Dr. Charles N Nwako, PharmD, is the Chairman, National Publicity Committee, Clinical Pharmacists Association of Nigeria (CPAN). In this interview, he highlights the dangers in the misuse and abuse of medications and proffers the way forward on responsible sourcing of drug products. APPOLONIA ADEYEMI reports
Why drug education and counseling?
In the Nigerian pharmacy space or drug world, it is becoming almost impossible to differentiate between some supermarkets, provision shops, patent medicine stores, unregistered pharmacies and the properly registered and licensed pharmacies. In all these, you find almost apparently same types of drugs and related products. All appear to offer same services of drug provision, but many are without the provision of the required and accompanying professional ‘drug information’. This is because these drug outlets aside the properly registered and licensed pharmacies, are not manned by pharmacists. It is only in properly registered and licensed pharmacies manned by Superintendent Pharmacists that one can receive ‘professional pharmaceutical services or care like drug information through effective medication education and counseling’. Even licensed patent medicine dealers are not knowledgeable to counsel patients on ethical drugs.
Why many shun pharmacies
The populace are even more confused as a good number of them tend to rush to the non- pharmacies as they claim they spend less time, less amount of money, etc in these so-called drug stores. It has been observed that an appreciable number of Nigerians tend to shy away from patronising the registered and properly licensed pharmacies that are manned by pharmacists on the account and alleged belief that services in pharmacies are costlier, more time consuming, among other challenges.
Drug information for good use
What most Nigerian clients or patients do not know is that, it is not just about drugs being given out but also about the ‘associated dispensed drug information’ that accompany such medications. It is also important to emphasise here that it is not the size of a church building that makes it a cathedral, but the presence of a bishop. Every drug has a set of specific and accompanying drug information that rightly guides its proper usage, otherwise such use could turn out to be harzadous. Some of the deleterious effects may not manifest immediately but years later. Those who rush to these unlicensed drug outlets to obtain their drugs without the correct and associated information are like someone who rushes or attends a church or mosque service without actually hearing and receiving the main sermon. It is not by visiting or occupying space in church or mosque, but by how one utilises and applies the sermon in his life. What changes one is the message or sermon preached. Without the sermon or gospel, attending a church or mosque service is grossly incomplete. So also is getting the right and sufficient information when you visit a pharmacy establishment. Currently, there is an upcoming report from some recent studies and findings that ‘drug related deaths are now ranking third place after cancer and heart disease globally’. If such findings are seen in advanced societies where drugs are strictly utilised under the supervision of pharmacists or other highly qualified medical personnel and are mainly obtained through legal means such as prescription or pharmacy only medicines (pharmacy initiated medicines), how much worse will the case be in a country like Nigeria with chaotic drug distribution?
In Nigeria, almost everyone is misusing or abusing drugs, irresponsibly self-medicating with drugs as well as being non adherent to their medications’ guidelines for usage. Suffice it to say that the incidence and prevalence of drug- related complications or deaths are expected to be unimaginably high and unreported in Nigeria. One keeps wondering at the negative impacts and drug-related complications that could have been created and caused by the unchecked activities of quacks and traders who have infiltrated and hijacked the pharmacy practice in Nigeria.
Why drug education
Effective drug education, medication review and counseling are thereter fore the only ways out of this menace. Such could only be accurately provided by pharmacists who are the healthcare professionals globally known and trained to ‘excel on the knowledge and actions of all types of drugs’. Since pharmacists are the highest trained healthcare professionals on drug knowledge and matters, any other person who assumes the post or duty of a pharmacist and involved in drug refilling, dispensing or handling as an occupation with respect to patients or clients care, is best described as an impersonator or an usurper. ‘Such a person’s action could pose a great danger to the health of the citizenry and must be discouraged’. Even when other trained healthcare professionals are involved in medication handling, it should be done under the direct supervision of pharmacists. That is the position of science and the proper or healthy practice too. Many of our people are much more concerned in some cases about cheap cost of their medications and less time spent in non- pharmacies or other nonproperly registered drug outlets, but are oblivious of the fact that majority of such drugs obtained in these nonpharmacies could be either substandard, fake or subject to misuse due to absence of professional guidance . This partly explains why many Nigerians suffer from treatment failure, drug resistance, adverse drug reactions, drug induced diseases and even untimely death.
Many people in the society think that every person who handles drugs in a drug outlet is qualified to do so and that one does not need to spend some time with the pharmacist. Some don’t even know who is a pharmacist and think he is just anyone in a drug store. Many are not even aware or do not care to know that any pharmacist they see in Nigeria must have graduated from the university and licensed, af-er spending about six or seven years (depending whether it a Doctor of Pharmacy or Bachelor of Pharmacy Programme) plus an additional one year Natiònal Youth Srevice Corps (NYSC) programme. Some pharmacists also have advanced degrees in Clinical Pharmacy or Patient Oriented Pharmacy Practice. Of importance too, is the fact that many of the fake drug outlets do not have signposts clearly indicating their names. That is dangerous as it makes them unidentifiable. An establishment dealing in drug matters should have a proper signage to show if it is a pharmacy, patent medicine shop, or supermarket.
All drugs are potential poisons
Before drugs can be assured to be safely and appropriately used; they will be accompanied by some professional information and education from the pharmacists who are the medication experts.
Signs of pharmacist presence
It is the pharmacist that designs and manufactures all orthodox medicines and really understands the workings of the drugs. For instance, in developed world, their citizens are familiar and deeply understand the sign; ‘Pharmacist on Duty’ or ‘Pharmacist not on Duty’. These patients or clients are never in a hurry while in the pharmacies as they patiently wait for their pharmacist’s Medication Education & Counseling. No wonder the United States of America (USA) passed a Bill called , ‘Omnibus Budget’, ‘Drug Reconciliation Act’ This ACT makes it mandatory that the pharmacist owes the patient the duty of providing ‘Drug Information’ and must educate and counsel the patient on the proper use of drugs. Some other countries have theirs too.
Quacks invade pharmacy practice
It is very unfortunate in Nigeria, that non pharmacists and quacks have invaded pharmacy practice, a practice that is supposed and meant to safeguard the health of people. Almost all our streets are occupied with drug stores that are in many cases operated by illiterates, semi literates, school dropouts and non-pharmacists.
Almost every Tom, Dick and Harry in Nigeria wants to invest in pharmacy practice without being aware of the dangers such action can pose on the health of the unsuspecting public. People see drugs as ordinary articles of commerce, but in other countries citizens are jailed if caught with drugs or medicines when they are not licensed pharmacists, or not a patient with a valid Prescription (or other recognised means of medicine possession). Dispensing, effective medication education and counselling are even more important than the actual provision of the drug itself, as the wrong use of any drug could kill or harm rather than cure the patient or client.