A drug may be described as a chemical substance that can alter the biology, chemistry, physiology and/ the anatomy of the body for curative, preventive, examination or research purposes etc, in either man or animal.
Drugs usually have both wanted & unwanted effects. The wanted effect is usually considered as the therapeutic effect while the unwanted effect is described as the side or adverse drug effect.
Several scientific documented evidences and reports have proven that a drug can harm or even kill depending on the dosage used.
It is also a fact that a dose of a drug considered to be normal in a population, could equally cause serious effects & even deaths.
There are reports that some persons have suffered from serious drug reactions after taking some drugs at doses considered even lower than the average normal doses used in the average population. There are also several reports of severe anatomical abnormalities in babies (fetuses) when some pregnant mothers are exposed to certain drugs. An instance is the deleterious experience of a medication called Thalidomide in the 60’s which caused many babies to be born with either short or no limbs at all. This drug was given to many pregnant mothers in the 60’s to assist them control some signs & symptoms of *Morning sickness*(vomiting associated with pregnancy).
There are also incidences of fatalities associated with the use of some drugs, like the case that happened in University of Nigeria Teaching Hospital, Enugu where many children lost their lives due to an error made in the preparation of a drug.
Again, there are several deleterious effects of drugs especially when used in some groups of subjects with compromised organ function such as liver, kidney, heart impairments etc.
Some drugs or medications are also contraindicated (not allowed for use) in babies, children, pregnant women, elderly, certain illnesses, etc.
Furthermore there are situations whereby, when two or more medicines are taken concurrently, or a drug is taken with food or taken with a herbal product, it could cause a serious or fatal effect (DRUG INTERACTION).
There are also situations whereby a drug with far date of expiration has already expired due to poor storage conditions. This is why it is important that only a Pharmacist (professional in the healthcare team specifically trained to excel on knowledge of drugs actions) should handle drugs on behalf of the people.
Most drugs sold in open drug markets & patent medicine stores often lose most of their potencies, get completely denatured or expire due to poor storage conditions and lack of professionalism of the operators.
Any drug can generally be regarded as a potential poison in the sense that it could cause damage of health or result in the death of the consumer if wrongly or even sometimes when rightly applied despite its classification, as either prescription only medicine, pharmacy only medicine or over the counter drug, popularly called, OTC.
What determines if a substance is a medicine or poison is the dosage used or certain characteristic traits of the individual consumer.
A drug that is generally accepted as safe over a particular range of doses could suddenly turn out to either harm or kill the consumer depending on the consumer’s state of health.
It is therefore hazardous and highly risky for drugs (so-called medicines) to be dispensed by anyone that is not a Pharmacist.
As of today, there are undisputed & scientifically documented evidence or researches which have shown that deaths resulting from the use of drugs are now ranking 3rd in the global ranking of health related causes of deaths, after those due to cardiovascular diseases & cancer (https://pubmed.ncbi.nlm.nih.gov/25355584/).
The shocking & disturbing thing is that these researches were conducted in organized climes where there are no patent medicine stores or vendors and/ open drug markets in existence.
The truth is that these researches were carried out in societies where drugs are strictly under the control & supervision of the Pharmacist & most drugs are dispensed on the prescription of competent Prescribers.
What is more disturbing is that while most countries have seriously made & dished out stringent policies that make it almost impossible for people to access drugs freely outside licensed Pharmacies, Nigerian policy makers are busy turning blind eye to or liberalising the handling & distribution of drugs such that laymen or “quacks” still have serious access & inputs in the movement, dispensing, administration and prescriptions of medications.
Due to the complexities associated with drug use in humans & animals, and also due to advancement in Science & technology, many countries have responded to science and upgraded the years spent in studying Pharmacy as a profession from the usual 5 year Bachelor of Pharmacy Degree Program to a 6 year Doctor of Pharmacy Degree (Pharm D).
After the first 6years of didactic studying & learning of many skills & knowledge, a Pharmacist still undergoes further trainings or a one year period of Internship (Housemanship) in an approved and relevant health care institution.
Most Pharmacists also undergo further trainings such as that called Pharmacy Residency & Fellowship programmes, where he or she is appointed as Consultant Pharmacist in the hospital or other healthcare settings for his expert inputs.
In other words a Pharmacist is a highly & specially trained medical Professional who is a medicines expert in both animals & human beings.
He has all the necessary trainings of the knowledge & skills required for production/manufacture, transportation, storage, dispensing, application, monitoring , evaluation etc of drugs in animals( Veterinary Pharmacy) & human beings.
No wonder, the essential roles of the pharmacist have been highly recognised in many countries.
