Pharmaceutical Drug Abuse

By Ibtihal Alsalhi

Aden, Yemen,July 20,2015 (The New Arab) – His journey to drug addiction began with chewing Qat. From there he got hooked on narcotic drugs that he would easily procure from pharmacies in Aden without a proper drug prescription. As a result he lost both his health and mental abilities and was abandoned by his family.

Similar to Hisham, 29, thousands of young people are abusing “controlled drugs”, medicine that can only be sold by pharmacies against a prescription. Violating pharmacies are profiteering in violation of the licensing regulations of the Yemeni health laws.

These pharmaceutical drugs are accessible alternatives to prohibited drugs. In Aden, the procurement of medication without a medical prescription is no longer difficult. After months of investigation, this reporter found that one fifth of licensed pharmacies do not refuse to sell these addictive drugs.

The reporter visited 25 pharmacies in four different regions. She convinced operators at five pharmacies to sell her without any prescription Restyle, Valium, and Diazepam pills – among the most popular drugs that are abused by addicts.

This happens because of weak monitoring by the department of health in the province and the districts, the obstruction of enacting the law that regulates this sector and continued disagreements between the official regulatory and supervisory bodies.

Half of the pharmacies which the author visited refrained from selling sedatives without a prescription. Seven other pharmacies confirmed that they have stopped dealing with these sedatives ever since they were attacked by addicts to whom they refused to sell these drugs without a prescription.

Sample of the 25 Pharmacies

The journalist documented that 13 pharmacies refrained from selling drugs without a prescription. Five pharmacies agreed to selling drugs without a prescription while 7 others said that they do not store these kinds of drugs. These pharmacies were convinced that the author was one of the young people who abused these kinds of drugs. She was charged double the original price for medicines she bought. She paid for a 10-pill strip of Restyle for Yemeni Riyals (YR) 3000 ($14) while its original price is $7. A 10-pill strip of Valium cost YR 860 ($4) against its  original price of $1.5.

Absent Control

Only four employees work at the departments of health in the province and the district. They are responsible for monitoring 400 registered pharmacies in Aden, according to the head of the Department of Health, AlkhodorLsour. In addition, there is no law that regulates the sale of medication or the licensing of pharmacies.

The blocked draft bill that has been sitting in the Yemeni parliament drawers for a long time is supposed to “limit the distribution and smuggling of sedative drugs, to regulate drug sale and to set certain standards for establishing pharmacies, guaranteeing the monitoring and liability for drug sale.” According to Lsour, it would regulate the “procedures for licensing a pharmacy that would necessitate that the distance between the pharmacy and the closest hospital be 250 meters starting from the hospital wall. It would also require that the drug sale be supervised by a pharmacist”.

A Threat in the Street

Pharmacies are not the only source for drugs without a prescription. Many dealers are present in the streets of the city which has a population of 866,000, half of whom youth. This reporter followed one of four dealers whom she was introduced to via a young addict. She managed to pressure him into providing her with a Restyle strip and a Tramadol strip at YR 6000 for the Restyle strip ($8 dollars), four times more than the set pharmacy price. For Tramadol, she paid the equivalent of $14.5. However, he did threaten to kill her in case she informed the police about him: “If you tell on me, it will be last day of your life. I know how to reach you.”

The drug dealer, in his late 20s, said: “In each one of the regions of Aden, such as Sheikh Osman, Mansoura and others, there are four to six people selling drugs to addicts who don’t have to visit a pharmacy.”

One of the drug addicts also said that he takes “one or two pills per day. Some people take up to 20 pills, which make up two full strips.” In that case, “one is unable to stop even for one day. If he does, he would start behaving bizarrely and he would have intense episodes of neuralgia.”

According to Pharmaceutical expert Mounira Al Saqaf, such a dosage poses a potential threat to the user. “They are not fatal in the short term, but they put the body in a constant state of sedation, and they affect the medium term of the user’s nervous system”, she said.

Morphine is considered the most important sedative and psychotropic substance that is also sold in pharmacies against a medical prescription. It is used in hospitals as a painkiller after major surgery. Its continuous usage may cause addiction.

The drugs that are commonly used and that are quite popular among addicts are: Tramadol; used for relieving moderate to strong pain – Diazepam; used for anxiety symptoms and psychological disorders and for sleep. It is supposed to be taken for a short period of time since it is addictive. In addition, there is Codeine; a derivative of Morphine but with a quarter of its efficiency. It is a painkiller; it helps with relaxation and sleep, and it is used to treat coughs.

Alparzolam is another popular drug; it is of the Diazepam group. It is an anxiety reliever and a sleeping pill but it can cause psychological and physical addiction. The same applies to Restyle; it is used for treatment of anxiety and mental disorders, and it is a sleeping pill. It should be used for a short period of time to avoid addiction. Valium is an anti-anxiety medicine and a tranquilizer; it affects the central nervous system and it gives off signals to all body parts. Pethidine is another Morphine derivative and has a short-term effect which does not last more than three hours. It is used as a painkiller for medical interventions and for sickle cell anemia.

