DISCUSSION

Human resource for health is a critical component of a health system and the quality of health care providers is also a sine qua non for effective and efficient health service delivery. Community health workers (CHWs) are an indispensable component of the Nigerian health care system and the schools of health technology are important training institutions for grooming these cadre of health professionals to provide the much-needed health care services at the primary health care level.

To the best of our knowledge no study has been carried out to assess drugs/substance abuse among students in schools or colleges of health technology in Nigeria, undergoing training to become community health workers. Previous studies of drug abuse among health care professionals undergoing training or internship in Nigeria have focused primarily on medical and pharmacy students in tertiary institutions.^14,17,18

The dearth of studies on the involvement of CHWs in training in drugs and substance abuse, was the rationale for undertaking this study to determine drugs/substance abuse among these critical human resource for health and how their abuse of drugs/substances can impact negatively on the effective and sustainable delivery of primary health care services in Nigeria.

The findings of our study showed that the lifetime prevalence of any drug use among our respondents was 37.5%.  The reported lifetime prevalence of drug abuse among medical students in tertiary institutions reported by Ihezue¹⁷, Makanjuola et al.¹⁸ and Babalola et al.¹⁴, respectively was 56%, 78% and 65%. Umukoro et al.¹⁹, in their study among non-medical students of tertiary institutions in Abeokuta, Ogun State, Nigeria, obtained a lifetime prevalence of drug abuse of 69.2%.

The lifetime prevalence of drug use among our subjects is lower than the figures recorded among the medical students, probably because the social and academic contexts of our subjects are different from their medical students’ counterparts.  It is however generally believed that health professionals in training are confronted with heavy workloads which puts lots of pressure on the student, thereby making them resort to stimulants to cope with the stress of studies as alluded to by Omokhodion et al.²⁰, Babalola et al.¹⁴, and Everson.²¹

Alcohol was the most commonly abused drug among our study subjects with a current prevalence of 53%. This figure is higher than the 40.4% prevalence found among medical students by Makanjuola et al.¹⁸, It is however slightly lower than the findings by Ihezue¹⁷, and Babalola et al.¹⁴, who obtained current prevalence of alcohol abuse among medical students of 63.4% and 60% respectively.

As shown in Table 4, our study found that alcohol was used either singly or in combination with marijuana and nicotine. The prevalence of alcohol/marijuana and alcohol/nicotine was of 3.0% respectively. This abuse of alcohol with other substances was also reported by Oshikoya et al.²², Makanjuola et al.¹⁸, and Essien²³, who in their various studies found alcohol, marijuana and nicotine as the most prevalent drugs/substances that are abused together by students.

The abuse of alcohol by students is common, largely because it is easily available and affordable. Moreover, alcohol has the paradoxical effect of acting as an initial stimulant by eliciting a sense of feeling high some minutes after being consumed; but later producing a low or down feeling, thereby acting as a depressant. It is therefore an easily available drug for the relief of either academic, social or economic stress by students facing stressful situations.   

Abusers of alcohol, often lose sight of the fact that alcohol as a drug of abuse has both short- and long-term physical, mental and psychological effects. The physical effects of alcohol include alcoholic hepatitis and fibrosis^24,25 as well as raised blood pressure that could result in stroke.^26,27 The mental effects include: poor concentration, loss of coordination and critical judgement, and dementia while the psychological effects include: depression and withdrawal²⁸. Additionally, the behavioural effects may include: decreased inhibitions and risky sexual behaviors.²⁹

Marijuana is another substance that is equally abused by the youth in Nigeria. The prevalence of current use of marijuana among the respondents in our study group was 6.1%. This is lower than the 11% current usage of cannabis among medical students reported by both Ihezue,¹⁷ and Babalola et al.¹⁴.  Fatoye,³⁰ in a study of drug abuse among undergraduates of the University of Ile Ife in South West Nigeria, reported a current prevalence of cannabis use of 8.2%, while Uchendu et al.⁸ reported a current prevalence of 9.0%.

