Side event: Strengthening the evidence base on drug use in Nigeria

Organized by the Government of Nigeria and the United Nations Office on Drugs and Crime, Country Office for Nigeria

Vivian Okeke, the Nigerian Ambassador, welcomed all on behalf of the organizers. She emphasized the strong partnership between the Nigerian government and the UNODC country team. The first ever national survey on drug use in Nigeria was launched on 22 January 2019 as the most important reference document on drug use in Nigeria, bridging an important data gap. Data is the basis for being able to address the problem, understand the demography and the amounts used, data is also important for international cooperation.

Oliver Stolpe, country director UNODC Nigeria, introduced the panelists and highlighted EU support to fund the study and a lot of other programmes in Nigeria.

Miwa Kato, Director, Division of Operations, UNODC emphasized that this was the first ever national drug use survey in Nigeria. A solid evidence base is needed to inform policies. In Nigeria UNODC has cutting edge projects, good relations with government and strong support from donors. This publication can serves as an example for the entire continent. It is a wakeup call, showing that the problem is serious and actors cannot continue business as usual. The past year prevalence of drug use in Nigeria is more than twice the global average. Close to 3 million live with a drug dependence but there is a lack of treatment services. What is the way forward? We need to understand the nature of the condition: not weakness of character but chronic relapsing condition. In response, a balanced approach is needed that ensures the availability of essential medicines. There is need for a nuanced response and it is important to get it right in Nigeria, one of the most populous countries in the world. There are clear signs of the commitment at the highest levels: the President set up late last year the Presidential Advisory Committee on Elimination of Drug Abuse-

Lambert Schmidt, First Counsellor, EC reiterated that the EU promotes a balanced approach, as well as policy based on evidence. This survey is very important to dispel myths and false perceptions. Some findings were surprising, e.g. that past year drug use was highest for people in their 30s; that while high, prevalence was not as high as some thought; no use of fentanyl. They are looking forward to the drug control master plan which will draw on this survey and it should be considered to repeat it in 5 years.

Isidore Obot, CRISA: The survey was a collaborative effort. At an important moment, when there is attention at the highest political levels, we can bring evidence to the discussion. The document draws on 3 separate data collection exercises, covering all 36 states. A household survey covered almost 40,000 households, another survey 9,000 problem drug users, and another study 3,000 key informants. The situations is worse than we thought. 14% of population has used drugs in the last year. Cannabis is the most prevalent with 10.6 million users, followed by opioids, cough syrups (could be merged with opioids). One out of 4 drug users is female. The biggest difference in drug use between males and females is in cannabis, for opiods etc the numbers are actually quite similar. The prevalence of drug use is highest between 20 and 39 years of age. There is a surprising spike in amphetamine use for 60-64 year olds. One in 5 drug users is dependent. For cannabis this is 1 in 3.

Looking at high risk drug users (those who have used opioids, cocaine, amphetamine at least 5 times in past 30 days) 90% use opioids. There are about 80,000 injecting drug users in Nigeria. Polydrug use is common and a majority uses 3-4 drugs. The prevalence of injecting drug use is relatively low. There is a fear of injecting and awareness of risks. Those who inject do so about 3-4 times a week. Needle sharing is quite frequent, shared because they trust the person they were injecting with. About a third of men who inject drugs never use condoms. The self-reported prevalence of HIV is high. 37% say they urgently need treatment and a total of 80% say they need treatment. Reasons for not accessing treatment are lack of money, treatment not available, stigma, having no information on what exists. The most frequent treatments are counselling, detoxification where people remain an average of 5 days. Most treatment offered is by faith-based treatment organizations and NGOs. 70% of high risk drug users have been arrested for possession at some point.

Implications: there is a need for affordable, evidence-based treatment; HIV prevention, treatment and care; law enforcement targeted to mid/high level traffickers; and regular monitoring.

Col M.M. Abdallah, Chairman, NDLEA thanked those involved in the survey. The government will apply the 3 conventions STRICTLY. This excellent survey will help us eradicate the drug menace in our country. Law enforcement must take precedent as you first need to stop the flow of drugs. We should not focus our efforts on the heroin users which are only 87,000.

Questions from the audience

Axel Klein: Question on the use of opioids. A majority are for pain management. As pharmacies are not available in rural Nigeria, people buy on the gray/black market.

UNODC HQ Research section: The question for the survey was specifically about non-medical use with purpose of getting high – the question was not about pain management.

Ministry of Health: We are working to ensure availability of scheduled drugs, to ensure proper prescription and disbursement. We are not comfortable with the influx of drugs into the country illegally and we have serious concerns about use of tramadol and cannabis.

Second official from Ministry of Health: We need to improve the supply chain and the availability of core medicines including opioid painkillers.

Abel Basutu, African Union: welcomes the study as fully in line with the AU Plan of Action, especially the need to improve research expressed in it and the AU Commission expresses its full support.

Adeolu Ogunrombi, YouthRise Nigeria: The study is very welcome as it bridges a huge gap in data availability. However, data needs to be translated into policy. We need to learn from the HIV movement – don’t be in denial just because numbers are low now. There might be only 80,000 injecting drug users but they are responsible for 90% of new HIV infections and that poses a risk for the whole population.

Col M.M. Abdallah, Chairman, NDLEA: There are more pressing problems, we need to take care of the majority first.

Isidore Obot, CRISA: 80,000 is a big number. We need to act today to prevent an epidemic. How long would we wait to act, what would be the threshold? An HIV epidemic can get out of hand very quickly.

Oliver Stolpe, country director UNODC Nigeria: As is clear from the meeting, this data is not remaining on the shelf. We have also seen that women are a concern: They are 1 in 4 drug users but only 1 in 20 of those accessing treatment. Stigma plays a big role there. 25-35 year olds as group with highest use is also a key issue to look at. The Nigerian delegation in its composition shows in itself a balanced approach (health ministry, drug agency etc)

Vivian Okeke, the Nigerian Ambassador: Thanks to all stakeholders who worked on the report. Nigeria is committed at the highest political level. We need to address our high levels of cannabis and tramadol abuse.

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