Table of Contents

  • The Bulletin on Narcotics is a United Nations journal that has been in publication since 1949. It is printed in all six official languages of the United Nations (Arabic, Chinese, English, French, Russian and Spanish).

  • One of the major characteristics of Nigeria as a country is its large and youthful population; another is that although it has become the country in Africa with the largest economy, close to half the population lives in extreme poverty. For more than 50 years, illicit drugs have had a presence in the lives of Nigerians, in particular the urban population, as either articles of trade or substances of abuse. It began with cannabis in the 1950s, but the situation today is much more diverse and complex, involving illicit drugs such as heroin, cocaine and methamphetamines, and pharmaceutical substances such as opioid analgesics. Although there has been a general lack of reliable data on drug availability and use, a recent national survey has provided much-needed information on the state of the drug problem in Nigeria. The annual prevalence of illicit drug use among adults is 14.4 per cent, which is significantly higher than the global prevalence of 5.5 per cent; cannabis is the drug used most often in Nigeria, followed by opioids, cough syrups containing codeine, and tranquillizers and sedatives. High-risk drug users reported adverse health consequences such as drug use disorders and infections. Although most drug users expressed a need for treatment, the country lacks adequate opportunities for treatment and care. The articles published in this issue of the Bulletin on Narcotics have addressed these and other issues, and they deserve greater attention from professionals and policymakers if a major drug crisis is to be averted in the country.

  • Cannabis is one of the most widely used drugs in Nigeria. This use has been sustained, in part, by widespread cannabis cultivation and trafficking in certain parts of Nigeria, which have persisted despite the destruction of many hectares of cannabis crops by law enforcement agencies every year. The present study is aimed at exploring the socioeconomic factors that underpin the cultivation of cannabis in selected communities in Nigeria. In-depth interviews and key informant interviews were conducted in two communities in Oyo State. The pool of participants consisted of 68 respondents comprising 52 men (76.5 per cent) and 16 women (23.5 per cent). Focus group discussions were also conducted to get a deeper understanding of some of the factors at play. Results from the interviews and discussions suggest that unemployment, corruption, the relative ease of cultivation, the demand from users ready to buy and relatively higher economic returns are some of the drivers of cannabis cultivation and trafficking. The need for stakeholders to shift focus and address those salient underlying factors in order to achieve a reduction in cannabis cultivation and trafficking was emphasized.

  • Tramadol and codeine-containing mixtures are the pharmaceutical opioids with adverse health consequences most used in Nigeria. Widespread use has provoked stricter State control of these drugs, yet trafficking and availability remain a challenge. Knowledge of the trafficking routes of these substances may provide insight into how to control them better and reduce demand. The present study was aimed at investigating the routes through which tramadol and codeine get to illicit users in Nigeria. The profile and characteristics of those users, as well as their willingness to receive treatment in Enugu State, were also explored. A mixed-method approach was used, and 119 pharmacists and patent medicine dealers participated in focus group discussions, while 70 tramadol and codeine users completed the drug use assessment scale and participated in in-depth interviews. We found that tramadol and codeine had complex but well-developed traffic routes, making them easily accessible to users, in spite of restrictions. Established networks of corrupt customs and other security officials aid and abet the passage of the drugs to the markets. The open drug market system in Nigeria exploited by profit-seeking business persons facilitates an illegal flow of these opioids. Supplies from the open markets feed pharmacy and patent medicine dealers through whom users acquire the drugs. Users have dealers supply the drugs to “safe centres” for easy access. The drugs are also peddled by hawkers and sold at roadside kiosks. Findings also showed that tramadol and codeine use was spread among people from diverse walks of life, though young men, students and artisans were perceived to be particularly at risk. A total of 47.4 per cent of users of tramadol and 30 per cent of users of codeine-containing mixtures expressed the desire to receive treatment. However, many users of tramadol (47.5 per cent) and codeine (50 per cent) did not know where to go for help. The authors of the study recommend easy and free access to treatment, youth-targeted drug abuse awareness campaigns and the removal of restrictions on codeine and tramadol as critical to demand reduction.

