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.
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.
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.
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.
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.