For instance, the United States citizenry adjudged the pharmacist as the most trusted healthcare professional for many consecutive years.
Also, one of the British Kings was known to be repeatedly appointing a pharmacist as a permanent member into his most trusted cabinet some centuries ago based on his undiluted & unalloyed trust in the pharmacist.
Many American Presidents have prominently and publicly acknowledged the indispensable status of the pharmacy profession, as drugs cannot be viewed as ordinary articles of commerce.
According to John F Kennedy of the United States, the Pharmacist is so indispensable that if there were no pharmacists, the world would have created one.
The US government & policy makers made a policy in 1990 called Omni Bus Drug Budget & Reconciliation Act (OBRA 90) which mandates a pharmacist to provide a form of *Pharmaceutical care or counseling* on any drug consumed by an individual patient.
Also there is a general slogan in most advanced climes which says that ,”when another healthcare professional makes an error , a single life can be lost ; but if a Pharmacist makes an error, thousands of lives could be lost” . For instance an error made by a pharmacist in drug manufacturing could affect a batch of a drug that could wipe away thousands of lives. Even in the area of “Over the Counter Drug” classification, a drug is still a drug irrespective of its classification, & has the potential to cause harm.
For instance, an ordinary common (OTC) drug such as Paracetamol could worsen the condition of, or likely cause the death of a liver diseased patient if consumed.
In many countries of the world, it is a criminal offence for any person who is not a qualified Pharmacist( no matter the profession) to be caught or seen handling drugs except under the supervision of a Pharmacist. such an offence could be an jail able one
There are no records of the existence of patent medicine drugs stores or Open Drug Markets in any civilized nation of the world.
What baffles one is why our governments and leaders are still allowing the continued existence of Patent Medicine Shops & Open Drug Markets at the detriment of the health of innocent Nigerians.
Nigeria was at a study rated as the 189th out of 191 countries in terms of global health indices.
Many Nigerians including unborn ones, children, women, those with compromised organ functions, the elderly etc are already facing an indescribable & undocumented drug related risk when persons without the requisite knowledge and skills are permitted to handle drugs under our laws, or even in spite of our laws against open drug markets .
Our policy makers should realize that we are now in the 21st Century & that the issues of chaotic Drug Distribution should be taken seriously.
The proposed Pharmacy Council Bill that has passed the 3rd reading in our National Assembly needs an urgent attention or assent by the presidency to enable Nigeria bounce into the league of Nations with enviable health indices.
The continued existence of Open Drug Markets & Patent Medicine Stores, even if it has some legal backing should be urgently revisited.
Many countries have continuously been reviewing old laws & policies & have continued to discard the outdated and hazardous ones. We cannot continue to uphold & upgrade policies that have deleterious effects on the health of our citizenry.
Nigeria cannot continue to remain the only country in the world where patent medicine vendors and open drug market dealers still exist, when relatively poorer nations have sanitized theirs. Life has no duplicate and anybody can become a victim of fake, substandard drugs or even wrong use of a drug.
That you consumed a medication today which was purchased from an open drug market or unprofessional, and you did not notice any harm , does not mean that you are free from the associated harm which may manifest years later .
If Government should engage most of the Pharmacists we have in Nigeria, our nation will also come up as the largest exporter of drugs & vaccines with solid capital base in Africa if not the entire world.
The era of COVID-19 pandemic should be a source of serious lesson and learning for us.
Even if we cannot produce vaccines or be self-sufficient in medicines production for now, we should be able to take advantage of the inherent healthcare benefits in our Pharmacists who have been trained with our tax payers money at the various Nigerian Universities or Pharmacy Schools rather than still celebrating quackery in the 21st century via the proliferation of open drug markets and Patent Medicine Vendors stores..
We should not continue to allow the operations and existence of quacks in the health sector under any guise or reasons, whereas many countries without a single Pharmacy school still insist that only licensed pharmacies should exist and must be strictly operated by qualified pharmacists.
In many countries patients/clients may even need to travel very far away or kilometers before they could access their drugs for reasons that have been adequately explained above.
Nigeria should not be an exception as life has no duplicate.
Nigerians, our policy makers and the various tiers of government should realize that the continued existence of open drug markets & patent medicine vendors in the 21st Century is highly counter- productive, archaic and should be outlawed as it is like having a square peg in a round hole.
For how long are we going to allow the killing of our people through unprofessional use of drugs?
Even the British who gave us independence do not have or tolerate any form of quackery in the operation of their medications handling activities.
We cannot continue to toy with precious lives of our Citizenry.
Written by: Dr Charles Nwako, a clinical pharmacist from Owerri, Nigeria