28 February 2016

Tanzania: Breaking Up With Drug Addiction


"Now I think people are realising that I am a woman, not an animal," Magreth says, halfway laughing. She sits on the benches at Muhimbili Methadone Clinic with her face towards the clinic's yellow wall. Her arms are smooth and intact without syringe scars. They have changed. The veins on her arms used to be marked by sores from needles that led heroin into them. When she walked through her neighbourhood in Buguruni, Dar es Salaam, people would yell "Teja" (drug addict) after her. But when she passes by her neighbours now, they look up at her and tell her that they are there for her.

Magreth, 30, is among the 700-750 people who come to Muhimbili Methadone Clinic every day during the morning hours. She waits for her turn to go to a barred window where she receives a plastic cup with liquid methadone. The methadone replaces her need for heroin, ceases her crave and gives her more peaceful days.

Although methadone is a way to slowly decrease the need for heroin and step out of drug use, it comes with a risk of overdose if those taking it still use heroin on the side

"Before I was thinking about how I should get money to buy drugs. Sometimes I would even steal my roommate's money. But now I just wake up and come here. It changed everything," she says.

Muhimbili Methadone Clinic opened in 2011 as the first of its kind in sub-Saharan Africa, and it offers liquid methadone as a free treatment to people who inject heroin. The clinic is the result of collaboration between the United States' President's Emergency Plan for AIDS Relief (Pepfar) and the Tanzanian government.

Head of the clinic at Muhimbili National Hospital, Dr Frank Masao thinks the clinic gives the humanity back to the drug users.

"Before the clinic opened the lethal and criminal offences were high among drug users. The only thing that mattered was money, drugs, money, drugs and so on. So the humanity was lost. By bringing forth the methadone clinic we were able to break that chain," he says.

Heroin is among the most commonly used drugs in Tanzania with around 50,000 heroin injectors in the country, of whom 20,000 to 30,000 live in Dar es Salaam.

Dr Masao considers heroin the major drug issue in Tanzania, although it wasn't until the early 2000s he first saw people who injected heroin in the major Tanzanian cities. When he and his colleagues noted a rise in heroin use they decided to work towards an exit programme for heroin users.

They found that heroin was not only a problem for the heroin users themselves, but for the general society.

Sharing of needles and desperation to access drugs led to many drug users being HIV and hepatitis positive. When they did a survey in Kinondoni District in Dar es Salaam in 2010, they found that more than half of the people who injected heroin were HIV positive and among women the rate was 62 per cent. At the same time eight out of ten of the women who injected heroin had hepatitis. They asked themselves "Why were women more affected?"

"Women were also doing sex work to be able to afford drugs and all in all it was more risky," Dr Masao explains.

Magreth knows the desperation that comes with drug use and the constant search for the next state of high. She first tried drugs when her boyfriend convinced her to try it. She was 15. Soon she became addicted to heroin and they used to share the costs for the drugs, until the day he left her and their daughter behind.

She tried to scrape money together from her job as a waitress, but when the restaurant owner discovered her drug use he kicked her out. She left her daughter with her mother and went to the street to get money for drugs as a sex worker.

Sometimes she would steal money from the men she slept with, but they would come after her and molest her. Every time she tried to stop injecting heroin, she felt a pain grabbing her.

"When I was not touching drugs I would feel an extreme pain. I tried to stop so many times but I couldn't. It was so bad," she says.

When she first tried methadone, she waited for the pain to return, but it didn't. Now she comes here every day, works as a community outreach worker and helps coordinate the long line of people in the morning.

"Before when I wanted to see my child, she hid behind my mother and cried. But now when I come home, the child comes to me and calls me 'mother'," she says.

Methadone and heroin are both opioids, but because methadone is active in the body for a longer period of time, the user will not feel the urge to inject heroin.

Dr Masao explains that some refer to methadone as a "substitute" for heroin, but because people tend to think that methadone and heroin are two words for the same drug, he prefers to call the treatment "Medication-Assisted Therapy".

Although methadone is a way to slowly decrease the need for heroin and step out of drug use, it comes with a risk of overdose. Dr Masao estimates that 20 per cent of the people that come to the clinic still use heroin on the side.

If they drink methadone in the morning and inject heroin when they come home, they are at risk of an overdose. For some of the users the time of transport is an issue too, and if they can't make it to the clinic they might resume their heroin addiction at home.

Therefore, it is not the methadone alone that helps the drug user, but also the conditions that come with it; no sharing of needles, a place with medical assistance and a drug without unclean ingredients like on the black market. It prevents the drug user from roaming a dangerous world in search for money to buy heroin.

"The safety of their lives lies on methadone," Dr Masao says.

Godfrey, 39, started injecting heroin in 1998 and he doubts he would be here if he had not started using methadone in time.

"If there was never methadone, I would not be here. When you start it is for the pleasure, but with time you become an addict," he says.

Like Magreth he is a community outreach worker and furthermore an assistant programme coordinator at the organisation Methadone Family against Drug Abuse (MEFADA). In his earlier days the thought of heroin would follow him everywhere. He remembers his days in college in Dodoma.

"We were in a class examination and I went out after half an hour to take a shot," he recalls.

Sometimes he would steal money and clothes from his fellow students to be able to afford the drugs. He was not able to finish his education and in 2010 he left college. It felt like a punch in his self-esteem. He wanted to cease his addiction and he admitted himself to a psychiatric hospital in Dodoma twice and tried to isolate himself in his family home near Moshi. But neither did it help, and he found himself in Dar es Salaam once again with a heroin needle in his hand.

In 2011 he was introduced to methadone, and today he drinks two milligrams of methadone every day. By the end of March he hopes to scale down to one milligram and then eventually to "graduate" and live a life with neither methadone nor heroin.

"Now I can do my important issues. I can work and I have never stolen since I started on methadone," Godfrey says.


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