Drugs in every form, state or preparation are important tools used in administering treatment to humans, but if overused, misused or abused can lead to severe catastrophes that will, in most cases, endanger the life or lives of the person or people involved. The drug paracetamol, for example has been shown to have dangerous effect on the liver. Prolonged use, misuse or abuse of this drug will therefore predispose an individual to severe liver abnormality which may end in its failure and ultimately death of the person in the absence of transplant. Against this background, it is important that we widen our understanding of the use of these all important and yet potentially dangerous substances.
The 1984 Nairobi declaration of the principle of treatment has its cardinal features regarding drug prescription which emphasizes the importance of prescribing:
· to the right patient
· the right drug
· the right dose
· at an affordable cost.
Each of the above four conditions should be closely looked into to ensure successful treatment of a particular disease with minimal or no adverse effect on the patient/individual.
Regarding “to the right patient”, it is but important we understand that the prerequisite of any form of treatment is a reliable diagnosis, or at least, an assessment of the clinical need. This in most cases can only be done by trained or experienced medical personnel.
Self medication (the act of taking a drug(s) without the consent of medical personnel), a culture that has seriously affected medical practice in Sierra Leone, is one such condition that has cost the lives of hundred to thousand people in this nation every year. An accurate diagnosis, I must hasten to mention, ensures that a patient is not exposed to the hazards of a particular drug or unnecessary expenditure in buying the drug. In some instances, a particular drug is only effective on a subgroup of patients with a specific disorder. Lack of knowledge of this fact will prompt the patient to take more and more of the drug in order to gain quick recovery; exposing that individual to the dangers surrounding that drug. Trastuzumab, for example, is a drug that is only effective in women with breast cancer. If, for any reason this drug is taken by a woman without breast cancer, it will cause massive reduction in the size of the breast and may cause failure of the woman to conceive a baby.
The use of drugs in the newborn and infants poses special problems. Apart from the well known fact that the rate of breakdown and removal of drugs from their bodies is reduced, the following have also been elucidated:
· many of the now available drugs have never been subjected to formal trials in children and their benefits and risks have not therefore been adequately assessed in this age group. Though several international efforts are being made to redress this problem, it is worthy to note that till date, no convincing details have been released.
· for most drugs, there are no special preparations for children especially in terms of dosage regimen. Instead, adult products are used and as stated above, drugs are slowly removed from their bodies, predisposing them to the toxic effect of these drugs.
The use of drugs in the elderly is also of uttermost concern. Many of the problems associated with the use of drugs in children are also evident in the elderly. While in children the main cause of drug toxicity is immaturity of organs involved in secreting substances (enzymes) for the breakdown of these drugs, in the elderly the main cause is reduction in the secreting ability of these organs due to prolonged use.
Clinicians as well as patients should be extremely cautious in prescribing and using drugs during pregnancy and only essential treatment should be given. When a drug is known to cause severe effect to the unborn, the potential effects should be discussed with a patient, especially those of child bearing age, preferably before conception. If she decides to become pregnant, she should be offered an appropriate regular scan to assess whether there is damage to the unborn. This aspect is very necessary as medication is discontinued as soon as damage is noticed.
Another very important aspect of the Nairobi declaration is “selection of the right drug”. This essentially involves three aspects:
· the drug’s importance for the purpose for which it is used
· the balance between the drug’s importance and it’s safety
· the patient’s preference
The later must be closely monitored by the medical personnel as the person is expected to know the side effect(s) of any medication prescribed, taking the patient’s compliance into consideration.
The last aspect on the Nairobi declaration to consider is the drugs’ affordability. The money available for healthcare varies widely across the world. All healthcare systems try to provide their population with the highest standards of care within the resources at their disposal. In Sierra Leone, for example, drugs are given free to patients suffering from HIV/ AIDS and tuberculosis (TB). Normally, the cost of treating one patient with TB is well over $600,000, meaning if the cost of such treatment where to be dependent on the patients, thousands of people would have died every year from these diseases.
The phrases substance abuse and drug abuse are often applied to the use of an illegal or illicit chemical substance (e.g. heroin). However, these terms may be applied when a legally obtainable medication is used excessively and for unintended purposes or is diverted to someone else’s use. Also, some legal substances (e.g. nicotine, alcohol etc) are used to the detriment of the individual. Inappropriate use or abuse is the excessive self administration of any substance for non- medical purposes.
Prominent among the drugs mostly abused in Sierra Leone today include paracetamol cocaine, marijuana, nicotine, morphine, diazepam etc. These and many more must be handled with extreme care for their indiscriminate use will cause a whole lot of problem. An additional aspect of drug abuse is the production of hazardous or harmful effect to the individual which will reflect on the society. For example, the ever increasing abuse of marijuana in Sierra Leone has not only led to much mental disarray among youth, but also increased the rate of arm robbery among others. The 10 year of senseless civil war which left our nation zero in the human development index was kept that long largely as a result of drug abuse, coupled with selfishness, greed, jealousy, envy, to name but a few.
In any case, drug abuse has no good side of it and it is high time we started doing something about it. If we, as a nation, are to move from this level to a point of global recognition in terms of development, it is clear that the drugs in use have great role to play. The government of the day, if I may suggest, should set out strategies to track drug traffickers, especially those involved in the judicious act of importing counterfeit drugs into the country.
Youths are the pillars of a nation. This group has all the energy, intellect and enthusiasm for good work. If for reasons such as peer pressure, frustration, socioeconomic status, thrills seeking etc, they are disturbed by drugs, then the future of our nation is really at stake.
Almost all abused substances produce an effect on the brain that is perceived as desirable and will initiate a “drug seeking behaviour.” The professional in the drug abuse field have such diverse background that adopting a common terminology for terms such as addiction and dependence has been difficult. Drugs mostly found in this category produce effects that are so desirable that the user is compelled to obtain more of the drug. Recurrent abuse of a drug may properly be termed as addiction when the individual becomes so obsessed with constantly obtaining and using it that it becomes a primary goal and disrupts the ability to function in family, social, or career settings. Studies made on humans reveal that most individual who abuse any one drug also abuse, or co-abuse other drugs during the same period.
In Sierra Leone, it has been estimated that about 75% of people who abuse alcohol also abuse cigarette. Alcohol remains a leading cause of liver damage. Currently, more than 5,000 people die annually from chronic cigarette smoking. This figure is really heart rending for a country which boast her-self of about 5,000,000 people. It has also been proven that smoking 20 cigarettes sticks a day for one month reduces one’s lifespan by a day. It means 12 precious days are reduced from that life each year. This can be regarded as a medical suicide.
Children unfortunate enough to be born by parents who are alcoholic are not only deprived of basic needs because of mismanagement of available resources, but are most importantly prone to becoming alcoholics themselves. Are these not important reasons to quit, even now? Save the future of your children by making this very wise decision.
To conclude, drugs can be of most benefit if handled and utilized properly, but can be disastrous when misused, abused or overused.
© Copyright by Awareness Times
Newspaper in Freetown, Sierra Leone.