literature review on drug abuse in nigeria pdf 2020

The Burden of Drug Abuse in Nigeria: A Scoping Review of Epidemiological Studies and Drug Laws

Affiliations.

• 1 School of Pharmacy and Pharmacology, University of Tasmania, Hobart, TAS, Australia.
• 2 School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia.
• 3 Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmaceutical Sciences, Ahmadu Bello University, Zaria, Nigeria.
• 4 School of Global Health and Bioethics, Euclid University, The Gambia.
• 5 Hospital Services Management Board, Ministry of health, Gusau, Nigeria.
• 6 Department of Pharmaceutical Sciences, Università Degli Studi di Milano, Milano, Italy.
• 7 Malaria Consortium Nigeria, Dutse, Nigeria.
• 8 Department of Pharmacology and Therapeutics, Faculty of Pharmaceutical Sciences, Bayero University Kano, Kano, Nigeria.
• PMID: 33796340
• PMCID: PMC7904248
• DOI: 10.3389/phrs.2021.1603960

Background: The burden of drug abuse is becoming a public health concern in Nigeria. Preventive measures should include identifying the root causes of the burden for targeted intervention. We, therefore, aim to conduct a scoping review of the literature to summarize the findings of epidemiological studies on drug abuse and provisions of drug laws in Nigeria. The review also provides appropriate recommendations as interventions for prevention. Methods: We conducted a systematic search of the literature on PubMed to identify information on drug abuse and drug laws in Nigeria from the inception of the database to March 2020. Additional information was retrieved from Google Scholar, a manual search of included articles, discussion with experts on the subject matter, and gray literature. Study selection was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statements. Information from gray literature was assessed for quality and accuracy using the AACODS checklist (authority, accuracy, coverage, objectively, date, significance). Results: The systematic search of the literature generated 253 studies. Nine articles were obtained from other sources. After the selection process, 23 eligible studies were included for review. A prevalence of 20-40% and 20.9% of drug abuse was reported among students and youths, respectively. Commonly abused drugs include cannabis, cocaine, amphetamine, heroin, diazepam, codeine, cough syrup and tramadol. Sources where abusers obtained drugs, were pharmacies/patent medicine shops, open drug markets, drug hawkers, fellow drug abusers, friends, and drug pushers. Drug abuse was common among undergraduates and secondary school students, youths, commercial bus drivers, farmers, and sex workers. Reason for use included to increase physical performance, stress and to derive pleasure. Poor socioeconomic factors and low educational background were the common risk factors associated with drug abuse. We identified several drug laws and policies that were established under government agencies such as the National Drug Law Enforcement Agency (NDLEA), National Agency for Foods and Drugs Administration and Control (NAFDAC), Pharmacists Council of Nigeria (PCN) and a Presidential Advisory Committee. Conclusion: Findings from epidemiological studies on drug abuse in Nigeria has demonstrated that the burden of drug abuse is still high despite the existing drug laws, policies, and strategies for prevention. Measures to reduce the burden should involve the community, government, and religious bodies. Preventive measures should target the youths, the students, identified sources of the drugs, reasons and risk factors associated with drug abuse in Nigeria.

Keywords: Nigeria; cocaine; codeine; drug abuse; public health; reviews.

Copyright © 2021 Jatau, Sha’aban, Gulma, Shitu, Khalid, Isa, Wada and Mustapha.

The Burden of Drug Abuse in Nigeria: A Scoping Review of Epidemiological Studies and Drug Laws

Preserved fulltext.

Academia.edu no longer supports Internet Explorer.

To browse Academia.edu and the wider internet faster and more securely, please take a few seconds to  upgrade your browser .

Enter the email address you signed up with and we'll email you a reset link.

• We're Hiring!
• Help Center

The Burden of Drug Abuse in Nigeria: A Scoping Review of Epidemiological Studies and Drug Laws

2021, Public Health Reviews

Background: The burden of drug abuse is becoming a public health concern in Nigeria. Preventive measures should include identifying the root causes of the burden for targeted intervention. We, therefore, aim to conduct a scoping review of the literature to summarize the findings of epidemiological studies on drug abuse and provisions of drug laws in Nigeria. The review also provides appropriate recommendations as interventions for prevention.Methods: We conducted a systematic search of the literature on PubMed to identify information on drug abuse and drug laws in Nigeria from the inception of the database to March 2020. Additional information was retrieved from Google Scholar, a manual search of included articles, discussion with experts on the subject matter, and gray literature. Study selection was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statements. Information from gray literature was assessed for quality and accuracy using...

Related Papers

Tobi Oladepo

Background: Drug is an essential part of health care services yet their misuse and/or abuse constitutes a very serious public health and security problem that obstructs the socioeconomic development of people, especially youths in the society. Objective: The objective of this study is to assess the knowledge and perception of drug abuse among university students in Warri, Delta State, south-south, Nigeria. Methods: A cross-sectional survey was done over a period of 4 months using a structured questionnaire. A total of 400 questionnaires were distributed among eligible students and 273 were retrieved, sorted, and entered into a spreadsheet, the data were analyzed. Frequency distributions were carried out for socio-demographic characteristics. Chi-square and one-way analysis of variance (ANOVA) was done, as well as Post hoc analysis, and a P-value of less than 0.05 was considered significant. Result: Most of the respondents were within the age range of 16-25 years and most of them were 100 level and 200 level students. In the study, it was seen that the highest level of education of parents of respondents is first degree, (35.6%) and (46.6%) for father and mother respectively. The findings also revealed a significant difference in all the ages (15-18, 19-22, 23-26, and 27-30 years) of the respondent in a Multiple Comparisons Turkey HSD when compared with the knowledge of drug abuse at a P-value of less than 0.00. Conclusion: The students in the study had fair knowledge and poor perception of drug abuse. The perception of the various levels of students did not differ significantly. Health education for students and parents intervention as role models through being informed by education is recommended.

THE INTERNATIONAL JOURNAL OF HUMANITIES & SOCIAL STUDIES

Mbave J Garba , Abanyam Noah Lumum

The history of the human race also includes drug usage and perhaps misuse. In and of itself, drug usage is not a bad thing; in fact, certain drugs have been a medical godsend. Herbs, roots, and bark leaves have alleviated pain and managed illness from time immemorial. According to history, the Chinese used opium to treat diarrhoea before the 18 th century. Drug misuse is a worldwide issue that threatens the lives of people, society, and several nations' political stability and security. The use of illegal drugs has expanded globally, and the key global trend is the rising availability of various types of narcotics to an ever-expanding user base. Concerning is the fact that youngsters seem to be the new market for the global pharmaceutical business. According to the World Health Organisation (WHO), substance abuse is the harmful or risky use of psychoactive substances, such as alcohol and illegal drugs. Psychoactive drug usage may develop into dependency syndrome, which is the continuous, repetitive, and persistent use of the substance despite its adverse effects, resulting in the prioritization of substance use above other activities and responsibilities. Generally, drugs are helpful when properly used and destructive when misused or abused, but most youths are guilty of substance abuse (Mohammad, 2014). The use of illicit substances is a major public health problem in high-income countries like the U.S. However, this problem of illicit substance use has spread rapidly to middle and low-income countries, where most youth and adolescents are actively engaged in this illegal practice (Aliyu, 2014 & Mohammed, 2014). Many authors and researchers have shown that many contributing factors lead to substance abuse among the youth. Adolescence is the phase of life between childhood and adulthood, from ages 10 to 19. It is a unique stage of human development and an important time for laying the foundations of good health. Adolescents experience rapid physical, cognitive and psychosocial growth. This affects how they feel, think, make decisions, and interact with the world around them. Despite being considered a healthy stage of life, there is significant death, illness, and injury in the adolescent years. Much of this is preventable or treatable. During this phase, adolescents establish patterns of behaviour, for instance, related to diet, physical activity, substance use, and sexual activity that can protect their health and the health of others around them or put their health at risk now and in the future (WHO, 2022). Adolescence is characterised by increased adventurous tendencies and peer influences.