Hisham’s Journey with Addiction

Unaware that Hisham would head toward addiction on drugs, his parents gave him money to purchase and use Qat. His ordeal started when he began looking for a job. He met a group of friends who would use Qat to stay up late.

With sad eyes and a trembling voice, Hisham’s mother recalls how they initially provided him with Qat before refraining from doing so. That is when his demeanor began to change gradually; he would scream and shout, demanding money. This pushed the parents to “occasionally give him money”.

However, the situation worsened and Hisham began to “steal his mother’s and sister’s gold jewelry, and to borrow money in his father’s name”. His father found out; he got into a fight with him and kicked him out of the house”. At that time, his friends got him deeply involved with drugs. He returned home “in a dreadful state”. He had become very thin, he smelled badly, his clothes were dirty and his eyes were sunken.

The grieved mother added: “I felt sorry for him and I begged his father to allow him to return home. However, he had become a different person – he couldn’t articulate, his speech was incomprehensible, he stayed up late and he was moody.” His mother’s suspicions were confirmed when she found an empty strip of Restyle on him.

Hisham’s family became aware of his addiction when his situation turned critical. “One night, my son came home late and in a bizarre state. An hour later, the whole family was awakened by his young sister’s screaming. Houda, 15, was crying for help after he had torn up most of her clothes, attempting to rape her”. With great pain, Hisham’s mother recalled the dire state to which her son’s addiction journey had reached.

Hisham’s father hit him “with a piece of metal on his head so he fainted and broke his leg and arm. We took him to the hospital afterwards. We don’t know anything about him ever since, because his father refuses to allow him to return to our home”.

Lacking Supervision

Aden’s Department of Health prohibits pharmacies from selling any medication – especially sedatives – without an official medical prescription that has a doctor’s stamp and the clinic address. Also, the type and dosage of the medication should be indicated, as per the Ministry’s directions.

The journalist discovered that the department’s monitoring is almost inexistent. The department sends merely three to four employees “once every two months to hold ineffective seasonal campaigns” to check on a random and limited sample among the 400 licensed pharmacies. The department takes action when it receives a notification about a pharmacy that is selling medications without a prescription.

The Other Side

The pharmacies in the city confirmed that the monitoring is weak. Pharmacist Affan, 30, from the Khor Maksar Governorate said: “I cannot recall the last time I had a visit from the inspectors of the Department of Health to look for any counterfeit or smuggled drugs.”

The mechanism for the field visits and random inspections of pharmacies in the governorates require an element of surprise, based on the legal regulation lists of pharmaceutical work.

Pharmacies that do not abide by licensing terms may be shut down for a period of one week to one month. In case a pharmacy repeats the offense of selling drugs without a prescription, it may be closed down permanently. However, the Health Department has not closed down any pharmacies since 2008. This confirms the inefficiency of the monitoring system against the violations documented by this reporter.

An Open Market

Psychiatrist Dr. Abdullah Al Shabihi, confirmed that his patients get what they are looking for from both the pharmacies and the street dealers. “It is not difficult to procure these drugs.”

Three drug users agreed to talk to the reporter. They confirmed that they can “easily” find drugs but they find it difficult to pay for them. Prices range between RY1000 ($5) to RY 5000 riyals ($25), according to the quantity and quality of the drug.

Beginning of the Problem

The phenomenon of drug addiction began to spread among the youth since 2007, with the start of the political uprising against the central authority system in Sana’a. According to some drug users, the problem became evident four years ago, with young people fearlessly flaunting their drug use as a result of the absence of supervision and security. 

The causes and motivations of drug abuse varies among the youth. Each has his/her reason. Some take it to “improve their mood and to feel a high” similar to that ofQat. Some take it to “cure their insomnia and to fall asleep”. Other do drugs to “run away from their bitter realities or their tough social circumstances.” According to Dr. Al Shabihi, some students take drugs to help them focus during exams.

Drug Law Hidden Away 

The absence of a law for the regulation of drug sale exacerbates the sale of prescription drugs. The draft bill was sent to the parliament in 2010, according to a statement published by former Health Minister Ahmad Qassem Al Ansi. It has 93 articles categorized in 7 chapters.

When confronted, the Head of the Health Department Dr. KhodorLsour, admitted that “the drug problem has become too overwhelming for the department, and that the biggest obstacle is the lack of rehabilitation centers for addicts.”

Lsour confirms that the monitors supervise abiding pharmacies “who keep records of incoming and outgoing drugs”. But when this journalist visited pharmacies, the employees denied keeping any records. When she informed him of this matter, Lsour simply shrugged, expressing his surprise and avoiding the question.

With the outbreak of the 2015 war, the journalist revisited those same pharmacies in July, asking for drugs without providing a prescription. She found out that, in general, the pharmacies who agreed to sell her those drugs prior to the war, agreed to sell them to her yet again, without a prescription. Meanwhile, the ones who refrained from selling these drugs before the war still refrained from doing so.

Senior Directions

Dr. Lsour complains about interference in the work of the department of health: “They create problems. That is, when we decided to shut down a pharmacy in the year 2010 because it was selling drugs without a prescription, we received senior directions from parties (which he did not name), and the decision of shutdown was not executed.”

