abuse in Nigeria

In Nigeria, the South-West zone had a prevalence of 22.4% drug users in 2017, followed by the South-South (16.6%), South-East (13.8%), North-East (13.6%), North-West (12%) and North-Central (10%) (UNODC, 2017). The lifetime consumption of cannabis as well as psychotropic substances like benzodiazepines and amphetamine-type stimulants, was about 11%, while heroin (1.6%), and cocaine (1.4%) were reported the least consumed in both urban and rural areas (UNODC, 2017). That same year, drug abuse appeared to be more common among males (25.2%) than females (approximately 8%), and the age range of first use was 10 to 29 years.

Table 1: annual prevalence of drug use by age group 15-64 years (UNODC, 2017)

Table 2: prevalence of drug abuse in the North-East region of Nigeria (UNODC, 2017)

Table 2 above shows the annual prevalence of drug use by drug type in the North-East zone (which is the zone with the highest prevalence of drug use). The results follow the trend of cannabis (8.1%) being the singular most abused drug followed closely by opioids, specifically cough syrups (codeine, 6.5%). Compared to the North-Central zone in table 3 below, it is evident that there is a constant use of cannabis (8.4%) while the use of codeine (1.1%) is quite low in contrast to the North-East zone. With regards to the prevalence of drug abuse in the North-West zone as presented in table 5 below, the use of opioids was slightly higher (2.7%) compared to the North-Central zone. Kano state had the highest prevalence of drug use (16%) followed closely by Zamfara (13.5%), Kebbi (12.6%) and Katsina states (12%). Furthermore, table 6 and 7 show the prevalence of drug abuse in the South-South and the South-East zones with states like Delta (18%), Rivers (15%), Imo (18.1%) and Enugu (16.3%) highlighted in these regions.

Table 4: drug use in the North-Central zone of Nigeria (UNODC, 2017)

Table 5: Prevalence of drug use in the northwest zone

Table 6: prevalence of drug abuse in the south eastern zone

Table 7: prevalence of drug abuse in south-south Nigeria

Lots of studies have been conducted to show the use of drugs for social, rather than, medical purposes. In 2012, Nigeria ranked among the highest users of dangerous drugs such as alcohol, tobacco, cannabis, benzodiazepines, cocaine and opioids when compared with other developing countries (Fareo et al., 2012). A review of literature indicated a steady increase in the prevalence of drug use and its associated consequences within the last three decades. 

Due to the fact that drug traffickers usually use Nigeria as a conduit to transport drugs from South-East Asia and South America (Bolivia, Peru, Brazil and Colombia) to Europe and North America, almost all types of psychoactive substances are available in Nigeria (NIDA, 2013). 

In a cross-sectional community-based descriptive study conducted in North-Western Nigeria, the prevalence of drug abuse was 10.1% and the most abused drug was tramadol, with significant associations observed between drug abuse and type of family, occupation of respondents and monthly income (Lawal and Aliyu, 2020). Findings from a separate study showed that peer pressure (19.5%) and desire for enjoyment (13.3%) were the major causes of drug abuse by the respondents. The most commonly abused substances by the respondents include: 

1, Tobacco (29.2%), 

2, Codeine (17.7%); 

3, Marijuana, also known as Indian hemp (14.3%), and 

4, Cola nut (3.4%)

Majority of the respondents perceived the negative effects of drug abuse to be poor mental health (55.2%) and aggressive behaviors (18.5%) (Adamson et al., 2015).

There is a high prevalence of drug abuse among youth, especially students (Okafor, 2011). According to a research carried out in the University of Lagos, using a WHO student drug survey, of the 1,000 students surveyed, Marijuana (45.7%) was the most common drug seen by most of the students, and 33% of students were currently abusing one or more drugs. In addition, coffee (43.1%) was the most commonly used drug, followed by alcohol (25.8%) and marijuana (7.4%). 

Image 5: prevalence of drug use by gender in Nigeria (NBS, 2018)

Why Do People Abuse Drugs?

Studies have revealed that most drug addicts started smoking in their youth. As they grow older they seek new thrills and gradually go into hard drug abuse (Oshodi, Aina & Onajole, 2010; Igwe, at al., 2009). A nationwide survey of high school students in 2008, reported that 65% used drugs to have a “good time” with their friends, 54% wanted to experiment to see what it is like, and 20-40% used it to alter their moods, to feel good, to relax, to relieve tension and to overcome boredom (Abudu, 2008). Some other reasons include:

1, Curiosity And Desire To Find Out The Effectiveness Of A Particular Drug: Curiosity to experiment the unknown facts about drugs thus motivates youth into drug use. The first experience in drug abuse produces a state of arousal such as happiness and pleasure which in turn motivates them to continue.

2, Influence Of Peer Group: Peer pressure plays a major role in influencing many youths into drug use and abuse. 

3, Environmental Conditions: Many young people live in communities or slums which suffer from multiple deprivations, with high unemployment, low quality housing, lack of water sanitation and hygiene, increased violence and crime rate, and where the surrounding infra-structure of local services is splintered and poorly resourced. In such communities drug supply and use often thrive as an alternative source of quick money often controlled by powerful criminal groups.