Science Journal of Analytical Chemistry

Atumeyi Anthony Ugbedeojo

Substance abuse has been a thorny public health concern throughout human history. Manifestly, prevention and treatment are the two main strategies commonly adopted to tackle the problem of substance abuse. They are in fact cross-disciplinary, and they relate to the various domains of heredity, biology, psychology, cognitive science, family, social development and cultural structures. Almost everyone, directly or indirectly, comes in contact everyday with drug/substance use or abuse. The drug scene is a varied one that includes licit and illicit drugs, street drugs, prescription drugs, over- the-counter drugs, drugs for pleasure, and drugs to ease pain. This special issue, “psychoactive substance abuse”, has been reviewed going through the global world and Nigeria in particular to enhance a re-think on processes and influences of substance abuse across different domains, through which a multilevel perspective is considered more helpful for analyzing its complex nature, courses and co...

Research Journal of Library and Information Science

inemesit udoh , Chukwuemeka Chukwueke

The rate at which youths, especially students in the tertiary institutions engage in drug/substance abuse in Nigeria is increasing on a daily basis. This has resulted in youth restiveness as well as other crimes, which has made it a serious challenge to national development and growth. What should be done, becomes the question in everyone’s mind. To this end, this study was developed. The study examined the roles of librarians in curbing drug/substance abuse among students in universities in Nigerian. It adopted the descriptive survey research design using the final year students of University of Uyo, totalling 1407 students. The accidental sampling technique was adopted in selecting 70 students, which represents 5% of the population. Questionnaire was used for data collection. Data generated were analysed using the descriptive statistics of frequency counts, mean scores and standard deviations. Findings of the study revealed that Alcohol-ethanol, tobacco, tramadol, etc. were found to be abused. Peer pressure, poverty and unemployment were among the determinants of the abuse. The behavioural patterns include dizziness, easily provoked, loss of self-control, etc. Consequences associated with drug/substance abuse and roles of librarians in curbing drug/substance abuse were found out. The study recommended intensified efforts by librarians in bringing to the knowledge of the students the dangers of drug/substance abuse and how to avoid them.

choice terah ibrahim

olley benjamin

Texila International Journal of Public Health

Texila International Journal

The patterns of tobacco smoking, alcohol, and illicit drugs use by young people has presented new public health challenges in lower-middle-income countries like Nigeria. The goal of this study was to assess the patterns of substance use among young people in Ado Ekiti, Southwest, Nigeria. This was a cross-sectional descriptive study carried out among 415 enrolled young people aged 10-24years in Ado Ekiti, Southwest, Nigeria between August 2021, and January 2022. Information on the pattern of substance use was obtained from the respondents using an adapted and pretested structured questionnaire. Enrolled study participants from the four selected geographical areas were randomly chosen using a multistage cluster sampling method. The analysis was done using SPSS version 20; quantitative outcomes were analyzed using descriptive analysis. The result from this study showed that the prevalence of current use of at least one psychoactive substance among the respondents was 69.9%. The most current used substance by the respondents was alcoholic beverages (42.4%) followed by cigarettes (28.3%), cannabis (7.2%), and tramadol (6.6%). The study also revealed that the lifetime rate of alcohol use decreased with age, while cigarette smoking increased with age. This study had shown that alcoholic beverages, cigarettes, and cannabis are the most abused substances by the participants in this location. Intervention strategies that will reduce the rate of substance use among the younger population to the barest minimum are paramount, particularly within the health education arena.

IOSR Journal of Humanities and Social Science

Mukhtar Shehu Aliyu

Chuks G A B R I E L / G C Nwala

Background: Over the years different substances of abuse have been reported from one setting to the other. The availability, accessibility and affordability of these materials determine the pattern of their abuse in these areas. Gateway substance like alcohol and tobacco were commonly reported among adolescents. However, newer substances are now been abused due to their cheaper cost and difficult detection by available drug screening methods. The current study had a critical look at the current drugs being abused among adolescent students enrolled in secondary schools in Umuahia. Methodology: A cross-sectional descriptive study of adolescent students in secondary schools in urban and rural communities in Umuahia. A modified WHO student drug use questionnaire and UDT kits were used to ascertain the drug use status of participants. Chi-square was used to test for significant association between categorical variables. p-values <0.05 were accepted as significant. Results: The commonest licit substance by self-report was coffee in 128 (32.0%) current abusers followed by kola nut in 75 (18.8%) of them. Among the illicit substances, cannabis had a prevalence of 18.8%. The least self-reported substance was cocaine with a prevalence of 0.8%. Oxycodone was the commonest substance detected by UDT with a prevalence of 24.8%, cocaine was also the least by UDT with a prevalence of 1.5%. Conclusion: The study revealed that coffee was the most abused licit drug followed by kolanut by self-report. Cannabis and "Lacatomtom" were the most abused illicit materials with cocaine being the least by self-report. UDT obtained oxycodone, cannabis, opioids and methamphetamine with cocaine as the least. Recommendation: Mandatory random drug use surveys should be introduced in our schools to monitor and offer mitigating actions against the rising drug demand among our adolescents.

RELATED PAPERS

SOCIOLOGICAL STUDY OF DRUG ABUSE AMONG YOUTH

Suleiman A H M E D Bakori

Asian Research Journal of Arts & Social Sciences

omolola oluwasola

International Journal of Business and Social Science

Adebimpe Adetutu Adenugba

QJM: An International Journal of Medicine

Diego Fernando Bocanegra Sacristán

Festus Asikhia

Festus U W A K H E M E N Asikhia

usman Muhammad Alhassan

Aristotle Jacobs

Prof Sam Smah

South Asian Journal of Social Studies and Economics

peggy okodogbe

International Journal of Advances in Medicine

Yusuf Muhammad Abdullahi

JASH MATHEW

Texila International Journal , D. Akinboye , Emmanuel Ugwu

Nurudeen Okikiola

International Neuropsychiatric Disease Journal

Nasiru Lawal

SSRN Electronic Journal

MORUFU RAIMI

Journal of Advances in Medicine and Medical Research

Olawale Oladapo

International Journal of Research Publications

Babatope ONI

International Journal of Environmental Research and Public Health

oliver Ezechi

Shehu Yahaya Tsagem

Pattern of Drug Abuse among Adolescents in Lokoja Metropolis of Kogi State, Nigeria

Dr. Oche Joseph Otorkpa

Olubayo O . Stephen

(2017). Drug-crime nexus among Nigerian youths: A solution through crime prevention strategies

Jamilu Ibrahim Mukhtar

Onu Fidelis Chikodi

Bello Babatunde Paul

Kausik Sarkar

IKENNA D A N I E L MOLOBE

Amina Lawal Mashi

Information Impact: Journal of Information and Knowledge Management

Chinyere Ikonne

Olusegun Barnabas Maiye

Journal of Studies in Social Sciences

Ali Ado Siro

Review of African Political Economy

Maimuna B. Hussain

Social Work in Public Health

Samuel Adejoh

International Journal of Scientific and Research Publications (IJSRP)

CHUKWUNWIKE NWONU

ADEYIGA Y ADEBAYO

Zongo Nebanat

Journal of Political Sciences & Public Affairs

Dr Temitope Francis Abiodun

Babatunde R Ojebuyi

RELATED TOPICS

•   We're Hiring!
•   Help Center
• Find new research papers in:
• Health Sciences
• Earth Sciences
• Cognitive Science
• Mathematics
• Computer Science
• Academia ©2024

The burden of drug abuse in Nigeria: a scoping review of epidemiological studies and drug laws

Publication title, article number, department/school, place of publication, rights statement, repository status, socio-economic objectives, usage metrics.

• Toxicology (incl. clinical toxicology)

• Advanced search
• Peer review
• Record : found
• Abstract : found
• Article : found

Review of Drug Abuse In Nigeria: A Social And Public Health Menace

• Download PDF
• Review article
• Invite someone to review

Author and article information

Affiliations, author notes, author information.

This work has been published open access under Creative Commons Attribution License CC BY 4.0 , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Conditions, terms of use and publishing policy can be found at www.scienceopen.com .

Comment on this article

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• World J Psychiatry
• v.12(10); 2022 Oct 19

Substance use and substance use disorders in Africa: An epidemiological approach to the review of existing literature

Olakunle james onaolapo.