  • Populations displaced by conflicts experience many negative and stressful events that increase the risk of substance use as they try to cope with these experiences. The aim of the present study was to determine the prevalence and pattern of substance use among internally displaced persons. A cross-sectional quantitative study was carried out among 847 participants aged 18 years and older. It was conducted in six local governments, two each in the Plateau, Nasarawa and Benue States of north-central Nigeria. The national drug survey questionnaire used by the United Nations Office on Drugs and Crime and the Federal Ministry of Health of Nigeria in 2016 was adopted for use in the collection of data. A total of 25.4 per cent of the participants reported that they had used a substance. Among those participants, 17.5 per cent had used alcohol, 8.1 per cent had used tobacco, 4.8 per cent had used opioids, and less than 1 per cent had used cannabis, tranquillizers, amphetamines, hallucinogens or solvents. Substance use disorder was found in 4.5 per cent of the participants, with alcohol use accounting for 36.8 per cent of the disorders, tobacco use for 33 per cent, tramadol use for 10.5 per cent and cannabis use for 5 per cent. Because substance use among internally displaced persons in north-central Nigeria is an emerging issue of significance to public health, substance use prevention programmes need to be integrated into services provided to internally displaced persons in order to help curb this growing problem.

  • Empirical studies indicate that one in every four drug users in Nigeria is a woman. Increasing economic burden has necessitated women working outside the home in low-income petty trading. Anecdotal observations reveal that market women who own stalls and peddle their wares at local markets are a group vulnerable to the non-medical use of opioids. The aim of the study was to examine the lived experience of market women, including with regard to knowledge, drug use and misuse and social networking related to the non-medical use of prescription opioids, in Ibadan, a large city in Nigeria. A total of 181 purposively sampled women took part in the study. Qualitative and quantitative methods, by means of focus group discussions and structured self-administered questionnaires, respectively, were employed to collect data. Findings indicate that there is general knowledge about pharmaceutical and local opioids among market women. However, the type of trade was a factor in knowledge of and experience with specific types of opioids. In particular, liquor sellers were more conversant with the different types of opioids, such as tramadol and codeine, than women trading in other goods. A large number of participants admitted to using tramadol, but use was mostly restricted to the relief of body pain and ache arising from the stress of their trade.

  • Treatment-seeking behaviour significantly influences the course and outcome of mental, social and physical problems associated with substance use disorders. However, there is a dearth of information on the treatment-seeking behaviour of persons with drug use disorders in south-west Nigeria. We conducted the present qualitative study to identify the factors influencing treatment-seeking behaviour among persons with drug use disorders in other to develop recommendations to improve the uptake of drug treatment services in south-west Nigeria. There were 44 in-depth interviews conducted on drug users that had sought or received treatment for drug use. There were also three focus group discussions and six interviews of key informants. We used topic guides based on research questions and analysed transcripts using qualitative content analysis. The common themes found to influence treatment-seeking behaviour among participants were the perceived need for treatment, stigma, treatment cost and availability of funds, social support, fear of treatment-related issues, beliefs about treatment and alternative therapies and the perceived quality of care. It is important to understand the context and rationality of decision-making among persons involved in drug use. Exploring the clients’ views could potentially help professionals to improve the quality of health services, inform policymakers and promote programmes that could increase the uptake of drug treatment services in Nigeria.

