Drug Use: How expired are 'expired drugs' for Bauchi rural dwellers?
Charly Agwam FASLN
As good as medicines are, they could also be disastrous when inappropriately taken or mismanaged, especially if it involves dispensing and consuming expired drugs, says Bashir Muazu, the Bauchi State Director of National Agency for Food Drug Administration and Control (NAFDAC).
Recently, in December 2019, NAFDAC destroyed what it termed 'unwholesome drugs' worth 1.32 billion naira. According to the NAFDAC Director-General, Prof. Mojisola Adeyeye, the drugs were destroyed because they were expired, substandard, counterfeited or banned goods.
The African Science Literacy Network (ASLN), in its effort to bridge the gap in science communication and raise awareness about the importance of science misconceptions, funded a research for a tripartite story series that focuses on the the use of drugs in Bauchi state.
According to Wikipedia, "A drug expires the date after which a drug might not be suitable for use as manufactured. Consumers can determine the shelf life for a drug by checking its pharmaceutical packaging for an expiration date".
However, for most Bauchi rural dwellers who are barely literate with very low income sources, investigation revealed that drugs only expire when and if their local dispensers (usually sellers of drugs in small shops, also called chemist) say so. At least 68 percent of rural patients interviewed said that they only rely on the discretion of their local dispenser for safety and efficacy of non-prescription drugs they buy over-the-counter.
One of the patients, Isa Mukaila, a resident of Kururu in Ningi local government area of Bauchi told Vanguard that because he was in dire need of a drug for his ailing daughter, he relied on the judgement of a drug dispenser in his locality for the expiration of medicine.
"Most medicines in our drug stores are either expired or near expired, probably due to our location. The other day I needed to buy a drug to manage my daughter's health condition, I searched almost all the drug stores in this village without success, except in two stores whose drugs were already expired.
"As a man in need, I relied on the judgement and assurance of one of the chemists (drug dispenser) whom I know personally, on the efficacy of the drug before giving it to my daughter. Thankfully, the drugs worked really fine, "he said," for me, if my chemist says a drug is good, it means the drug is good."
Similarly, one of the several interviewed local drug dispensers who pleaded anonymity revealed that he's been faced with situations where he had to administer expired medicines which he claims healed his patients.
He further claimed that he could tell whether drugs were efficacious, the first three months after their expiry dates by their physical appearance, while also praising his 'supernatural instinct' for detecting fake and expired drugs.
"I am a trained Chemist (local drug dispenser) so I know an expired drug when I see it. I have this ability to look at a drug and tell if it's expired or not, "he boasted," but I must say that I don't give my patients drug whose expiry date is older than 3 months no matter its appearance."
When asked if he knew that it was dangerous to administer expired medicines to patients, the Chemist who cited scarcity of drugs and emergency as excuses, said he "chose the doctrine of necessity" to save the lives of his patients.
Reacting, the Director of NAFDAC in Bauchi state, Bashir Muazu, who expressed shock at the use of expired drugs in the state, noted that expired drugs are not supposed to be on the shelves in drug stores, much less selling to patients whose lives might be at risk.
"I am shocked to hear this. For the umpteenth time, NAFDAC has directed drug store owners to dispose off all expired drugs in accordance with the guidelines issued to them. They have no rights whatsoever to keep expired medicines on their selves much less selling them to unsuspecting consumers. We will immediately swing into action to rid our communities of these bad eggs," he said.
When contacted, Pharmacist John Kabari stressed that expired medicines should not be administered to patients unless and until it has been tested and confirmed by a pharmacist to be safe for consumption.
"I want to categorically say that there's only one condition for anyone to use medications after their expiry dates. And that's only when they have sought and gotten permission from a pharmacist who happen to be the drug expert. The reasons for this is not far fetched: every drug product that can be degraded or get spoilt, usually has its expiry date predetermined during production and in the determination of the expiry date, a lot of factors are considered; such as temperature, humidity, agitation, and some other thermodynamic parameters, and with lots of complex and simple calculations.
"However, due to storage condition, a drug can expire before or after the predetermined expiry date. Exposing drugs to humidity, severe temperature conditions and anything capable of tampering with the integrity of a medication will certainly accelerate the reaction process occurring in that drug and that might lead to expiration even before the predetermined expiry date because the expiry date is determined on the basis that the integrity, packaging and other factors are intact.
He further explained that poor storage of drug may cause the medicine to release harmful byproduct even before expiration.
"For a drug to be said to have expired, it means that the active ingredients that is supposed to cure a disease is no longer effective in treating that condition or it may still have a high concentration of the curative elements but due to reactions taking place in the drug which may release some toxic byproduct, it makes the drug unwholesome for consumption.
"So people shouldn't just take medications because they heard someone say drugs could still be effective after expiration, they should always consult their drug expert because the pharmacist has the capacity to test the efficacy of a drug. But let me say it is advisable to not take medication that are expired, unless where necessary steps have been taken to determine the potency of the drug.
Corroborating Pharmacist Kabari's position on expired drugs, a medical doctor who is into private practice, Dr Alheri Abu charged regulatory agencies to live up to expectations by ensuring that only unexpired drugs are sold to patients by certified drug dispensers.
"Expired and fake drugs are undermining the efforts of health professionals as they continue to put the lives of unsuspecting patients at risk. I will advise that nobody should take expired drugs unless it has been tested and confirmed to be safe for consumption by an expert. The relevant government agencies must now carry out proper and timely disposal of all unsold, expired drugs to safeguard the lives of Nigerians," she said.
Meanwhile, drug stores in government-owned medical institutions, that should provide alternative for less supervised private drugs stores in local areas, are barely a shadow of themselves as most of them lack basic drug as common as paracetamol.
According to the Bauchi State 2020 revised budget, only five million naira was budgeted for drugs and medical supplies for a population of over 7 million people.
Charly Agwam is a Fellow of the African Science Literacy Network and writes from Bauchi State, Nigeria