4, Promotion and Availability: Alcohol and pain relief drugs are regularly advertised on television especially at peak hours. The advertising of tobacco products is now banned, but research from Strathclyde University (published by the Cancer Research institute) concluded that advertising did encourage young people to start smoking and reinforced the habit among existing smokers. Despite legislation, children and adolescents have no problems obtaining alcohol and tobacco from any number of retail outlets. A variety of products are openly hawked in kiosks, at parks and on the roadside. It is not uncommon to see people openly advertising sexual enhancing drugs to pedestrians all over major cities in the country.

5, Enjoyment: Despite all the concerns about illicit drug use and the attendant lifestyle by young people, it is probably still the case that the lives of most young people are centred on school, home and employment and that most drug use is restricted to the use of tobacco and alcohol. They may adopt the demeanour, fashion and slang of a particular subculture including the occasional or experimental use of illegal drugs without necessarily adopting the lifestyle.

6, Lack of Parental Supervision and the Socio-economic Status of the Parents:  Socio-economic status of the parents entails direct costs which are very important to families

7, Self – medication of primary psychological disorders. 

The public health impact/consequence of drug misuse

The harms associated with illicit drug use include increased mortality from overdose and from other directly or indirectly associated harms such as;

1, Increased risk of infection with blood-borne viruses (HIV, hepatitis B and hepatitis C); 

2, High levels of depression and anxiety disorders: Psychiatric comorbidity is common in drug misuse populations, with anxiety and depression generally common, and antisocial and other personality disorders in opioid-using populations (Regier et al., 1990, 1998). Drug misuse disorders complicated by other comorbid mental disorders have been recognised as having a poorer prognosis and being more difficult to treat than those without comorbid disorders; comorbid disorders are more likely to be chronic and disabling, and result in greater service utilisation.

3, Social problems such as disrupted parenting, employment and accommodation: Lost productivity and unemployment increase with the severity and duration of drug misuse, and personal relationships are placed under considerable strain by dependent drug use. Problems with accommodation are also common in such groups. For example, in the National Treatment Outcomes Research Study (NTORS), 7% of the study group were homeless and living on the street, 5% were living in squats and 8% were living in temporary hostel accommodation (Gossop et al., 1998). 

4, Increased participation in income-generating crime (Darke & Zador, 1996).

Nigerian Legislation to address drug abuse

1, National Drug Law Enforcement Agency (NDLEA) Act No. 48 of 1989 (as amended) which established the NDLEA to be responsible for preventing illicit cultivation, production, manufacture, trafficking in, and abuse of drugs.  

2, National Agency for Food and Drug Administration and Control (NAFDAC) Act No. 15 of 1993 which set-up the NAFDAC, a parastatal under the Federal Ministry of Health, to authorize (control) the importation and exportation of narcotic drugs, psychotropic and other controlled substances, to ensure that their uses are limited to medical and scientific purposes. NAFDAC is also mandated to collaborate with NDLEA in measures to control drug abuse in the country. 

3, Money Laundering (Prohibition) Act, 2011  (as amended), addresses the problem of drug money laundering. 

4, Other relevant legislation include the Dangerous Drugs Act, 1935; Indian Hemp Decree, 1966 (as amended); Food and Drugs Act, 1976 (as amended); and the Counterfeit and Fake Drugs and Unwholesome Processed Foods (miscellaneous provisions) Act, 1999.

Conclusion and recommendation

Drug misuse can cause social and socioeconomic disadvantage which may further lead to drug dependence and a myriad of other adverse outcomes. In addition, it directly affects millions of Nigerians every year, causing motor vehicle crashes, crimes, injuries, impaired health, mental disorders and reduced quality of life. Prevention policies and programs that are based on sound evidence-based principles have been shown to reduce substance misuse and related harms significantly. Embedding prevention, treatment, and recovery services into the healthcare delivery system in Nigeria will greatly improve the outcome of drug abusers nationwide (UNODC, 2017). 

Drug abuse is one of the health-related problems among Nigerian youth and has been a source of concern to national stakeholders. It is a serious issue; a global and international issue particularly in developing countries like Nigeria; a major public health, social and individual problem and is seen as an aggravating factor for economic crises; hence, Nigeria’s poverty status. While youth are supposed to be the major agents of change and development, some have been negatively impacted by drug abuse (rendering them unproductive). This menace has a negative impact on the education of undergraduates in universities across the country and globe. The overall health of the user is affected negatively and behaviors associated with drug abuse predispose the abuser to crime and contagious diseases including HIV/AIDS (Center for Disease Control, 2000).

Lots of research has been done to expose the burden of drug and substance abuse in the country including the biological, psychological, and social underpinnings of substance misuse. Future research needs to focus on public health interventions to guide policy making. Education, personal resilience and prevention programmes are also very essential, particularly for those who are vulnerable and may be susceptible to substance misuse.

In addition, families and communities play key roles in providing support, showing care and setting a good example to young people. This cannot be overemphasized as they help establish rules and consequences, keep track of prescription drugs as well as young people’s activities. Help for mental illness (resulting from drug abuse) needs to be readily available and accessible by those affected. A major issue when it comes to drug abuse and addiction is that a lot of people view victims in a discriminatory manner thereby driving them underground rather than encouraging them to seek medical help. A balance of work and healthy play needs to be focused on by work spaces, tertiary institutions and secondary schools so as not to give the notion of a docile youth population. Exercise or playing sports helps release natural “feel good” hormones called endorphins which make the body feel nice, encourage young people to learn new fun skills like painting, gardening, music or a new language.

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