Diversion of pharmaceutical opioids for extra-medical consumption: the role of patent and proprietary medicine vendors in Nigeria

Background: studies have identified various sources from which pharmaceutical opioids are obtained for extra-medical consumption. Yet, the role of informal medicine vendors remains relatively unknown. In Africa, there is a dearth of research on the supply of pharmaceutical opioids for extra-medical consumption, which could help to highlight the role of informal medicine vendors. Nevertheless, research has implicated these vendors in other public health problems such as distribution of falsified and substandard drugs. Methods: We conducted in-depth interviews with young Nigerian men (aged 15–35 years) who consume pharmaceutical opioids extra-medically (n = 39) to explore the sources from which they obtain pharmaceutical opioids for this consumption and the factors that inform their choice for these sources. We used ‘liminal legality’ as a conceptual tool to understand the role of Patent and Proprietary Medicine Vendors (PPMVs) in this supply process. Results Accounts revealed that participants obtained pharmaceutical opioids for extra-medical consumption from Patent and Proprietary Medicine Vendors (PPMVs), street drug dealers and friends/relatives. PPMVs were identified as an important source of these drugs due to their liminal legality, which is a state of quasi-authorization by the Nigerian state. The position of PPMVs betwixt the formal and informal drug markets create unique opportunities for obtaining prescribed drugs (such as pharmaceutical opioids), which PPMVs are not authorized to sell, in the guise of selling/buying over-the-counter drugs. This affordance in turn made buying pharmaceutical opioids from PPMVs easier compared to street dealers and provided a measure of protection from law enforcement, which is unavailable in street drug markets. The dependence of most street drug dealers and other consumers (i.e. those who supply friends and relations) on PPMVs for primary supply further establishes these vendors as a primary source of pharmaceutical opioids for extra-medical consumption. Conclusion The study shows how the absence of effective policy framework to regulate the operations of PPMVs creates opportunities for accessing pharmaceutical opioids for extra-medical consumption. It calls for government regulation of these vendors through licensing, training and routine monitoring.