Substance use and related problems in Nigeria: Research and policy perspectives.

AIM: To provide an overview and critical analysis of substance use and related problems in Nigeria within an evolving sub-regional and regional markets and policy landscapes. The analysis covers epidemiology, prevention, treatment and harm reduction as well as policy and research. METHODS: The analysis is based on narrative synthesis of available academic and grey literature, policy documents and relevant reports produced by government and non-governmental organizations. This synthesis captures trends in substance use, describes prevention and treatment programmes, analyses trends in policy and comments on the state of addiction science in Nigeria. RESULTS: There is a long history of consumption of psychoactive substances in Nigeria. Alcohol, tobacco and cannabis use were seen as problems to be addressed before independence in 1960. Cocaine and heroin joined the list as a spillover effect of their trafficking through West African countries to western markets beginning in the 1980s. A recent trend is the rise in the use of synthetic substances (opioids, stimulants and depressants) across West Africa. The rising problem of substance use has evoked a response from government and civil society in the form of substance use prevention, treatment services for substance use disorders and essential harm reduction services for people who inject substances or consume opioids. Yet, these services are insufficient and people who use substances face barriers to accessing treatment and harm reduction. Despite some reforms, especially implementation of essential harm reduction services, enforcement-based approaches remain dominant in Nigeria's policy as in most African countries. Commendably, mechanisms have been established to collate data on substance use and related harms at regional and sub-regional levels, which has helped to shape public health responses to substance use at country level. Nigeria has also conducted national surveys of substance use, with support from international partners. Nevertheless, data collection remains irregular and more qualitative studies are needed to provide insights into contextual factors shaping substance use. CONCLUSION: The rising level of substance use in Nigeria highlights the importance of a balanced and comprehensive policy that prioritizes demand and harm reduction measures. This requires funding for research to generate evidence to inform and shape interventions.