The former head of the Drug Enforcement Administration (DEA), Colonel Khaled Al Najjar also spoke about past failed attempts to control the phenomenon of illegal pharmaceutical drug sale. In the year 2005, a committee was created with members from the province, the Health Department and the DEA. The aim was to inspect and monitor violating pharmacies, but it stopped working in the year 2012.

Al Najjar and Lsour attributed the halting of the committee’s work to “lack of means”. Al Najjar confirmed that failed requests for the parliament since August 2010 to amend the laws and to add sedatives to the “narcotic lists and to mention punishments for illegal dealing and using.”

Overlapping Authorities

The head of the DEA Colonel Fadel Saael confirms that the committee resumed its work in 2013, but it stopped again “and the reason this time was lack of good intentions”. The committee visited drug companies and asked them for lists of sedatives and drugs that they import and sell to pharmacies. But the committee was not provided with any list.

There is no law that gives this committee the authority to monitor the companies. That is, they are supervised by the Higher Commission for Medicine, according to the General Manager of the Commission and the Government Medical Monitor in Aden, Dr. Abdul Qader Al Bakri.

Dr. Al Bakri says that this committee is illegal and that the participating parties are not authorized to carry out this mission. “It is the job of the department of health and the commission; security authorities or the DEA have nothing to do with it”.

 When the journalist asked for an explanation about the source from which young people purchasing pharmaceutical drugs, Al Bakri answered: “The companies who import these drugs are not responsible for those who deal with them or abuse them. The illegal sale of these pills is the source. He added that “these drugs are smuggled into the country either through border crossings or from other governorates.”

The journalist confronted Dr. Al Bakri with the fact that she was able to procure these drugs from pharmacies. He replied by saying that the monitoring of these pharmacies is not the job of the commission – it is the responsibility of the Health Department.

However, Dr. Al Bakri reconfirms that the problem lies in the lack of laws that regulate the use of sedative drugs. “The abuse of sedatives is not included in the narcotic law, despite the fact that the World Health Organization classified them as narcotics”. Yemen signed the United Nations Convention against Illicit Trafficking in Narcotic Drugs and Psychotropic Substances in 1992.

Al Bakri affirmed that the commission has been demanding “a narcotics law since the year 1992, which would regulate these gaps if it were issued.” The DEA’s job is limited to monitoring the companies that import drugs, including narcotics or sedatives. According to Bakri, after importing them from the source country “the importer is only permitted to sell them to pharmacies and hospitals. If the company violates this law, we take necessary action against it and we prohibit it from importing. But until now, we have not received any report of such an incident”.

Regulation and Violations

In 2014, the DEA in Aden referred several cases to the prosecution, “including 27 cessation cases, five of which were of sedative drugs and 22 cases of hash and cocaine (33.61 kilos of hash and 52 grams of cocaine, and 300 Diazepam pills, 267 Prazole pills and 178 Restyle pills.

In Aden, there are 400 licensed pharmacies and 130 drug storehouses, according to 2012 data provided by the Health Department. In the Sheikh Othman governorate there are 105 pharmacies, in Al Mansoura 150 pharmacies and in Crater 35 pharmacies. Several pharmacies and drug storehouses are found in the other five governorates in the province. But the real number is more than that because of the existence of unlicensed pharmacies in Aden, according to a medical source who estimates their number at 800 pharmacies.

Dr. Abdullah Salem Al Shabihi, psychiatric specialist, divided the “drugs that affect one’s psychological state into two types: the first type changes one’s mood, general state of consciousness, and directly affects the brain’s nerve cells. This type is divided into three categories according to their effects on the nervous system: Stimulants, sedatives and hallucinogens.”

According to Al Shabihi, the second type affects “the pathological mental state. Most of them work in an indirect manner, despite their immediate effect on the brain cells. Their therapeutic effects do not clearly appear before a few weeks when the nerve cells have adapted to their effect. This is called “Neural adaptation”. This type includes antidepressants, antipsychotics and anti-anxiety drugs.”

Losing Faith

Lawyer and activist Faysal Al Daqem confirmed that “citizens have lost their faith in the official authorities’ abilities to resolve this matter. Even us, the activists; we have lost our faith in them.”

Al Daqem recalled that in “the year 2012, we arrested people who were dealing these drugs. They signed a pledge to quit these activities. We turned them over to the authorities but we were surprised to find out that they were released a few hours later.”

Colonel Khaled Al Najjar, former head of the DEA in Aden, said that such operations “are useless and don’t serve the cause.” He added: “If it were carried out in coordination with the DEA, it would have succeeded. The dealers were not caught red-handed which is a clear necessity in the law, in addition to the fact that those guys are not authorized to arrest them.”

Meanwhile, abusers of prescription drugs sold in pharmacies walk around freely and can procure sedatives from pharmacies that agree to violate directions in return for doubled profit, amidst weak official monitoring and conflict of responsibilities between official authorities.

*This investigation was completed with the support of Arab Reporters for Investigative Journalism (ARIJ) – www.arij.net