“50mg or 100mg?” asked the bespectacled pharmacist after we placed our order. If the confusion that hit us struck any impression on him, he did not notice.
We accepted a few pills of each, paid and stepped out of the pharmacy onto the busy streets of Nairobi’s CBD.
Just like that, no questions asked, no alarm raised, two girls acquired Viagra, a popular vitality drug that is supposed to be prescription-only, as stipulated by regulations governing their sale.
And the sexual vitality enhancer is not the only prescription drug whose over-the-counter sale has been outlawed. Cough syrups containing a highly addictive sedative called Codeine have since been pulled off the regular shelves by the Pharmacy and Poisons Board.
They are strictly prescribed and pharmacists who contravene the law risk jail term and hefty fine.
This new war front on drug abuse opened following a realisation that the face of substance abuse in the country is changing.
A while back, a mention of “drug abuse” would bring to mind narcotics such as bhang, heroin, cocaine and other substances that can get one in serious trouble with the law. Indeed, the law is justified to regard them in disdain —they do terrible things to victims.
In fact, a mention of “drug abuser” conjures images of spooky looking characters with blood-shot eyes, dishevelled near-zombies with hypodermic needles half buried in an arm or full blown zombies who have already fried most of their brain cells with white powders.
These are the typical drugs and their abusers. But they are facing stiff competition from legally available prescription medicine.
The new abusers are strutting the streets in expensive suits, use ‘Ubers’ to high-end offices, actively go to church each Sunday. Heck, some are not even aware they are addicts, captives of medicine easily accessible over the counter from the local pharmacy.
Cough syrups containing Codeine, a substance categorised on the same level with heroin, are the major culprits.
Their overuse is churning out addicts who cannot function normally without it.
Unlike their illegal counterparts, however, those dependent on Codeine do not have to turn to dealers in shady alleys for the ‘goods’, but can access the drug over the counter.
But, perhaps realising the ticking time bomb that is improper use of prescription drugs, the Pharmacy and Poisons Board banned the sale of all medicine containing Codeine without a doctor’s prescription in January.
“Overuse of this substance puts users at risk of addiction, fatal damage and even death in extreme cases,” the board said in a media statement.
Ideally, the government crackdown was meant to curb the destructive impact of Codeine abuse before it spawned into an epidemic. Those convicted face a maximum penalty of a jail term not exceeding three years or a fine not exceeding Sh100,000 or both.
Yet, we easily acquired this and other harmful medicines from several pharmacies in Nairobi’s CBD last week.
Without demanding for a doctor’s prescription, the pharmacists hurriedly fished out two types of syrups that contained Codeine.
After settling on one, we paid and the syrup was neatly packed in a brown envelope. The pharmacist did not even care to indicate the dosage. It is only after we inquired that he scribbled the critical detail on the package.
It was the same in several other chemists in the heart of the CBD. Just like the first chemist, the pharmacists offered options of all the Codeine drugs available before directing us to a cashier to make payments.
Was it the usual impunity, ignorance or genuine lack of knowledge that some even issued us receipts of the illegal sale? We couldn’t tell.
But like the first chemist, few were bothered with supplying dosage instructions. It was a curious omission.
But not all chemists missed (or were probably deliberately ignoring) the ban memo. They flatly declined to sell the drug without a valid prescription. Some of the cough syrups which contain Codeine are Coscof C, BronKof and retail between Sh200 and Sh250.
Ezra Omollo, a general practitioner with AAR Health Care says Codeine belongs to a class of drugs known as opiods and which are powerful painkillers.
Morphine and heroin belong to the same class of drugs. They are highly addictive and as such, are classified as dangerous drugs with guidelines requiring that they be stored separate from other medications and in locked cabinets designated for dangerous drugs in pharmacies.
“Cough syrups use Codeine as one of its active ingredients and as such have been shown to pose the danger of being addictive, they are not to be given without a prescription,” he says.
Some of the adverse effects include addiction, restlessness, false sense of well being, low blood pressure, blurry vision, deranged liver function and respiratory depression that may be life threatening.
Cough syrups containing Codeine should also not be given to children under six years while Codeine itself should not be given to children under 12 years.
They should also be avoided in pregnancy as well as by breastfeeding mothers as the babies may be affected.
Codeine can also cause seizures and death from respiratory depression. Caution should also be taken by machine operators and those driving as drowsiness could lead to fatal accidents.
Certain disease conditions may also mean that one should not use it including conditions that affect the kidneys, the liver, heart, head injuries, asthma and other respiratory diseases.
“It is, therefore, useful to take all these unique conditions a patient may have together with current drugs being used that may interact with Codeine before prescribing it. Such detailed history and evaluation cannot be done over the counter while at the same time taking care that the patient is not an addict,” says Omollo.
Back to Viagra
Back to the earlier acquisition, our investigations also revealed the extent of abuse of Sildenafil (Viagra), the prescription drug for treatment of erectile dysfunction.
“You want it, you get it,” seems the motto for most pharmacies. One tiny blue pill retailing under brand names Kamagra, Vega, Vig- RX to name a few costs as little as Sh50, for the generics and Sh1,000, for the original.
None of the pharmacists we visited demanded a doctor’s prescription before issuing the medicine. However, most declined to issue receipts of sale.
“We do not issue receipts for this product but for the rest we do,” that’s the only explanation one offered.
Another was, however, more candid, admitting that she would not issue a receipt since she was selling the product illegally. She said the sale was “a favour” to the customer.
It was baffling how easily these drugs were dispensed.
Omollo says besides erectile dysfunction, doctors have also prescribed the “blue pill” to treat pulmonary arterial hypertension (PAH), a life threatening condition in which the pressure is too high inside blood vessels in the lungs.
However, the drug is today abused by people who intend to have enhanced sexual energy and sustain erections.
“Using this drug without a doctor’s prescription may lead to adverse effects including sudden loss of vision or hearing, prolonged and painful penile erection, stroke, heart attack, insomnia among others,” says the doctor.
“People with history of diseases like hypertension, stroke, heart disease, ulcers, sickle cell anaemia, liver or kidney disease may be at high risk of adverse effects with use of Viagra,” he adds.
It is also useful to note that Viagra is heavily counterfeited because of its popularity so one may be taking fake medications that may lead to even worse effects, he says.
And still on bedroom matters, another of the most abused drugs, mostly by the youth is the morning-after pill or emergency contraceptive (e-pill).
It is taken within 72 hours of unprotected sex to prevent unplanned pregnancies.
In a bid to increase access to emergency contraception, the government has allowed it to be issued over the counter.
However, this permission came with a rider.
That the medical professional dispensing the emergency pill is to take relevant history from the client and give appropriate instructions on usage and possible side effects.
“Prolonged use of the emergency contraceptive pills of various types may increase risks of developing blood clots and other cardiovascular disease conditions. As such, it is useful for the dispensing medic to take a proper history of the client,” says Omollo.
He says that guidelines also require that clients be educated that emergency contraceptive pills do not guard against sexually transmitted infections hence the need to have responsible sexual behaviour.
People who find themselves frequently having to use the emergency pill should seek a long term contraceptive solution.
“The pills could also interact with other medication one may be currently using hence its important to take a proper drug history,” notes Omollo.
However, none of the chemists we visited for the e-pill seemed bothered with the ‘minor detail’. None bothered to orient us with possible side-effects or dangers of its abuse.