Behavioral Neuroscience Unit, Neuropharmacology Subdivision, Department of Pharmacology, Ladoke Akintola University of Technology, Ogbomoso 210214 Oyo, Nigeria

Anthony Tope Olofinnade

Department of Pharmacology, Therapeutics and Toxicology, Lagos State University, Ikeja 100001, Lagos, Nigeria

Foluso Olamide Ojo

Department of Anatomy, Ladoke Akintola University of Technology, Ogbomoso 210214, Oyo, Nigeria

Olufunto Adeleye

Joshua falade.

Department of Mental Health, Afe Babalola University, Ado-Ekiti 360282, Ekiti, Nigeria

Adejoke Yetunde Onaolapo

Behavioral Neuroscience Unit, Neurobiology Subdivision, Department of Anatomy, Ladoke Akintola University of Technology, Ogbomoso 210214, Oyo, Nigeria. moc.oohay@yibiyabgeda

Corresponding author: Adejoke Yetunde Onaolapo, MBBS, MSc, PhD, Reader (Associate Professor), Behavioral Neuroscience Unit, Neurobiology Subdivision, Department of Anatomy, Ladoke Akintola University of Technology, Old Oyo/Ilorin Road Ogbomoso P.M.B 4000, Ogbomoso 210214, Oyo, Nigeria. moc.oohay@yibiyabgeda

The relationship between man and substances that have abuse potentials, and whose use has been associated with the development or progression of substance use disorders has continued to evolve in terms of geography, economic implications, and time. History shows that local plants with psychoactive constituents can get exported worldwide through global travel, commerce, or even conquest. Time and globalization also change people’s relationship with substances of abuse; hence, an area that was initially alien to certain substances might evolve to becoming a trafficking hub, and then a destination. A case in point is Africa where a rapidly increasing prevalence of substance use/abuse and substance use disorder among adolescents and young adults is putting enormous strain on the economy, healthcare system, and society at large. However, there appears to be a paucity of scientific literature and data on the epidemiology, risk assessment, and contributing factors to substance use and the development of substance use disorders across Africa. In this narrative review, we examine extant literature (PubMed, Google scholar, Medline) for information on the prevalence, trends, and influencers of substance use and the development of substance use disorders. This is with a view of understanding the determinants of substance use and factors that influence the development of substance use disorders in the region, and how this information can be channeled towards developing a comprehensive intervention and treatment program.

Core Tip: Substance use for medicinal and recreational purposes dates back centuries; however, in recent times, substance use is increasingly becoming a global public health crisis. In Africa, there is a consensus that substance use is emerging as a public health crise, but there appears to be a paucity of data on the epidemiology, risk assessment, and contributing factors to substance use and the development of substance use disorders across Africa. Here, we examined the extant literature for information on the prevalence, trends, and influencers of substance use and substance use disorders as it relates to Africa.

INTRODUCTION

Substance use and substance use disorders are increasingly becoming a global public health crisis, largely due to their increasing prevalence, worsening disability-adjusted life years, and high socioeconomic burden[ 1 ]. According to the World Drug Report, 2021[ 2 ], approximately 275 million people used drugs worldwide in the preceding year, with another 36 million persons diagnosed with substance use disorders globally[ 2 ]. In 2019 alone, substance use disorders were linked to about 18 million years of healthy life lost. Also, about 180000 deaths were directly linked to substance use disorders, while another half million deaths were attributed to illicit drug use[ 3 ].

Substance use is generally defined as a patterned use of any substance (including alcohol and/or psychoactive drugs) in quantities (or through methods) that are harmful to the user or others[ 4 ]. Substance use is often associated with varying degrees of intoxication, which is associated with alteration of judgment, attention, and perception. The use of alcohol, illicit drugs, and illegal use of prescription medications has been associated with negative impact on the individual’s health and productivity, as well as a high socioeconomic burden on the family and society[ 5 , 6 ]. Globally, there is a rapidly rising prevalence of substance use and substance use disorders, with an associated increase in the morbidity and mortality. Also, in Africa, the use of illicit substances such as cannabis (the most widely used substance in Africa, with a prevalence of between 5.2% and 13.5% in West and Central Africa), amphetamine-type stimulants, and benzodiazepines is increasing rapidly[ 7 ]. Again, in the last decade, Africa has begun to be recognized as a consumer and a destination for illicit drugs, compared to being previously regarded as mainly a transit zone for these drugs (serving as a link between Latin America and Europe)[ 8 , 9 ]. This reversal of the illicit drug trend is believed to be a contributing factor to the rapid development of substance use epidemic, particularly in the urban centers of Africa.

There is a consensus that substance use (particularly among adolescents and young adults) in Africa is emerging as a public health crises; however, there appears to be a paucity of scientific literature and data on the epidemiology, risk assessment, and contributing factors to substance use and the development of substance use disorders across Africa. Here, we reviewed the extant literature for information on the prevalence, trends, and influencers of substance use and the development of substance use disorders. This is with a view of understanding the determinants of substance use and the factors that influence the development of substance use disorders in the region, and how this information can be channeled towards developing a comprehensive interventions and treatment program.

History of substance use and substance use disorders

Substance use for medicinal, religious, and recreational purposes dates back centuries. The earliest mentions of the use of alcoholic or fermented beverages in Chinese writing dates far back as the 7 th millennia B.C.E[ 10 ], although there is also evidence from Sumerian writing (2100 B.C.E) of the use of opium from the poppy plant[ 11 ]. While the earliest use had been linked mainly to medicinal and religious purposes[ 10 - 12 ], there are also documentations of their use for recreational purposes[ 12 ]. However, since ancient times, humans have recognized the health problems that may be associated with excess alcohol consumption[ 12 - 14 ].

In 2019, the United Nations Office on Drugs and Crime reported an estimated 35 million people having a substance use disorder necessitating treatment[ 15 ]. Surveys and results of prospective studies examining patterns of drug use among the general population has revealed substance use peaks between 18 years and 25 years of age[ 15 , 16 ] with drug use among young people exceeding that of older people[ 15 , 17 ].

History of substance use in Africa: From transit nations to major illicit drug destinations

The African continent has a long history of drug cultivation, production, trade and consumption; and there are also indigenous plants and herbs with psychoactive effects such as cannabis resin (known as hashish in North Africa), Catha edulis (known as Kath in East Africa), and cannabis (known as dagga in Southern Africa) that have also been used traditionally for centuries[ 18 - 21 ]. In the last few years, rapidly growing large-scale trade and recreational use of opiates, synthetic psychoactive stimulants, and prescription drugs are emerging threats in the African continent[ 21 ].

The relationship between North Africa and cannabis has existed for centuries, predating the arrival of the Spanish and French in the 19 th century. Also, during the colonial era, cannabis was cultivated in small quantities across the northern Rif mountains in Morocco, and throughout the northern parts of Tunisia and Algeria[ 22 ]. While production was mainly to meet local demands (with some smuggling and exportation to Europe), the era following independence of the different countries in the region saw regulations and laws being enacted and enforced to control the production, sale, and use of cannabis. However, across the four countries (Morocco, Algeria, Tunisia and Libya) that make up the Maghreb (an area also known as northwest Africa), the drug trade has not only continued to grow, it is also evolving. In the last few decades, a region known mainly for the production of cannabis destined for other markets (particularly the European market) has increasingly become an important route for the trafficking of cocaine and different psychotropic pills. Since the beginning of the 21 st century, trafficking routes for cocaine, cannabis resin, and psychotropic pills that existed between South America, Africa, and Europe shifted to transect the Maghreb region[ 22 ]. This change has been partly attributed to an increase in the demand for drugs in the region, and the perturbations of other transit zones such as the Sahel region, which has become unstable. Most important is the geographic location of the region, being a link between Africa, Middle East and Europe. While drug transit routes through North Africa is increasing, of more importance is the increasing rate of consumption of these drugs in the region. The use of psychotropic drugs, which are very addictive, is nearing epidemic proportions in the region; also, other substances being consumed include cannabis, cocaine and opioids[ 22 ].

