29 August 2022
Name: Nonso B.C Maduka
Location: Enugu, Nigeria
Job title: Executive director at Bensther Development Foundation
A pharmacist by training, Nonso B.C Maduka is also a public health and drug policy reform advocate, and a member of the National Technical Working Group on Harm Reduction, Federal Ministry of Health Nigeria.
Here, we discuss the impact decriminalisation could have on health-seeking behaviour and why Universal Health Coverage needs to factor in prison populations and people who use drugs.
Why did you choose to work with people who use drugs?
During my second year studying pharmacy, our class rep suddenly dropped out of school, and we discovered that it was because he’d been introduced to drugs by his roommates. I started to ask questions; why weren’t his roommates also dropping out? How did we not notice any signs of drug use? Why was there no help available?
I learned that people’s responses to drugs differ greatly and that substance use disorder is not an intentional act nor a moral failure. I also discovered that the knowledge gap in the country in the field of addiction was deafening. And finally, I learned that medical centres and hospitals really don’t know how to manage drug use disorder. At the time, the treatment available was the use of Benzodiazepines to induce perpetual sleep and this treatment approach was seriously complained about by inmates who used drugs held in prison asylum.
Tell us more about drug use in your country
Nigeria has a record 14.3 million drug users with 1 in 4 being female and 1 in 5 having drug use disorder. The narrative is that drug use is the root of crime in the country and the drug control approach is highly punitive. The minimum sentence for drug use has been 15 years.
I had a 360-degree turnaround after a survey I carried out with 80 convicted inmates with not more than three months remaining of their sentences on the role of Marijuana (Cannabis) in crime.
The inmates outlined three factors that determine the outcome of cannabis use; 1. Your personality, 2. The environment of use and 3. Your economic status.
I was consulting with the National Drug Law Enforcement Agency (NDLEA) Enugu State Command then, but I was afraid to publish the outcome of the research as that would have been an attack on the main premise of their existence. However, that research initiated my journey in drug policy reform advocacy.
What is the most important issue facing people who use drugs in Nigeria and why?
In Nigeria, it is the criminalisation of drug use. This negatively affects the health-seeking behaviour of people who use drugs and is the driving force of stigma and discrimination suffered by people who use drugs and their families.
Drug users are first human beings who were exposed to some risk factors for drug use, who – if given the required standardised treatment and care – are willing and able to contribute positively to our society.
But more than this, criminalisation encourages human rights abuse by law enforcement officers. During one of our Drug Policy Stakeholders events, a senior police officer was asked what would happen if a young Nigerian was stopped during a stop and search operation, and a wrap of cannabis was found for personal use.
We asked, aside from what the law says, would you see him/her as a criminal even though he /she has not committed any crime? The officer responded ‘that the young person is a POTENTIAL CRIMINAL so he will arrest him/her’.
The least that can be done to help is the decriminalisation of drug use. Decriminalisation will not only promote health-seeking behaviour among people who use drugs, and ultimately reduce demand for drugs, but will encourage government investment into healthcare provision for people who use drugs.
What about the issues facing people who use drugs in custodial settings?
The world is currently aiming for Universal Health Coverage (available, accessible, and affordable quality healthcare) for all. But how can that be possible if the minimal standard for healthcare provision (Mandela rules) for inmates is not observed in most African countries?
Currently, viral hepatitis testing is not even in the protocol of admission of new inmates into prison in Nigeria and other African countries, yet we know that injecting drug use happens in prisons.
Also, the recently-passed Basic Healthcare Provision Law in Nigeria has no provision for health issues affecting people who use drugs, even though we know that the prevalence of infectious diseases such as HIV, tuberculosis, and viral hepatitis is much higher among this population than in the general population (National Survey on Drug Use and Health in Nigeria UNODC 2018). Despite the discrimination people who use drugs face in accessing healthcare they are still expected to pay out of pocket for healthcare services.
Why did you join INHSU?
The best thing about being a member of INHSU is that this is an amazing network of diverse professionals. But INHSU is also a current source of insight into health management for people who use drugs.