The relatively low current prevalence of cannabis among students may be the result of under reporting. This be attributable to the fact that cannabis is classified as an illicit drug and its use has been criminalized by the National drug law enforcement agency (NDLEA) act of 2004.³¹ The common harmful effects of cannabis include; alteration of the state of consciousness, disorientation, impaired coordination and concentration, anxiety, panic attacks, toxic psychosis and hallucinations.³²

The abuse of prescription drugs is considered to be a major public health problem in Nigeria.  Until recently, before Nigeria prohibited the over-the-counter sale of codeine and tramadol without due prescription, these two addictive drugs were the most commonly abused prescription drugs in Nigeria. The abuse of psychoactive prescription drugs especially by health care professionals is another dimension of this national malady and a serious issue of concern. This is particularly so because health professionals who ought to know better are among the abusers. Moreover, they have easy access to these drugs.

Tramadol, a synthetic opioid analgesic is used to treat moderate to severe pain; however, an overdose of it can cause cramps, arrhythmias, cramps, coma and death. Tramadol use disorder is known to be associated with compulsive behaviour. Codeine on the other hand is also an opioid pain killer; and is a component of several codeine-based cough syrups. The abuse of codeine products can result in severe health outcomes such as peptic ulcers, liver damage, respiratory depression, coma and death, and more importantly, the concurrent abuse of codeine with alcohol increases the risk of adverse outcomes.³³

In our study, the prevalence of current abuse of prescription drugs by our respondents was 12.1%; and the commonly abused prescription drugs were codeine and steroids. About 2 (3.0%) of the subjects have used codeine in combination with alcohol, while 6 (9.1%) of them combined cocaine with codeine.  In a similar study by Akande-Sholabi et al.¹⁵, that was conducted among a combined number of 520 medical and pharmacy students in a Nigeria university, about 34.2% (178/520) of the respondents in multiple responses had generally used opioid-containing medications. Among these 171 respondents, 96.1% (171/178) of them have used formulations that contained codeine as cough syrup 95.3% (163 /178) and 4.7% (8 /178) of them as non-cough syrup formulations. 

Various reasons have been adduced from previous studies about why students engage in drug or substances abuse. Some of the reasons include relief from stress and the need to stay awake and alert at night to study.³⁴ The reasons given by our respondents for engaging in drug abuse in our study included: peer group influence (28.8%), the desire to get high (22.7%), socio-economic problems (13.6%), the desire to perform better (10.6%), curiosity (9.1%), academic problems (6.1), and the desire be inspired (4.5%). It is worth pointing out, even health professionals have the erroneous belief that drugs can enhance academic performance. In actual fact the drug abuse has been found to reduce academic performance.

The age of initiation of drugs by our respondents is worthy of note. Majority, 57.6% of the students abusing drugs/substances reported that they initiated drug/substance abuse as teenagers, within the 13 – 18 years age bracket.  A similar result was obtained by Babalola et al.¹⁴. In their study conducted among medical students. The researchers found that most of their respondents were first exposed to drug use as teenagers, between the ages 15 and 18 years.

Umukoro et al.^`19 in their study among tertiary students in a university in Abeokuta, Ogun State, Nigeria, showed that a 39.7% of the respondents got involved with drugs while in secondary school, while about 16.5% them started using drugs when they entered the university. In a related study by Eze et al.³⁵ among undergraduates in the University of Abuja, located in the Federal Capital City of Nigeria, the researchers reported that about 34.7% of their respondents had their first drink of alcohol between the ages of 11 and 18 years.

The evidences from these studies point to the fact that most abusers of drugs / substances in the tertiary institutions started using drugs/substances as adolescents while in the secondary school. The adolescence period is one of the most vital developmental phases in life during which the adolescents grows and develops in the physical, mental, cognitive, emotional and social domains³⁶. It is also the period in young people tend to experiment with new behaviours, practices or lifestyles, whether good or bad. 