Before West Africa began to be considered a transit zone for drugs, it was also a producer of cannabis products (although not on the scale of the North African countries), which were shipped to Europe and the United States. Although, at the same time, marijuana was being imported into Nigeria from South Africa and a region now known as the Democratic Republic of Congo[ 23 ]. The smuggling of heroin through West Africa was first documented in 1952[ 23 ]; however, West Africa’s rise as a major drug smuggling hub began sometime in the 1960s, coinciding with a period of increased demand for illegal drugs, including marijuana which was grown and exported from Nigeria in large quantities to Europe. Despite attempts by governments in these countries to stem the tide of the marijuana export, marijuana trade continued illegally for several years until the demand for newer psychoactive substances such as cocaine and heroin overtook the demand for marijuana[ 24 ]. By the 990 th year of the 2 nd millennium and the 90 th year of the 20 th century, West Africa had become a major transit and repackaging center for substances such as cocaine and heroin through a transnational trade route that originated from South America and Asia, to Europe. While drug trafficking through Africa was not new, an intense clamp-down on the South-North American trade routes by the United States anti-narcotics strategies and the increase in demand for drugs across Europe saw to the rapid expansion of the West African trade routes in the early 21 st century[ 25 , 26 ]. The geography of the West African states (made up of large areas of uninhabited islands and archipelagoes found in countries like Guinea Bissau) eased transit and made detection difficult[ 27 ]. Also, the vulnerable political environment with the presence of civil wars/insur-gencies created fertile grounds for the development of criminal networks in the West African sub region[ 27 ].

Previously, when compared to West Africa, the drug trafficking routes through the Eastern belt of Africa were less robust; however, in the last few decades of this century, the trend is an increase in the trafficking of and the variety of trafficked drugs through the East African states of Kenya, Uganda, and Tanzania. Specifically, the trafficking of heroin and cocaine through these countries has grown considerably. Trafficking routes begin in Afghanistan where heroin is produced, through Pakistan and then East Africa enroute over Europe. The cocaine transnational trafficking routes began to go through East Africa in a bid to bypass the West African routes that were increasingly being watched by anti-drug trafficking authorities[ 28 ]. Also observed was that the increased consumption of these substances coincided with an increase in trafficking and affordability of the drugs.

In South Africa, a country in the southern region of Africa, the trafficking of drugs has increased. There are reports that since the period prior to and following the transition to democracy, there has been an escalation of drug trafficking. Trafficking in these parts has increased as a result of the easing of the strict control of land, air and sea borders, and an increase in international trade that occurred following the reintegration of South Africa into the committee of nations following the end of apartheid. Also, the effective policing of traditional smuggling routes prompting the search for other shipping routes also accounts for the increased trafficking of drugs through South Africa[ 29 ]. The increased trafficking is also worsening the substance use problems as a proportion of the drugs trafficked end up on the local market. There have also been reports that drugs such as methaqualone are also produced in clandestine laboratories in the region[ 30 ]. Overall, the level of affluence in the region makes it an attractive ‘emerging market’ for illicit drugs[ 30 - 32 ]. South Africa also has a history of drug use that dates as far back as the 15 th century. Cannabis, which is known as dagga in South Africa, has been consumed traditionally for centuries. The cannabis plant was brought to southern Africa by Saheli merchants from eastern Africa and some members of the bantu tribe of central and southern Africa where it has been cultivated since the 15 th century. Around the 16 th and 18 th century, the consumption of cannabis increased significantly[ 33 ]. Although initially popular only among the African population, over time, its use extended to the white population of South Africa[ 30 ].

Overall, while the current substance use epidemic in the African continent could be linked to the global trend in substance use, the transformation of African nations from mainly transit points in the international drug network to consumer countries would seem inevitable[ 34 ]. Also, the rapid socioeconomic changes that have occurred across the different countries that make up the African continent could have facilitated this shift in what can be assumed to be the “normal trend”.

EPIDEMIOLOGY OF SUBSTANCE USE ACROSS THE AFRICAN CONTINENT

Across Africa, reports spanning the last two decades show that substance use especially among adolescents and young adults is increasing at alarming rates[ 19 , 35 - 41 ]. The World Health Organization and the United Nations Office on Drugs and Crime reported, an exponential increase in the per capita consumption of alcohol as well as the cultivation, trade, and consumption of cannabis in most of the countries in Africa, with suggestions that this could inevitably have adverse socioeconomic and public health implications[ 42 - 44 ]. At the time, about 10 countries in Africa were listed among the 22 countries with the highest increases in the use of alcohol and other psychoactive substances including cannabis, tobacco, cocaine, and heroin[ 45 ]. In 2013, the United Nations Office on Drugs and Crime World Drug Report estimated that across the African continent, more than 28 million people had a current history of substance use. Cannabis was also reported to be the most commonly used drug on the continent, with the prevalence estimated to be 7.5%, which was almost twice the global average. The use of opioids was also reportedly on the rise[ 46 ].

While it has been recognized that Africa is beginning to battle a drug use epidemic, with an estimated 37000 people in Africa dying annually from substance use-associated complications[ 47 - 49 ]; available data for Africa are still either weak or nonexistent. To date, in many African countries, there is still a paucity of national data regarding the epidemiology and patterns of substance use across populations, with available data largely limited to small prospective population studies and retrospective hospital-based studies.

In West Africa, the paucity of data regarding the prevalence of drug use undermines our ability to adequately understand the full extent of the substance use problem, and how it is creating a public health problem that further threatens the already fragile health system that currently exists. It also creates a false sense of safety, because it fosters the erroneous belief that substance use is under control. However, in the last few years, this trend is becoming more difficult to ignore, because there is now increasing evidence from the increase in crime/criminal behaviors and an increasing need for medical attention that arises from the development of substance use disorders or complications of risky behaviors that are consequences of drug use. In the last decade, in West African countries like Ghana, incident reports from health professionals, lawyers, and law enforcement officers are beginning to show dramatic increases in the domestic consumption of illicit drugs. However, these reports do not adequately portray the scale of substance use problem; because there is a dearth of national figures that can accurately quantify the prevalence of drug use in Ghana or most other West African countries. All of these result in a huge dependence on small-scale cross-sectional studies (Table ​ (Table1). 1 ). A 2008 population-based study conducted among school-going adolescents, reported that the prevalence of any substance use in the preceding 1 mo was 3.6%[ 50 ]. The results of an earlier study that interviewed a sample of 894 high school students with a mean age of 17.4 years, reported that the lifetime alcohol use in these cohort was 25.1%; with cigarette use and lifetime marijuana use being 7.5% and 2.6%, respectively. Also, current alcohol use was reported to be 46.2%; current cigarette and marijuana use was 44.6% and 58.3%, respectively[ 51 ]. The result of a 2014 cross-sectional survey of a sample of 227 street children and youths revealed that the current prevalence of alcohol and marijuana use was 12% and 16.2%, respectively. Sex differences in substance use was also reported with more females using alcohol, marijuana, and smoking cigarettes compared to males[ 52 ]. In Nigeria, reports from small-scale studies have demonstrated a high prevalence of substance use among adolescents and young adults. A 2009 study that examined the prevalence of substance use among 280 students at a senior secondary school in a town in Northwest Nigeria, revealed that about 56% of them had a history of substance use, with the most common being kolanut, cigarettes, and marijuana[ 53 ]. Idowu et al [ 54 ] also examined the prevalence of substance use among 249 students (mean age = 16.3 ± 2 standard deviations) of secondary schools in a metropolis in south western Nigeria and reported that the prevalence of alcohol and substance use was 21.7% and 26.3%, respectively, with tramadol being the substance of choice[ 54 ]. The magnitude of the effect was best conveyed by the results of the 2018 National Drug Use Survey which revealed that approximately 14.3 million people (accounting for 14.4% of the population aged between 15 years and 64 years) had a history of current and continuing substance drug use, with close to 3 million having at least a form of drug use disorder[ 48 , 55 ]. A difference was also observed in the prevalence of drug use between the Northern and Southern geopolitical zones, with a higher prevalence in the regions in the south (13.8%-22.4% of the population) compared to those in the northern geopolitical zone (10%-14.9% of the population). In Nigeria, cannabis was the most commonly used drug, which was followed by opioids (non-prescription or in cough syrup)[ 48 , 56 ]. The survey also highlighted a rise in the current use of psychoactive substances (including cannabis), the non-medical use of prescription drugs such tramadol, codeine, morphine or cough syrups that contain codeine or dextromethorphan[ 55 ]. Also observed was an overall high incidence of drug use (excluding alcohol) among males compared to females (10.8 million males vs 3.4 million females), although the sex difference in the non-medical use of prescription opioids, cough syrups, and sedatives was not as significant (6% among men compared to 3.3 among women). The survey also reported a higher incidence of drug use among young adults (24-39) compared to those aged 24 and below[ 55 ].

