|Year : 2022 | Volume
| Issue : 1 | Page : 48-52
Pattern of substance abuse in Northwestern Nigeria: A laboratory survey in an urban community
Sanni Musa1, Zainab Uba Ibrahim2, Idris Ainavi Isah1, Kabiru Abdulsalam2
1 Department of Chemical Pathology and Immunology, Kaduna State University, Kaduna, Nigeria
2 Department of Chemical Pathology and Immunology, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
|Date of Submission||01-Sep-2021|
|Date of Decision||10-Jan-2022|
|Date of Acceptance||10-Jan-2022|
|Date of Web Publication||12-Jul-2022|
Dr. Zainab Uba Ibrahim
Department of Chemical Pathology and Immunology, Bayero University/Aminu Kano Teaching Hospital, P.M.B 3452, Kano
Source of Support: None, Conflict of Interest: None
Context: Available information indicates that substance abuse poses a major political, social, and health challenge worldwide. Availability of drugs, negative peer pressure, poverty, and frustration are among the factors that increase the burden of substance abuse. Urine drug testing (UDT) is a reliable laboratory method of analyzing substances of abuse because many drugs and their metabolites remain detectable in the urine for longer periods. Aims: To detect the laboratory pattern of substance abuse among youths in North-Western Nigeria and to make recommendations based on the overall pattern to curtail the effect on society. Settings and Design: A retrospective cross-sectional survey of secondary data of patients who presented to a clinical laboratory for urine drug tests. Methods and Material: Trained personnel carried out a supervised collection of fresh urine samples, which were analyzed using a qualitative immunoassay technique. The presence of a drug was determined by reaching the drug's limit of detection. Statistical Analysis Used: Data were analyzed using a Statistical Package for the Social Science (SPSS) version 2 software. Results: The screen prevalence of substance abuse was 60.9%. Among those who tested positive, 97% were males, whereas 3% were females. The majority of participants were youths below 30 years of age. The observed pattern revealed a few of the participants (26.48%) had only one drug substance present in their urine, whereas 73.53% tested positive for multiple substances ranging from two to five drugs in a urine sample. Conclusion: A high prevalence of substance abuse was observed and most of the participants were multidrug users.
Keywords: Laboratory, substance abuse, urine drug test
|How to cite this article:|
Musa S, Ibrahim ZU, Isah IA, Abdulsalam K. Pattern of substance abuse in Northwestern Nigeria: A laboratory survey in an urban community. Niger J Basic Clin Sci 2022;19:48-52
|How to cite this URL:|
Musa S, Ibrahim ZU, Isah IA, Abdulsalam K. Pattern of substance abuse in Northwestern Nigeria: A laboratory survey in an urban community. Niger J Basic Clin Sci [serial online] 2022 [cited 2022 Nov 29];19:48-52. Available from: https://www.njbcs.net/text.asp?2022/19/1/48/350720
| Introduction|| |
Substance abuse has become a major public health problem globally. The rates of drug abuse continue to rise, leading to increased prevalence and complications within the last three decades., The consequences may include increased crime rates, increased risk of developing mental illness, economic hardship, and the rising cost of medical care. It is also a significant risk factor for exposure to HIV-1 and the development of acquired immune deficiency syndrome, as well as HBV and HCV diseases. Deaths attributed to it have also increased significantly. The use of prescription drugs for social rather than prescribed medical reasons has been on the rise among Nigerian youths. A comparison with other third-world countries reveals that Nigerians rank among the highest users of “harmful drugs” such as alcohol, tobacco, cannabis, benzodiazepines, cocaine, and opioids. Almost all types of psychoactive substances are available in Nigeria due to their spill over into the country from drug traffickers who use Nigeria as a conduit to transport drugs from South East-Asia and South America to Europe and North America. Nearly every deviant act in the community is directly or indirectly attributed to drug use and several works have pointed out that young people are ruining their lives through the misuse of drugs.
Despite being a major public health concern, to our knowledge, there are a few studies in the region that examined the pattern of commonly abused drugs using laboratory methods. Most studies were carried out using (indirect methods); oral interviews or questionnaire-based methods, which may have the limitation of false responses or non-disclosure by some patients. Urine drug testing (UDT) is a more reliable method of analyzing substance abuse because many drugs and their metabolites remain detectable in the urine for longer periods. UDT samples when carefully collected and thoughtfully interpreted offer a critical adjunct to clinical care. It has clinical application in evaluating life-threatening symptoms in patients presenting with signs and symptoms, suggestive of substance abuse in both acute psychiatric and medical settings. National guidelines in the United States recommend UDT not only to assess compliance; however, also to detect undisclosed substances using an extensive UDT test menu that includes both commonly prescribed medications as well as commonly abused drugs.,,
A laboratory report of UDT when appropriately interpreted considers the pharmacokinetic parameters of the drug and the metabolites as detected by the method. Although testing for some drugs may not appear cost-effective; however, the prevention or reduction of morbidity and mortality may offset any laboratory costs.
