Towards a drug demand reduction strategy in Africa
Preliminary assessment of the drug situation
The summary below is based on Country Reports information for a limited number of countries in Africa. It may not apply equally to all African countries. Country Reports contain more details. In general, more research is needed to assess the drug situation in Africa.
Extent of Drug Abuse
Cannabis appears to be the most commonly abused drug in most countries in Africa. Most of the abuse of cannabis appears to be traditional and community concern in relation to it is low.
Volatile substances abuse is reported in the region, especially among street youth, but its prevalence is low.
Concern is growing over the abuse of methaqualone, sedatives and narcotic analgesic preparations which are readily available in street markets. More recently, a surge in the abuse of drugs such as LSD, amphetamines, cocaine and heroin has been reported.
Overall, it may be concluded that the prevalence of drug dependence is very low and that it is not of significant concern to most African countries. Often, concern is more significant over abuse of alcohol and local drugs such as khat.
Abuser Characteristics
Drug abusers tend to be mostly males, although abuse is growing among women. Abuse of cannabis, methaqualone and volatile substances among women has been highlighted in recent reports. In addition, abuse of narcotic analgesics is more pronounced among women.
Most drug abusers tend to be children and young adults, 11 to 21 years of age. Cannabis abusers tend to be in the 12-40 age range, methaqualone abusers in 14-30 years of age, and volatile substances abusers 10-16 years of age. Initiation to drug consumption appears to be at a relatively young age (10 years or so).
Cannabis abuse is prevalent among all social strata, including the unemployed. All ethnic groups abuse drugs. Concern is increasing over the abuse of drugs among students of higher socio economic background, especially those who have studied in foreign countries. Primary responsibility has been attributed to students who have studied abroad, for introducing to the region drug abuse behavior characteristic of foreign countries, especially in relation to cocaine and heroin. Some drug abuse is specific to selected social groups, for example khat among Muslims in Kenya.
Regional Variations
Drug abuse, previously reported to be common in metropolitan areas, is now increasing in rural areas. Traditional use of selected drugs such as cannabis is common in rural communities.
Trends
There is a significant increase in the abuse of diverted licit drugs . In addition, increases in the availability of illicit drugs, such as heroin, cocaine, methaqualone, "Wellcanol", dipipanone hydrochloride, a synthetic narcotic analgesic are also reported.
Increases in the consumption of diverted licit drugs and illicit drugs are attributed to unemployment, family disintegration, decline in religiosity, urbanization, changes in attitudes in the community, foreign influence and peer pressure.
There are signs that cannabis cultivation is increasing throughout Africa, but it is especially pronounced in selected countries such as Morocco and Zambia. It should be noted also, that with increasing involvement of Africans in international trafficking, the supply of non-traditional drugs is bound to increase in Africa. However, the trend that is likely to raise most concern is increases in availability and use of diverted licit drugs.
Mode of Intake
Drug injection is not widespread, although it is reported in selected areas (mainly in South Africa). Most drugs are smoked. Some are ingested. Multiple drug use is reported.
COSTS AND CONSEQUENCES OF ABUSE
Information on costs and consequences in the region is fragmented. Drug related hospitalization is reported in the region, although most are alcohol rather than other drug related. The combined use of cannabis and methaqualone appears to be associated with significant health problems, especially in the south African countries. The use of khat has been associated with social problems in Kenya.
NATIONAL RESPONSES TO DRUG ABUSE
National Strategy
Countries in the region are in the process of developing drug policies and programmes coordinated by national Committees. Government representatives often lead the committees. Occasionally, representatives from relevant non-governmental organizations (NGOs) join the coordinating bodies. National programmes tend to focus on the control of drug supply. Attention to demand reduction activities is limited but increasing. Special efforts are required to develop national strategies which include demand reduction programmes.
Programmes in educational settings and the workplace appear to be gaining momentum. Programming is strong in South Africa, in comparison to all other countries. South Africa could be instrumental in training and guiding the development of drug related programmes in its subregion. Elsewhere, there seem to be significant concentrations of well educated professionals in Kenya in the East, Nigeria in the West and in Morocco, Tunisia and Egypt in the North. Other pockets of well educated professionals are likely in almost every country but a more systematic search may be needed. Special efforts are required to retrain existing professional resources and develop specialized drug expertise in the area of demand reduction programmes.
Treaty Adherence
Some countries in the region are not party to international treaties. Special efforts to put in place drug related legislation is needed. Elsewhere, legislation is non existent or too weak to regulate effectively the use of drugs. Thus, licit drugs are easily diverted to open street markets. Special efforts are required to develop drug control legislation and regulation policies to contain likely increases in demand for drugs.
DEMAND REDUCTION ACTIVITIES
The response to drug abuse and related consequences, is constrained by the overiding problem of limited access of the population to primary health care and educational services. It is generally, held that without the development of these services, the effectiveness of the response to drug abuse will remain limited.
Primary Prevention
The level of activities reported in the area of primary prevention is impressive. It is difficult to assess the extent of coverage of the activities reported and its distribution across countries. In spite of the limitations of this information, it indicates that there is some awareness as to the type of demand reduction programmes required in the region.
The media has been active in promoting drug prevention messages, mainly awareness programmes aimed at the whole community. Programmes consist of radio programmes on drug abuse, which aim at young adults and newspapers ads and articles aimed at schooled segments of the population. Although more of these programmes may be needed, their reach is limited by the limited access of the population at large to radios, newspapers, televisions and schools.