Epidemiology of substance use across the African continent

In East Africa, there is also a dearth of national statistical data on the prevalence of substance use in a number of the countries, with researchers and policy makers needing to rely on information from studies involving subsets of the populations. In Ethiopia, alcohol, Kath and tobacco are the most popular substances that are consumed[ 57 , 58 ]. A 2012 Ethiopian demographic and health survey reported that 4% of youths and 6.3% of individuals in age groups of 25-29 years smoked cigarettes, whereas 53% of men and 45% of women consumed alcohol[ 59 ]. Also, the results of a study by Girma et al [ 60 ] that analyzed data extracted from the 2016 Ethiopia Demographic and Health Survey revealed that of the 12688 male cohorts of the Ethiopian Demographic and Health Survey, at least 62.5% (7931 males) had a current history of substance use (alcohol, Kath, or tobacco) as at the time of the survey. Inhabitants of the Amhara, Tigray, and Oromia regions have a current substance use prevalence of 18.5%, 14.2%, and 12.8%, respectively. Alcohol (53.1%) is reportedly the most commonly consumed substance, followed closely by Kath, which has a prevalence of 25.9%[ 60 ]. Reports of small cross-sectional studies have also corroborated the high prevalence of alcohol, Kath, and cigarette smoking among Ethiopian youths[ 61 ]. Adere et al [ 61 ] examined a cohort of 730 university students in Northeastern Ethiopia and reported that the lifetime prevalence of alcohol consumption, Kath chewing, and cigarette smoking was 33.1%, 13%, and 7.9%, respectively, whereas the current prevalence of these substances is 27.9%, 10.4%, and 6.4%, respectively[ 61 ]. The prevalence observed in this study was similar to that observed in an earlier study carried out among the students at a University in a town in North Ethiopia[ 62 ]. While earlier studies among university students did not report evidence to suggest the use of illicit drugs, the results of a 2021 cross-sectional study among 794 students of Addis Ababa University, showed that 73.7% of the study participants had a history of substance use with the use of illicit drugs having a lifetime prevalence of 23.3%[ 63 ]. However, similar to other studies, alcohol, Kath, and cigarettes were still the most commonly abused substances[ 63 ].

In North Africa, data and information on substance use, production, trafficking, and consumption are also limited. This has been attributed to a lack of capacity for data collection and analysis[ 64 ]. In Egypt, there are reports that substance abuse rates are as high as 10%-20% the global average, with cannabis and tramadol being the most abused substances[ 65 ]. In Tunisia, an increase in the trafficking and consumption of psychoactive substances have been observed since the political uprising that occurred in 2011[ 66 ]. There have also been reports of increased availability of drugs of abuse, particularly to school students[ 66 ]. These increases have been confirmed by a few epidemiological studies[ 66 - 68 ]. Moslah et al [ 68 ] carried out a study to examine the pattern of substance use among 298 persons with a history of drug use between 2010 and 2015. The results showed that among these cohort of young adults, cannabis was the most widely consumed illicit drug, followed by benzodiazepines, buprenorphine, cocaine, and ecstasy[ 68 ]. Reports from the Mediterranean School Survey Project on Alcohol and Other Drugs (II) carried out in Tunisia in 2017 revealed that tobacco, alcohol, and cannabis were the substances most frequently used by secondary school students[ 67 ], whereas psychotropic drugs such as ecstasy, cocaine, and buprenorphine were less frequently consumed. More importantly, it was observed that the frequency of use of these substances has increased significantly since the first survey published in 2014[ 66 ]. Chaouali et al [ 69 ] carried out an epidemiologic/toxicological investigation to evaluate patterns of drug abuse in 11170 suspected drug users. Urine samples collected between January 2016 and December 2018 were also analyzed. Results revealed a preponderance of males (97.4%) compared to females, with a median age of 29 ± 7.91 years. Also observed was that a large percentage of these drug users were single (91.3%). Examination of the urine samples revealed that about 48.4% tested positive for illicit drugs, with cannabis being the most widely consumed drug (95%), others were benzodiazepines, buprenorphine, cocaine, and opiates (0.13%). There was also a history of poly drug use[ 69 ].

In Southern Africa (although there are limited national data in most countries in the region), a rise in substance use has been reported[ 70 ]. In some of these countries including Zimbabwe, there is anecdotal evidence suggesting an increase in substance use among adolescents and young adults, with prevalence of substance use reportedly ranging from 6.1% to 13.8%[ 70 ]. Alcohol, cannabis, heroin, glue, and cough mixtures are among the most commonly consumed products in Zimbabwe. Cannabis, which is commonly known as mbanje, is grown locally (also smuggled into Zimbabwe from Malawi and Mozambique), and remains the most popular illicit drug among young Zimbabweans. Drugs are also trafficked through Zimbabwe to other countries in the region, including South Africa. In South Africa, an increase in substance use has been reported, which has been linked to the increased availability of illicit drugs including cannabis, cocaine, heroin, amphetamines, and ecstasy; either from diversion during trafficking or increased cultivation and local production[ 29 , 30 , 71 , 72 ]. Other factors that have contributed to the increase in substance use include an increase in migration and easing of border controls following the commencement of democracy, which have facilitated the development of youths’ movements that indirectly or directly promote substance use[ 30 ]. Results from surveys have revealed a gradual increase in cannabis consumption among adolescents and young adults in South Africa.

A 2002 school-based survey reported that 13% of the students (aged 19 years and below) had an history of cannabis use, although current use was 9%. About 12% had a current use of heroin, 11% used inhalants, and 6% consumed Mandrax[ 73 ]. The results of another study (a 2005 National household survey) showed that the prevalence in the past 3 mo for cannabis among 15-19-years-old was 3%[ 74 ]. In another study examining the prevalence and patterns of use of illicit substances among persons presenting at drug treatment centers in South Africa, it was revealed that cannabis (16.9%), methamphetamine (12.8%), cocaine (9.6%), and prescription drugs (2.6%) were the substances commonly used among patients. Also, there was evidence of poly drug use, with cannabis and mandrax having a prevalence of 3.4%, whereas heroin and opiates had a prevalence of 9.2%[ 75 ].

Prior to 1994 and the first democratic elections, alcohol, cannabis, and methaqualone were the primary substances of misuse in South Africa. With South Africa’s transition to democracy and subsequent reopening of borders, there has been an influx of and a growing burden of harm associated with illicit drug use. Alcohol, however, remains the most commonly misused substance, with 14% of the population having a lifetime diagnosis of alcohol abuse and/or dependence (Herman et al [ 76 ], 2009). Although the overall levels of alcohol consumption do not exceed those in the developed world, the pattern of consumption differs markedly, with hazardous and binge drinking being common.

New and emerging psychoactive substances in Africa

Use of novel psychoactive substances is an emerging trend in substance use that is fast becoming a public health challenge globally[ 77 , 78 ]. Novel or new psychoactive substances have been defined by the United Nations Office on Drugs and Crime[ 79 ] as substances of abuse (existing either in its pure form or as a preparation) that are not controlled by either the 1961 or 1971 conventions on narcotic drugs and psychotropic substances, respectively, but pose significant threats to public health globally due to spikes in intoxications and fatalities associated with their use[ 79 , 80 ]. The term ‘novel’ or ‘new’ that is used in relation to these substances depicts their recent emergence in the global market. Substances that currently fall within the novel psychoactive substance category include (but are not limited to) synthetic cathinone and cannabinoids, synthetic opioids, image and performance-enhancing substances, tryptamine derivatives, piperazines, phencyclidine-like dissociatives, gamma amino-butyric acid (A)/beta receptor agonists, novel hallucinogens, benzodiazepines and psychotropic plants/herbs[ 77 , 81 , 82 ].