  • Epidemiological studies suggest that the gender gap in substance use disorders is closing. Some studies have shown that women seem to be less likely than men to seek help or to be diagnosed with substance use problems. In Nigeria, little is known about female drug users and there are no studies, programmes or forums specifically targeting women who use drugs. The present study is aimed at identifying the problems of female drug users in the five drop-in centres sponsored by the United Nations Office on Drugs and Crime in southern Nigeria (in Akwa Ibom, Enugu and Lagos States). A mixed method design was used in the study. A purposive sampling technique was used to select participants. Forty-nine female drug users were selected from Akwa Ibom State, 34 from Enugu State and 79 from Lagos State. A questionnaire for drug users on gender and access to treatment in drop-in centres in Nigeria was prepared and used to gather quantitative data, while focus group discussions were held in the drop-in centres with male and female participants to collect qualitative data. Results from the national survey showed that 38.3 per cent of the respondents wished to get help for their drug problems but were unable to. Some of the reasons were fear (16.1 per cent), affordability (17.1 per cent), lack of information (19.4 per cent), stigmatization (29 per cent) and unavailability of treatment services (19.4 per cent). In addition, 25.3 per cent of the women were not sure about the ease of access to treatment. This result also correlated with the qualitative study where the major reasons cited for not undergoing treatment were fear, stigmatization and lack of awareness. Participants also cited love and care, unconditional positive regard and acceptance, women-only care services, incentives and awareness as motivators for undergoing treatment.

  • Alternative treatment refers to health-care interventions developed and guided by ethnocultural and/or religious beliefs and principles. The World Health Organization estimates that, in Nigeria, as in other developing countries, up to 80 per cent of the population uses alternative treatment methods to meet their health-care needs [1]. Alternative treatment services are generally acceptable, accessible and affordable, especially in comparison with western and orthodox medical services [2]. While anecdotal evidence abounds regarding the nature, effects and outcomes of alternative treatment programmes, there exists a dearth of empirical evidence about existing alternative treatment practices (both orthodox and unorthodox) that would form the basis for engagement with alternative treatment providers. The objective of the present study was to assess alternative substance use disorder treatment services that exist and to examine principles, methods and practices used in the treatment of patients suffering from substance use disorders. The study employed cross-sectional qualitative methods to evaluate 27 alternative addiction treatment centres selected specifically in northern and southern Nigeria. Most of the centres (82 per cent) described their treatment approach as being based on a combination of traditional, cultural and religious concepts. The average number of staff members was 10 but varied widely, with some centres run by the proprietor alone, while others had up to 25 staff members. The patient capacity of the centres also varied widely, from small centres with capacity for four patients to centres with capacity for 350 patients. The centres also varied considerably in the maximum duration of time that patients spent in their care, from two weeks to up to four years. The majority of the centres believed that, in general, addiction resulted from spiritual causes and often involved demonic (or malignant) spirit forces, and their practices were developed in response to that belief. A notable finding of the present study, in all the centres visited, was the absence of documentation regarding treatment service processes. None of the centres created or stored written records of treatment and assessment protocols or updated treatment plans created with the involvement of the patients. Our findings support an urgent need for engagement with alternative treatment providers in the short term to establish a “documentation system” that would serve for improved patient services at the centres and provide critical data for a process and outcome evaluation of their practices. Such a documentation system is also important for further studies into alternative treatment services available for women in northern Nigeria, in particular in the areas that we visited.

  • As a party to the three major treaties on drugs, Nigeria is obliged to control the manufacture, use, distribution and possession of drugs. Drug control efforts in Nigeria rely heavily on interdiction, arrest and the criminal justice system. Adjudicatory control is one of the main mechanisms utilized in the criminal justice approach to drug control. Adjudicatory control is administered by the judiciary at the federal level, with the Federal High Court of Nigeria as the first and primary forum for dealing with drug cases. The Court controls drugs by establishing whether substances are considered to be narcotic or psychotropic under existing laws. Furthermore, it processes alleged offenders through a schematized mechanism of arraignment, trial, verdict and sentencing. In this context, the present article reviews 2,506 court cases to analyse the function of the Court as an institution of drug control. The analysis shows, among other things, that there is a wide disparity in the length of adjudicatory processes and sentences imposed for similar offences. Moreover, the possession and use of otherwise licit painkillers are being prosecuted under provisions enacted to control narcotic and psychotropic substances. This raises uncertainties in drug control efforts in particular, as the drugs that are expressly prohibited are not classified at all, not even according to their degree of harm to society. The result is a wide latitude of discretion afforded to executive and judicial officers in dealing with drug cases. Judicially, such latitude results in a disproportionate focus on possession of small quantities of narcotics, in contrast to larger quantities.