Opiate substitution therapy in developing countries

Laws that govern addiction therapies are not always in line with best current medical practices or research evidence. Such is the case with opiate substitution drugs in Kenya, East Africa. Dr. Peter Ndege talks here about why opiate substitution drugs such as buprenorphine or methadone are restricted in his country and names nine (9) barriers to getting people the medicine they need.

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Why is opiate substitution therapy (OST) banned in Kenya?

Opiate substitution therapy (OST) is not banned in Kenya but it is highly restricted for various reasons. These reasons include:

1. Ignorance of the nature of addiction

There is plenty of ignorance among both the citizens and professionals on the disease model or nature of addiction. Many view addiction as a moral deficiency that should be dealt with by the criminal justice system. Others prefer that the church deals with it. Many also believe that opiate substitution therapy is replacing one addiction with another and therefore see no benefit. This is so because policy makers have a poor understanding of the harm reduction concept of addiction treatment particularly for injection drug users (IDUs) who are at the greatest risk of HIV and other infectious diseases.

2. Lack of political will

In the past, many politicians have opposed opiate substitution therapy because of ignorance described above. A good number have also done so due to vested interest the procurement and distribution of methadone which a tightly controlled substance in Kenya, as in the rest of the world.

3. Shortage of addiction management professionals in Kenya

Kenya has very few well trained addiction counselors, psychologists, physicians, law enforcement agents, etc.

4. High levels of poverty cut access to opiate substitution drugs

Over 50% of Kenyans live below the poverty line defined as less than $1 per day. Many drug addicts belong to this group and will therefore not afford opiate substitution therapy services unless government gives it for free, something it ‘cannot’ afford at the moment. This has certainly contributed to the governments’ unwillingness to fund OST opiate substitution therapy since sustainability will not be feasible.

5. Other addiction priority areas

Alcohol abuse, and especially the use of illicit brews, continues to be a major threat to many Kenyans in terms of the high mortality and morbidity associated with it. The government therefore finds this a more pressing addiction issue compared to offering OST to drug addicts.

6. Poor opiate addiction alternatives

Implementation of ineffective (non-evidence based) treatment and rehabilitation programs can direct money and resources away from evidence based practice of opiate substitution therapies.

7. High levels of corruption within government

Misappropriation of public funds/resources is rampant and the culprits are, in most cases, politically connected individuals. Therefore, stealing public monies often goes unpunished. Hence, there is always a shortage of funds to support addiction treatment and rehabilitation services in the country.

8. Weak legal and law enforcement infrastructure

Our law enforcement and legal system is weak and de-motivated for various reasons such as: low pay, lack of personnel (low workforce), low budget allocation to police service, lack of equipment such as vehicles, and ignorance among low enforcement officers on benefits of OST – opiate substitution therapy. These are some of the factors which contribute to the current state of OST restriction.

9. Shortage of infrastructure for implementation

Few well designed evidence-based treatment programs exist throughout the country, making distribution of opiate substitution drugs to the addicts who need them very difficult.

10. Lack of funds

There is always a shortage of funds to implement opiate substitution therapy or OST programs. Reasons for this are many and include some of the issues mentioned above: Ignorance on the part of policy makers, poor prioritization and strategy by government agencies especially those charged with the responsibility of providing OST, corruption issues and implementation of ineffective (non-evidence based) treatment and rehabilitation programs.

About the author
Dr. Ndege is a former Hubert H. Humphrey scholar doing work in Kenya, East Africa on opiate substitution therapy and harm reduction measures, particularly among intravenous drug users, prisoners, and commercial sex workers. He lectures at Kenya Methodist University in the Department of Health Systems Management.
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