In the last few years or more, there has been a growing demand and supply chain for these new psychoactive substances[ 77 , 78 , 81 ]. In the last 10-12 years, the number of novel psychoactive substances has increased considerably. In 2009, only about 166 of them had been detected; however, by 2019, the number had risen to about 950, with more than 70% of these substances available in Europe[ 80 , 83 ]. While in the developed economies, a lot is being done to ensure continued documentation of novel psychoactive substances as they emerge, it would seem that Africa is only beginning to awaken to the emerging public health threat that these substances pose to her teeming population of adolescents and young adults[ 82 ]. While the lifetime prevalence of novel psychoactive substance use in countries such as the United States have been examined[ 80 ], there is a paucity of data on the prevalence of novel psychoactive substance use in Africa. Although across the continent, there is increasing awareness of the dangers of novel psychoactive substance use.

In 2017, attention was called to an increase in the use of designer drugs in Nigeria. Some of these substances which have street names such as “black mamba”, Colorado”, “Lamba”, “happy boy”, and” Scooby snax” are believed to contain synthetic cannabinoids. Their use is associated with a rise in the incidence of hallucinations, convulsions, psychiatric disorders, kidney failure and fatalities[ 84 ]. News outlets, including the British Broadcasting Corporation News and Premium Times, also reported that the use of and addiction to non-conventional psychoactive substances such as tramadol and codeine cough syrups among Nigerian youths was reaching epidemic proportions[ 85 , 86 ]. In Nigeria, available novel psychoactive substances also include mixtures with street names such as “gutter water”, a cocktail of cannabis, tramadol, codeine and ethanol), and “monkey tail ” , a cocktail of locally made gin and cannabis (seeds, leaves, stems, and roots). Some people have also been in a state of euphoria from drinking the mixture of specific carbonated drinks and menthol flavored candies[ 82 ]. The sniffing of dry human fecal matter, dry cassava leaves and seeds, Datura metal seeds, Moringa leaf, burnt tires, sewer gas, and nail polish have also been reported[ 82 , 87 ]. Different parts of some lizards, including the whitish part of their dung, are also smoked in a bid to achieve a “high”[ 82 , 87 ]. The inhalation of urine, sewage, petrol, and glue are also common practice among drug users in Africa. It is believed that the hallucinogens present in hydrocarbons from petrol, and gases produced from fermentation of sewage have the ability to cause a “euphoric high” similar to (but longer lasting) when compared to that derived from the ingestion of cocaine[ 88 ].

In southern Africa, particularly South Africa, there have been reports of the use of “Nyaope” also known as “Whoonga”, which is a cocktail of low-grade heroin (black tar heroin), marijuana, antiretroviral drugs (Efavirenz), and other undisclosed substances[ 88 ]. In East African countries such as Uganda and Kenya, the habit of using novel psychoactive substances such as the sniffing of aviation gas/jet fuel, toluene and glue is reaching epidemic proportions among persons aged between 16-25 years[ 89 - 91 ]. Other substances that are abused in this region include “kuber” and“ shisha”, also known as hookahs ,which are variants of smokeless tobacco. There have been reports that compared to cigarettes, the smoking of the shisha or hookah pipe exposes the user to higher volumes of smoke containing high levels of benzene, tar, and other carcinogens and increased risk of lung cancer[ 92 - 95 ].

In Northern Africa, the smoking of hashish and the chewing of Kath has become very rampant. Although there is little data from the region regarding the prevalence and patterns of use of novel psychoactive substances; reports from studies carried out in Egypt have suggested that the estimated prevalence of novel psychoactive substance use among adolescents in the country are largely underestimated[ 96 ]. However, tabloid reports have called attention to an increasing demand and use of novel psychoactive substances including “voodoo” and “strox” among adolescents and young adult in Egypt[ 97 , 98 ]. “Voodoo” is gaining popularity rapidly, and it is usually packaged and sold as an herbal incense. “Voodoo” is a heterogeneous mixture of several psychoactive substances, including synthetic cannabinoids, tramadol, amphetamine, methadone, benzodiazepines, penitrem A (a neurotoxin) and morphine derivatives. The concentrations of the chemical constituents and adulterants of voodoo also vary substantially among the different clandestine laboratories that produce it[ 96 , 99 ]. Another novel psychoactive substance that is gaining popularity in Egypt is “Strox”[ 100 ]. “Strox” or “Egyptian Spice” has been reported to account for approximately 4.3% of the over 10400 patients requiring medical support for drug-related complications[ 101 ]. Also, addiction to “strox” was responsible for 22% of calls to the addiction center hotline[ 101 ]. “Strox” is a potent synthetic narcotic that is mixed with tobacco and smoked; it is compounded in clandestine laboratories by adding veterinary grade chemicals to aromatic herbs such as marjoram. There have also been reports of the addition of pesticides to increase the potency, although this increases the toxicity[ 97 ].

The search for novel psychoactive substances is fueled by the need to create drugs that are able to evade the chemical processes used for detection and the legal processes that criminalizes the use and possession of conventional drugs of abuse. Also, the need for compounds that deliver fast and sustained psychoactive effects when compared to the conventional drugs also drive the search for novel psychoactive compounds[ 102 ]. However, the variability of the chemical constituents and/or adulterants of the different compounds present a conundrum for the health professional who has to decipher and manage the divergent symptoms and signs that complicate the use of these substances. Hence. there is an increasing need for continuous surveillance so that new or emerging psychoactive substances can be discovered before they wreak havoc on our communities.

African plants and herbs with psychostimulant potential: Are they being abused?

Several plants and parts of plants have been shown to have central nervous system effects[ 103 - 109 ]. Also, current literature reveals that novel psychoactive substances can be derived from either synthetic compounds or from bioactive principles of natural compounds. These bioactive principles which are mainly alkaloids are present in a wide variety of plants including Ayahuasca, Catha edulis and nicotiana tabacum; and have been reported to possess hallucinogenic and/or stimulant effects[ 110 ]. Plants with psychoactive properties are found all over the globe and have been used for centuries by humans, for religious, therapeutic and recreational purpose[ 111 , 112 ]. Studies have shown that the bioactive principles of these plants enable the profound alteration of the human perception allowing for divination, ancestral contact, and spiritual enlightenment[ 111 - 113 ].

Africa has a high floral diversity and a rich tradition of indigenous medicinal plant and herb use[ 111 ]. Africa is also rich in flora of medicinal plants that possess central nervous system effects[ 107 ]. Although there is a paucity of ethnobotanical surveys on African plants with psychoactive effects, evidence from African traditional healers and diviners who use plants such as the ‘Ubulawu’, a preparation containing Sileneundulata and Synaptolepis are pointers that there are plants indigenous to Africa that contain compound which have mood altering effects[ 113 ]. A few plant species that are indigenous to Africa, such as the Cola species (Cola nitida, and Cola acuminata), Catha edulis (Kath), Datura species (Datura stramonium), Pausinystalia yohimbe (Burantashi Pausinytalia yohimbe) and Tabernanthe iboga have reported psychoactive properties[ 111 , 114 ], and have been used recreationally (Table ​ (Table2) 2 ) for centuries in the countries in which they are cultivated. However, in recent times, the use of and dependence on some of these plants by adolescents and young adults (either alone or combined with established illicit drugs) is reaching epidemic proportions. In this section, we reviewed the abuse potential of some psychoactive plants that are indigenous to the African continent.