This study aims to determine the laboratory pattern of substance use disorder in Northern Nigeria as detected by convenient, reliable, and accurate urine drug tests.
| Subjects and Methods|| |
A retrospective cross-sectional survey of secondary data of 110 patients who presented to a private clinical laboratory between January 2020 to January 2021 with suspected substance use was performed. The research protocol was approved by the ethics committee of the State Ministry of Health (NHREC/17/03//2018). The laboratory provides UDT service with a primary focus on medical care (e.g., emergency care, inpatients, and outpatient clinics) and criminal investigations with the aim of providing guidance to clinicians in their selection and interpretation of the results generated from UDT.
A supervised urine collection was conducted on 110 clients who were referred to the laboratory either on physician's request, law enforcement agents, or parent's/care-giver's request.
Qualitative UDT was done using high sensitivity (95.1%–100%) drug of abuse multipanel integrated strip based on lateral flow immunoassay, reagent kits sourced from PRECISION plus (an American Screening Inc. San Diego California) for detection of a combination of 15 drugs. The test principle is based on competitive binding in which drugs that may be present in the patient's urine sample compete against their respective drug conjugate for binding sites on their specific antibody. The presence of a drug above the cut-off concentration in the urine specimen saturates all the binding sites of the antibody.
The test protocols were followed according to the manufacturer's instructions. The test strip, urine specimens, and controls were brought to room temperature before testing. The test strip was removed from the sealed pouch and the end of the strip was dipped into the specimen for at least 15–20 sec until migration occurs. The test strip was placed on a flat dry surface for 5 min after which the results were interpreted. A defined cutoff according to a method's analytical sensitivity and validation was used.
| Interpretation of Results|| |
The method adopted validation of cutoffs using the lower limit of detection (LLOD) for each drug. This is particularly helpful in detecting aberrant drug use. A recent study also emphasized that cutoffs that are validated at the LLOD, depending on the drug, demonstrated an increased rate in the detection of all illicit drug combinations. Interpretation of the results was based on the following observations:
- POSITIVE: Only one colored band appears in the control region (C). No colored band appears in the test region (T) for the drug in question. A positive result indicates that the drug concentration exceeds the detectable level for the drug.
- NEGATIVE: Two colored bands appear on the membrane; one band appears in the control region (C) and another band appears in the test region (T) for the drug in question. A negative result indicates that the drug concentration is below the detectable level for the drug.
- INVALID: Control band fails to appear.
Internal procedural controls were included in the test. A colored band in the control region was considered an internal positive procedural control, confirming sufficient specimen volume and correct procedural technique.
Positive and negative quality control specimens were used to confirm the test procedure and verify proper test performance.
Statistical analysis: Data obtained were recorded and analyzed using the SPSS. Percentages, means, and standard deviations (SD) were calculated.
| Results|| |
[Table 1] shows that among the 110 participants tested for the presence of drug substances in the urine, 86.4% were males. A screen prevalence of 60.9% was observed, out of which 59.1% were males.
The age range of study participants was between 15 and 50 years. The mean age was 26.35 ± 6.59. The predominant age group was 15–24 years; 48.1% of the participants were in this age group. The age group 25–34 years closely followed, and it constituted 42.7% of the participants as shown in [Table 2]. Male sex predominates in all age groups.
From [Table 3], multiple substance users were 73.5%, out of which 33.8% were positive for two drugs and 27.9% for three drugs. The highest number of substances detected in the urine was five, which were observed in 2.9% of those that tested positive.
|Table 3: Distribution of multiple substance use among participants that tested positive|
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[Table 4] shows that drug substances were most prevalent within the age group 15–24 years, in which 49% positive cases were recorded. This was followed closely by the age group 25–34 years, which accounted for 40.8%. The least prevalent was the age group ≥45 years, which had 2.6%.