Prevention through education is carried out in primary and secondary schools, but it targets only part of the student population. Some of the prevention activities consist of newsletters, lectures in youth camps and lifestyle training for street children. More efforts are needed to target students in colleges and universities. Although more of these programmes may be needed, their reach is limited by the limited access of the population to education.
Basic and advanced training is provided selectively to drug law enforcement personnel, doctors, nurses, pharmacists, social workers and teachers. Professional organizations, trade unions, voluntary agencies, religious groups and law enforcement agencies have been involved in the formulation and implementation of prevention programmes. Investment in training of practitionnners with knowledge and expertise in the area of drugs is likely to produce fertile ground for the development of awareness as well as good will activists who would lobby for drug programmes sustainability in the long run.
Community-wide and workplace drug education workshops have been conducted in some countries. Leisure time activities in the service of the continuing campaign against drug abuse, such as physical training, organized sports activities and camps organized by churches and other cultural groups, target school children, as well as youth and adults. Investment in drug related training among existing NGO’s and other bodies with developed networks at the community level, and especially the traditional community level, is likely to produce fertile ground for the development of awareness as well as grass root community controls to contain drug use.
Treatment and Rehabilitation
The level of activities reported in the area of treatment and rehabilitation is impressive in South Africa, but weak elsewhere. Although it is difficult to assess the extent of coverage of the activities reported, reporting does indicate awareness as to the type of demand reduction programmes required.
Treatment services tend to be centrally coordinated and consist of services in existing health centres as well as in NGOs. Many of the health centres are supported by WHO or NGO’s supported by foreign contributions and religious organizations. Although the reach of these programmes is likely to be minimal, it is the most promissing given the limited access of the population to health services.
After-care services are also offered, often by non-governmental organizations and churches, many are based on self help. In some cases, detoxification is carried out in neighboring countries (i.e., South Africa). In many cases, traditional healers are sought.
Some prisons provide drug dependent inmates with drug counseling, counseling on drug related diseases, vocational training, and general education. Drug education to female prisoners and staff has been reported. But the reach of these programmes is likely to be minimal.
Social reintegration of persons who have undergone treatment and rehabilitation programmes is available in the form of assistance in finding employment, counseling for ex-abusers and their families and accommodation in halfway houses. These services are provided by NGOs and organizations associated with churches. The reach of these programmes is likely to be minimal.
PROGRAMME IMPLICATIONS IN AFRICA
Basic observations
An effective drug demand strategy would have to take into consideration three key observations:
Based on very limited available information, it seems that the drug abuse situation in most of Africa is of limited concern. However, the potential for rising drug abuse and related problems is noted.
African countries are acutely aware of overriding priorities. Many hold the view that without extending the reach of health care and education services, the effectiveness of drug related programmes would remain limited.
To reach the majority of the population, most still in traditional setting, innovative community based approaches may be needed.
Principles for a demand reduction strategy
1. UNDCP intervention in the area of demand reduction would be more effective if done in collaboration with existing bodies involved in health, education and social services (I.e., WHO, UNESCO, ILO, relief and religious organization, NGO’s, etc...). UNDCP would extend its reach at a fraction of the cost by developing drug demand reduction components within existing UN wide programmes.
2. Aware that drug demand reduction programmes are likely to remain of secondary importance within collaborating agencies programmes, UNDCP has to engage in developing focal points which specialize in drug related services. To ensure that drug resources are not diverted to other activities, the country based focal point should be an NGO specialized in drug issues.
Implementation guidelines
Working with collaboration agencies
1.1. Identify key potential collaboration agencies such as WHO, UNESCO, ILO and key NGO’s.
1.2. Write to the identified agencies to propose collaboration on drug issues.
1.3. Collaborate with agencies who respond positively on the development of a drug component within their own programmes: for example, training nurses and doctors on drug issues in primary health care services in collaboration with WHO, developing drug related curriculum in collaboration with UNESCO etc...
1.4 Establish programme priorities by targeting selected countries and selected collaboration agencies. For example, UNDCP may choose to target Cote D’Ivoire, Gabon, Kenya, Nigeria, Senegal, Morocco and Egypt only and collaborate with three agencies only: WHO, UNESCO and ILO.
Developing a national focal point on drugs
2.1 Establish priority among the selected targeted countries for purpose of developing national focal point on drugs. Consider countries where UNDCP has already a field office (i.e., 1. Nigeria, 2. Kenya).
2.2 Field office to consult with collaborating agencies above, with leading professionals in related fields in universities (social sciences departments) and with
governments in order to identify an NGO which could become a focal point on drugs. Set up a new NGO if necessary.
2.3 Affiliation of national focal point with a social science department in a university, to draw on university resources when needed an to encourage the development of interest in drugs among professors and students.
2.4 Establish a network of agencies with interest in drugs as collaborators of the national focal point.
2.5 National focal point to set up a reference collection made of data and related research on drugs. Each collaborating agency would commit to send its information to the national focal point. The national focal point would commit to prepare a summary of information received and report it to its network members.
2.6 National focal point to conduct an annual consultation on the following:
2.6.a. Report from the network members on the drug situation and programme implications from an agency perspective.
2.6.b. prepare a summary report on the drug abuse situation and programme implication from a national perspective.
2.7 National focal point to act as a clearing house for information sharing and distribution.
2.8 National focal point to act as a facilitator for exchange of experiences for purpose of mutual training among network members.
2.8 National focal point to organize national training in targeted areas.
2.9 National focal point to seek funding for national programmes as identified in annual consultation by network members.
Sources
1995 briefing from me to management