African plants and herbs with psychostimulant potential

Kath (Catha edulis Forsk) is a flowering plant native to countries in East Africa and the Horn of Africa. Fresh young leaves and twigs from Kath are chewed daily by large populations of people for its psycho-stimulatory properties. The chewing of Kath dates back centuries, being a practice that is rooted in tradition, social custom and the culture of the indigenous populations[ 115 ]. It has been reported that more than 20 million people worldwide chew Khat[ 116 , 117 ]. Although traditionally a custom associated with older middle Eastern and Eastern African men, Khat’s use is now expanding to include women and younger persons. In the Eastern region of Ethiopia, approximately 30% of adolescent girls and 70% of adolescent boys chew Khat. The active principle contained in Khat is cathinone (an alkaloid), which is a stimulant that causes excitement, appetite loss and euphoria[ 117 ]. In countries such as Somalia, Ethiopia, Djibouti, and Kenya, the dependence on Kath is warranting its consideration as a substance of abuse. In Somalia a law prohibiting the use, cultivation, importation and trade of Kath was enacted and enforced by comprehensive national program[ 118 ]. At about the same period (approximately two decades ago), Kath was also considered by the World Health Organization and classified as a drug of abuse, although its abuse potential was not thought to constitute a serious problem compared with that of alcohol or tobacco[ 119 ]. Across a region extending across Africa and the Middle East, predominantly among the Ethiopians, Somalians and Yemenis, approximately 5 to 20 million people use Kath[ 116 , 120 ], with the consumers engaged in the practice for the best part of a day resulting in a loss of manpower and national income[ 121 , 122 ]. In 2005, a survey by the World Health Organization revealed a prevalence of 20% Kath abuse in Kenya, exceeding the prevalence observed in most of the other countries in the region[ 123 ]. However, more recent studies are demonstrating that in spite of attempts by the respective countries to criminalize the use of Kath, Kath chewing is fast becoming a common practice among young adults in countries like Kenya, Ethiopia, Somalia, Djibouti[ 124 - 126 ]. In Ethiopia, a study carried out among academic staff of a university revealed that the lifetime prevalence of Kath chewing was 41%[ 126 ], while another study carried out among college students reported a prevalence of 42%[ 124 ]. In Kenya, a recent household survey revealed that the prevalence of current Kath chewing in the region was 36.8%[ 125 ], which would suggest a significant rise from the 20% prevalence reported by the World Health Organization[ 123 ]. While Kath chewing was not previously known outside the regions within which it was cultivated, the effects of migration and trade have propelled it to a widely used psychostimulant globally[ 115 , 127 ]. Kath chewing has been associated with adverse health effects that is creating public health challenges in countries across Asia, Europe, Australia, and the United States of America[ 128 - 130 ]. When chewed concurrently with tobacco, there have been reports of cardiovascular stress response[ 129 ]. It has also been associated with the alteration of physical, mental, social and cognitive aspects of human functioning[ 131 ]. Chewing Kath chronically has been reported to cause memory impairment, sleeping disorders, liver toxicity, cardiovascular disease, psychosis and poor academic performance[ 126 , 132 ]. While attempts are being made by countries to criminalize the importation and trade of Kath, smugglers continue to find new avenues and trade routes. For example, in 2016, the National Drug Law Enforcement Agency of Nigeria reported seizures of Kath load, which was possibly destined for the Nigerian market or enroute countries[ 133 ]. However, in 2020, the United States customs reported seizure of Kath load from Nigeria destined for the United States suggesting that Nigeria is fast becoming a Kath transit hub[ 134 ].

In Nigeria, complicating the substance abuse epidemic is the emerging trend of experimenting with plant extracts or brews from a group of flowering plants belonging to the Datura specie, of the nightshade family Solanaceae[ 135 , 136 ]. Although members of the Datura specie which are broadly known as thorn apple, devil’s apple, devil’s trumpet or angel’s trumpet have their origin in central Americas and in the south-west region of the United States if America[ 137 , 138 ], they have become naturalized all over the world, being widespread in Asia, Europe, and Africa[ 139 ]. The datura specie is made up of herbs and shrubs with erect or branched stems, with alternate simple basal leaves and opposite leaves on terminal branches[ 139 ]. The fruit has a spiny capsule and reniform seeds[ 139 , 140 ]. All parts of the Datura stramonium and Datura metal plant has been shown to contain tropane alkaloids such as atropine, scopolamine, and hyoscyamine which have significant anticholinergic and hallucinogenic activity[ 141 ]. The high tropane alkaloid content of these plants increases their medicinal value and also opens them up to potential abuse. In Nigeria, Datura stramonium (thorn apple, devil’s snare, devil’s trumpet or jimsonweed) and Datura metal (Indian thorn apple) are naturalized. Similar to a number of countries across the world (United States of America and Canada) where there has been reports of datura-induced poisoning among adolescents who abuse the plant for its hallucinogenic effects[ 142 - 144 ], adolescents and young adults in Nigeria are also experimenting with the plant and getting poisoned[ 136 ]. Datura metal grows wildly (although at times it is cultivated) across the different regions of Nigeria where it is called ‘Myaramuo’ by the Igbos of south eastern Nigeria, ‘Zakami’ by Hausas of northern Nigeria and ‘Apikan’ by the Yorubas of southwestern Nigeria[ 145 , 146 ]. Datura stramonium also grows as a weed and is also cultivated across the different states of Nigeria. It is known as ‘Gegemu’ by the Yorubas and ‘Zakami’ by the Hausas[ 136 ]. Both plants have been reported to have hallucinogenic and euphoric effects when the different parts of the plant are either smoked or used to make concoctions[ 147 ]. Datura stramonium poisoning is associated with hyperthermia, tachycardia, delirium, pronounced amnesia, severe mydriasis, bizarre behaviors and painful photophobia[ 136 , 148 ]. These features can appear as early as 30 min to 1 h following consumption of the extract or smoking of the weed and have been reported to last several hours to days or at times even as long as 2 wk[ 148 ].

Another plant with psychoactive properties is the Western African shrub Tabernanthe iboga from whose root bark ibogaine, a hallucinogenic alkaloid is extracted. Traditionally, the concoctions from the roots have been used for their stimulatory, hallucinogenic, and sedative effects[ 149 ]. Ibogaine has been reported to exhibit stimulant effects at low doses and result in the development of hallucinations at high doses. Its use has also been associated with the development of ataxia, tremor, cardiac toxicity, and death[ 149 - 151 ]. There have also been reports that ibogaine has anti-addictive properties, although its use is limited by its deleterious effects[ 152 , 153 ].

In southern Africa, the use of extracts, dried-powdered herb, tincture, tea bags and seeds of the plant sceletium tortuosum also known as Kanna is also gaining traction. These different compositions of the plant can be chewed, smoked, snorted or swallowed resulting in increased libido, decreased stress, euphoria and appetite suppression. There are reports attributing the antidepressant and mood-elevating effects of the plant to the serotoninergic activity of its alkaloids including mesembrenone, mesembrenol, mesembrine, and tortuosamine. Indiscriminate use has been associated with the development of anxiety, headache, hypertension, irritability, insomnia and nausea[ 154 , 155 ]. A serotonin syndrome has also been observed especially when consumed alongside selective serotonin reuptake inhibitors or monoamine oxidase inhibitors. Although the use of a number of these plants and herbs may not be illegal in the countries in which they are consumed, increasing reports of poisoning arising from the use or these psychoactive plants solely or in combination with other compounds is drawing attention to the need to enact public health laws that can criminalize their use.

Synthetic cannabinoid in herbal products

Synthetic cannabinoids are compounds which are structurally similar to natural cannabinoids [tetrahydrocannabinol and cannabidiol ( CBD)] allowing them to exert their effect through binding to cannabinoid receptors (CBD1 and CBD2)[ 156 , 157 ]. Synthetic cannabinoids can be agonists at the CB 1 receptors or antagonists at other cannabinoid receptors. Although many of the synthetic cannabinoids are used in pharmacology in structure - activity relationships and receptor binding studies, others have medicinal uses including in the treatment of anorexia, as antiemetics in cancer chemotherapy and in pain management. In the last two decades, commercial preparations containing synthetic cannabinoids have become popular for their use as designer drugs marketed as herbal incense or herbal blends under the names ‘Spice’, ‘synthetic marijuana’, and ‘K2’[ 158 - 160 ]. The cannabinoid compound is sprayed onto inert plant material and smoked or ingested in liquid form[ 160 , 161 ]. Although often considered legal and safe alternatives to cannabis, there is evidence indicating that synthetic cannabinoids use is associated with significant health risks when compared to marijuana; there have also been reports that their distinct pharmacological effects and metabolic activity could also be a contributing factor to the increased toxicity observed following their use[ 157 , 162 , 163 ].

To date, the abuse of herbal preparations that have been spiked with synthetic cannabinoids continues to increase. This is evidenced by an increasing list of commercial preparations marketed in the United States and Europe under the names fairly legal, Pandora’s box, Angry birds, exodus, bonzai, annihilation, weekend blend, fire, strong spice, green Buddha, smoke, and Scooby snacks[ 102 , 164 ]. In the last few years, Africa is also beginning to experience a surge in demand for and use of synthetic cannabinoids. In Mauritius, since the year 2015, there has been a reported increase the number of arrests involving synthetic cannabinoids[ 165 ]. In different countries in the continent they are marketed under various street names including, Wiz in South Africa[ 166 ]. In Nigeria it is marketed as Black Mamba, Colorado , Lamba, Happy Boy or Scooby Snax[ 167 ].