The adolescents, are often oblivious of the adverse consequences of their experimentation with negative habits or lifestyles. They are unaware that engaging in risky or deleterious behaviours can impair their holistic development and functionality in the five aforementioned critical developmental domains, thereby affecting their well-being and hindering them from becoming responsible adults

This period of adolescents is also where the pull of peer pressure is quite strong and the adolescent is more prone to yield to peer pressure. Our findings showed that majority (57.5%) of our studied sample got involved with drugs as teenagers and that 29% of them got involved as a result of peer group pressure.

The result of a related study on drug abuse by Adeyemo et al.³⁷ among university students in Benin City, Nigeria, indicated that peer pressure played a predominant role in the abuse of drugs by the students.

Majority of those surveyed agreed that (always or occasionally) their friends encouraged them to take: Coffee (66.9%); Alcohol (66.7%); Cigarette (57.1%); and Marijuana (52.2%). There is therefore need for school-based counselling on drug-abuse prevention even at the secondary level to obviate the effect of peer pressure in drug initiation.

CONCLUSION

Drug abuse by healthcare providers affects not only the individuals physical and psychosocial well-being, but can also impact negatively on the job performance. Health care professionals who abuse drugs/substances are more liable to commit errors in the administering of medications that can cause serious health harm to patients. They have a higher tendency for employee absenteeism, decreased concentration, poor judgement, low   productivity, and are prone to workplace accidents and injuries as well as increased susceptibility to illness. They are also predisposed to the pilfering of patients’ medications and other illegal activities at work.²⁷

The implication is that instead of adding value to the health system they would become liabilities. Therefore, the abuse of drugs/ substances by community health workers in training poses a great drawback to the national goal of bridging the human resource for health gap, particularly at the primary health care level. and improving access to qualitative and efficient PHC service delivery at the grassroots level.

RECOMMENDATIONS

There is need to address drugs/substance abuse among students in the College of Health Technology, Calabar with special regard to alcohol, cannabis and prescription drugs, through targeted behaviour change interventions, so as to mitigate the short- and long-term physical, health, and psycho-social effects of drug abuse on the abusers and their families. Moreover, since drug abuse is a national public health issue, there would be need to conduct similar studies in other schools of health technology across Nigeria to be able to determine the prevalence of drug abuse and the substances abused. This study is equally a call for the government to take urgent proactive preventive measures to reduce the increasing rate of drug abuse in the country among our youth in the various health training institutions in Nigeria who are the potential health workforce for the future.

LIMITATIONS OF THE STUDY

This was a cross sectional study, that is dependent on the sincerity of the participants in responding to the survey as truthfully as possible. Some students involved in the use of illicit drugs out of fear of being indicted by the law may not disclose information on the use of drugs/substances such as cocaine and marijuana. 

POLICY IMPLICATIONS FOR DRUG ABUSE PREVENTION IN HEALTH TRAINING INSTITUTIONS

The menace of drug abuse among the students of our schools of health technology poses a serious threat to the effective delivery of the much-desired goal of ensuring equitable and qualitative universal health care. To the best of our knowledge, this is the first study in the country that has examined drug/substance abuse among community health trainees or students in a School of Health Technology in Nigeria. This research has generated information on the prevalence of drug/substance abuse among students in the College of Health Technology, Calabar.

The findings can serve as basis for future assessments and provision of necessary ameliorative interventions.  It could serve as baseline information for future research within the college or for similar studies in other tertiary institutions. Furthermore, the findings of this study could be applied in designing interventions to curb drug/substance abuse and mitigate its effects in similar institutions in the country.

AUTHORS’ CONTRIBUTION

Both authors participated in the data collection, cleaning, analysis and writing of the manuscript.

SOURCE OF FUNDING

None.