[Table 5] shows that benzodiazepine (BZO) was the most prevalent substance that was detected in 30.0% of the urine samples, this was followed by tetrahydrocarnabinoid/marjiuana (THC) detected in 21.0%. The least drug substance recorded were morphine (MOP) and cotinine (COT), which were recorded in the urine sample of only 1 (0.6%) participant, whereas oxycodone (OXY) was not detected in any of the urine samples that were screened.
| Discussion|| |
Findings from this study have revealed that from the laboratory point of view, the burden of substance abuse among youths in Northern Nigeria is still high. A higher screen prevalence of 60.9% was recorded. This is similar to a laboratory-based study conducted by Musa et al. which reported a screen prevalence of 57.3%. However, the prevalence of 20%–40% was recorded from previous studies conducted using questionnaire-based methods.
This study reported a male preponderance of 86%. A study conducted in Lagos state Nigeria by Adesola et al. also reported 95.4% male predominance. This is in keeping with the findings of studies conducted both in Nigeria and abroad.,,,,,,
The observed male prevalence is lower in the study participants compared to the participants in the southwest due to the fact that there are fewer social activities in the north compared to the southwest where social events such as nightclubbing occur more frequently and are more likely to predispose young males to substance abuse.
This study found a high incidence of drug abuse (48.1%) among the younger age group of fewer than 24 years. This is similar to the findings of studies conducted by Adesola et al., and Onofa et al. in Lagos and Abeokuta, Nigeria in which the age with the highest prevalence was also less than 24 years. Other studies conducted in both Northern and Southern Nigeria also reported that the younger population was the most common group of people indulged in substance abuse. This high prevalence of substance abuse among this age group has even led to some studies specifically conducted among this group of people in the general population., Mohammed in Bangladesh also quoted a similar age group as the most prevalent. Similarly, Hassan in Eastern rural Iran also quoted <30 years as the predominant age group involved in substance abuse. The reason may not be far from lack of job opportunities among the age group. The majority of the individuals in this age group want to seek not only financial or economic freedom but psychosocial independence. This is also the age group who have completed secondary education and could not proceed due to poverty and financial constraints thereby putting them at high risk of negative peer group influence. Youth are the most valuable asset for sustainable social development in any society; unfortunately, most people in this age group lack awareness and knowledge of substance addiction that would empower them to escape drug abuse. This limitation was demonstrated in a study carried out among secondary school students and teachers in Nigeria. The study revealed that approximately 60% of students were never exposed to drug abuse education, whereas 73% of teachers reported that they currently did not teach their students about drug abuse education. This finding is another reason for the highest prevalence in the younger populations, and a crucial gap that could be targeted for interventions. Most male children in this age bracket in Northern Nigeria were also found to be either living alone or looking for menial, petty, casual, or strenuous jobs that usually require the use of energy. They end up using these drugs to enable them to carry out these hectic activities.
The majority of our study participants were polysubstance users (73.4%) as they tested positive for more than one drug. The high level of restiveness, experimental curiosity, negative peer influence, and the need for extra energy for daily activities are some of the reasons attributed to multiple substance use.
About 30% of participants reported in this study abused BZO, which was closely followed by THC (21%). The reasons attributed to this finding may be related to lack of education on substance abuse among youths and the rising rate of unemployment hence such youths are likely to follow up politicians as thugs, especially with the high poverty rate of about 50% of people in Nigeria.,,,,,,,,,,, This indicates how challenging the socioeconomic condition could be for many Nigerians. These conditions could predispose people to engage in substance abuse to work harder to ward off the stress and frustration of daily living in hardship.
This research work focused on the laboratory analysis of drugs in the urine to assess the screen prevalence, which provides confirmatory evidence of drug use and legally defensible results. This study was able to surmount some of the challenges that are associated with UDT in the medical setting such as inappropriate samples because a well-trained and experienced laboratory personnel collected the samples under supervision, a highly sensitive method were used, and problems associated with data interpretation were solved as interpretative commenting of all the results were provided by pathologists. The study adopted the qualitative testing method because reporting results quantitatively may potentially mislead providers into utilizing numbers to access compliance to a prescribed regimen. Many variables such as drug-drug interactions, genetic variation, drug clearance, and patient's clinical condition may affect drug or metabolite concentrations in the urine that is why reporting a binary result (detected/undetected) often offers sufficient information to access compliance. Qualitative testing is also more consistent and less confusing for caregivers to interpret.
In conclusion, findings from this study have revealed that from the laboratory point of view, the burden of substance abuse among youths in North-Western Nigeria is still high. A higher prevalence of 60.9% was recorded compared to the prevalence of 20%–40% recorded from previous studies. The majority of users were youths below 30 years of age who abuse multiple substances.
The authors wish to acknowledge the technical support of Optimum Diagnostics and Clinical Services, Kano Nigeria.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]