Across Africa, available evidence points to a growing use of novel psychoactive compounds which mainly contain synthetic cannabinoids. Synthetic cannabinoids have effects that are similar to that experienced with natural cannabis, although they are more potent and have been associated with more severe physical and psychological adverse effects necessitating hospitalizations[ 168 , 169 ].

PREVALENCE OF SUBSTANCE USE DISORDERS AND AVAILABILITY OF EVIDENCE-BASED TREATMENT CENTRES IN AFRICA

Substance use disorders are defined as the persistent use of alcohol or other psychoactive substances despite significant harm and untoward health consequences[ 170 ]. They are characterized by an array of social, emotional and behavioral problems. Across Africa, there is also a dearth of scientific data on the prevalence of substance use disorders or drug dependence[ 48 , 55 , 56 , 171 ]. In Nigeria, reports from the 2018 National Drug Survey revealed that one in every five persons who used drug in the past year also had a drug-related disorder[ 48 , 55 , 56 ]. In South Africa, results obtained from a nationally representative sample of 4351 persons aged 18 years and above revealed a lifetime prevalence of substance use disorders of 13%, with alcohol use disorder being the most prevalent type of substance use disorders[ 72 , 171 - 173 ]. In Egypt, reports obtained from the National Addiction Research Study revealed the prevalence of drug dependence in the different regions ranged from 3.2%-9.3%[ 174 ].

Left untreated, substance use disorders contribute significantly to the global burden of disease, including increasing morbidity and mortality and societal cost implications such as increased healthcare costs, lost productivity and costs related to social welfare and criminal justice[ 4 , 5 ]. Access to evidence-based treatment has been linked with a reduction in the risk for ill health[ 171 ]. Accordingly, towards reducing the burden of substance use globally, availability and access to evidence-based treatment facility were included in the United Nations’ Sustainable Development Goals for 2030[ 175 ]. However, despite reports of increasing prevalence of drug dependence and substance use disorders, reports from surveys carried out in a number of countries in Africa suggest that the availability of treatment centers are limited[ 171 , 176 ]. Factors contributing to this treatment gap include treatment infrastructure constraints, poor funding, and the high cost of private-for-profit treatment centers[ 171 , 176 ].

How can Africa’s burgeoning substance use and substance use disorder problem be addressed

It has become evident that there is a burgeoning illicit drug use problem across the African continent[ 47 - 49 , 177 ]. There had been predictions that by the year 2050, increased life expectancy and a rapidly growing population would result in approximately 130% increase in the burden of mental and substance use disorders to about 45 million years lived with disability in Africa[ 178 ]. While different factors, including increased access to illicit drugs and high level of youth unemployment have been adduced to explain the emerging drug use pandemic; its significant contribution to economic instability, crime, criminality and insecurity across Africa and worldwide means that governments and policy makers need to prioritize the need to develop ways to mitigate these problems. The dearth of comprehensive data and the uniqueness of the manifestation of illicit drug use to individual countries within the African region are factors that impede progress towards addressing this looming pandemic.

Understanding the different determinants of drug use within the different populations of Africans and how these impact the prevention and treatment of substance abuse disorders in the individual countries would be an important step towards addressing this emerging pandemic. Currently available data suggests that influencers of drug use (particularly in adolescents) which include family, social networks and peer pressure are common to most of the countries[ 179 - 184 ]. Other determinants of drug use also include childhood trauma and adverse life experiences such as sexual, emotional or physical abuse. Across age groups, demographic factors such as being male, lower level of education and attendance of private schools have also been reported by researchers from the different regions of Africa[ 185 - 187 ].

In addition to understanding the influencers and determinants of drug use, there is also a need for up-to-date national and regional data that can adequately determine the prevalence and incidence of drug use across all demographics. The availability of a detailed and comprehensive national data would provide a background against which policy successes or failures can be measured, it would also alert governments and international partners on the need for increased funding or more treatment facilities.

The deleterious health effects of drug use disorders means that the provision of effective prevention, treatment and care facilities for substance use disorders is a necessary investment in the health of the society as a whole. Research has shown that the availability of evidence based prevention programs and policies have the ability to significantly reduce substance use and related harmful effects[ 188 ]. Behavioral and medication-assisted treatment using a chronic-illness-management approach has also been shown to aid recovery and prevent relapse. There have been suggestions that easy access to support services assist previous substance users to achieve and maintain wellness long-term[ 188 ].

Addressing the ease of access to drugs and other illicit substances within communities and regions need to be taken more seriously. There is a need to gather information on the different types of novel psychoactive substances that are available within communities and also create awareness as to the adverse health effects associated with consuming these compounds.

Limitations and recommendations

One of the major limitations encountered in this review was the dearth of recent, community based and age specific scientific data on the prevalence and extent of the substance abuse problems in most of the countries in Africa. There was also a deficit of data on the details and impact of the country-specific intervention protocols. This led to reliance mainly on third party data from international; partners and a few independent researchers. The battle to win this emerging substance–use pandemic in Africa can only be successful if there is increased emphasis in documenting the extent of the problem and country specific interventions; particularly at the community levels with emphasis on how different age groups are impacted by substance abuse.

In Africa, substance use and substance use disorders drain struggling economies and health care systems. While the continent might have some general idea of what it is up against, understanding the details of the problem and availability of the willpower/wherewithal to subdue it remains a challenge. It is becoming obvious that there is no substitute for well-designed, accurate and comprehensive population-focused efforts at obtaining data that relates to substance use and substance use disorders, since such data will form the foundations for designing effective intervention strategies. Also, in Africa, interventional strategies should place emphasis on prevention, through identification of and mitigation of risk factors, as this approach is likely to consume less resources in the long run.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Provenance and peer review: Invited article; Externally peer reviewed.

Peer-review model: Single blind

Peer-review started: March 4, 2022

First decision: April 18, 2022

Article in press: September 7, 2022

Specialty type: Psychiatry

Country/Territory of origin: Nigeria

Peer-review report’s scientific quality classification

Grade A (Excellent): 0

Grade B (Very good): B, B, B

Grade C (Good): C

Grade D (Fair): 0

Grade E (Poor): 0

P-Reviewer: Kar SK, India; Liu XQ, China; Setiawati Y, Indonesia S-Editor: Wang JJ L-Editor: Filipodia P-Editor: Wang JJ

Contributor Information

Olakunle James Onaolapo, Behavioral Neuroscience Unit, Neuropharmacology Subdivision, Department of Pharmacology, Ladoke Akintola University of Technology, Ogbomoso 210214 Oyo, Nigeria.

Anthony Tope Olofinnade, Department of Pharmacology, Therapeutics and Toxicology, Lagos State University, Ikeja 100001, Lagos, Nigeria.

Foluso Olamide Ojo, Department of Anatomy, Ladoke Akintola University of Technology, Ogbomoso 210214, Oyo, Nigeria.

Olufunto Adeleye, Department of Anatomy, Ladoke Akintola University of Technology, Ogbomoso 210214, Oyo, Nigeria.

Joshua Falade, Department of Mental Health, Afe Babalola University, Ado-Ekiti 360282, Ekiti, Nigeria.

Adejoke Yetunde Onaolapo, Behavioral Neuroscience Unit, Neurobiology Subdivision, Department of Anatomy, Ladoke Akintola University of Technology, Ogbomoso 210214, Oyo, Nigeria. moc.oohay@yibiyabgeda .

The Federal Register

The daily journal of the united states government, request access.

Due to aggressive automated scraping of FederalRegister.gov and eCFR.gov, programmatic access to these sites is limited to access to our extensive developer APIs.

If you are human user receiving this message, we can add your IP address to a set of IPs that can access FederalRegister.gov & eCFR.gov; complete the CAPTCHA (bot test) below and click "Request Access". This process will be necessary for each IP address you wish to access the site from, requests are valid for approximately one quarter (three months) after which the process may need to be repeated.

An official website of the United States government.

If you want to request a wider IP range, first request access for your current IP, and then use the "Site Feedback" button found in the lower left-hand side to make the request.