A rapid assessment of trends in injecting drug use and risk of HIV transmission which was recently concluded in parts of Namibia has shown an increase in drug use.
Findings of the survey, which were disseminated during a meeting of stakeholders in Windhoek last week show, also, that some drug users were gravitating towards more potent drugs as they sought a "harder kick."
The United Nations Office on Drugs and Crime (UNODC) supported the assessment which was done in Windhoek, Walvis Bay, Keetmanshop and Oshikango in collaboration with the Ministry of Health and Social Services (MOHSS).
The assessment was meant to inform the drafting of the National Drug Control Master Plan (2019/20-2023/24).
Johan Strijdom, who led the assessment, said the findings had "surprised" him.
"I was really surprised. It was sad to see how some people were suffering because of drug use and how so many people are vulnerable," he said.
The first similar study was conducted in 1992. It covered the whole country and informed the first Namibian Drug Master Plan. A second study was done in 1999.
Strijdom said when findings of the earlier two studies are juxtaposed with findings of the most recent assessment, it becomes clear that the situation has worsened and that some people are experimenting with drugs earlier in their lives. He said this was due in part to the availability of crack cocaine in Namibia from some neighboring countries transported through "the high seas".
"Drug use has increased in the sites surveyed. We also witnessed a huge increase in numbers of drug dealers. Illicit drugs most widely used and cheaply available are cannabis, mandrax and crack cocaine," he said.
He said in the past there were a lot of university students doing drug use prevention related work in schools throughout the country.
"What we found then is that those prevention messages did not really stop people from experimenting with drugs, but experimentation was delayed by two or three years. Evidence shows that the later substance or drug use begins, the greater the chances of stopping it from becoming a substance use disorder," he said.
The recent assessment ascertained higher-income users tend to use cocaine hydrochloride, methamphetamines, including crystal methamphetamine, LSD and magic mushrooms, while sex workers used any drugs offered by their clients.
Strijdom said drug use was a serious risk factor for HIV infection as the "high" experience impaired cognitive judgment with respect to condom use.
"For sex workers, drug use inhibits condom use especially if they are offered more money for sex without a condom. Risky health practice of sharing the okapipe (hubbly bubbly) mouth piece, bottle top as well as the heated TV antenna pipe, increases the risk of transmission of tuberculosis (TB) and other infections," he said.
The assessment attributes the increase in drug trafficking and use to several socio-economic and demographic factors. It says poverty, insecure accommodation, being single, not living in a family and being in police custody or in correctional facilities predisposes some people to drug use.
"The socio-economic demographics indicate serious marginalisation or social exclusion of drug users regarding opportunities for education, training and employment to improve their lives and the lives of their children."
The assessment found that for most men, drug use commenced mainly as a result of peer pressure and for most women due to emotional issues and stress at home.
"Most people who used drugs also had a brother, uncle or male cousin in their family who were drug users and most of the participants' friends used drugs as well," Strijdom said.
The assessment recommends a revision of the current Abuse of Dependence-Producing Substances and Rehabilitation Centers Act, 41 of 1971; finalisation of the revision of the National Drug Control Master Plan to include harm reduction services; reestablishment of the National Drug Control Commission (NDCC); promotion of a public health orientated approach to drugs in the NDCC. An expansion of outpatient treatment programmes for substance use disorders to all 14 regions of Namibia is also recommended.
Additionally, it calls for strengthening of mental health care services around the country and reorganising of drug prevention and treatment services to support high impact programmes and priorities of the National Strategic Framework for HIV and AIDS Response.
To facilitate planning with rather than for people who use or inject drugs, the assessment advocates for formation of networks to allow for discussion on needs for health and social services.
Strengthening of the Namibian chapter of the Pan African Epidemiology Network on Drug Use; defining injecting drug use as a separate indicator; stocking naloxone at emergency wards to treat heroin overdose; and improving monitoring of and response to drug overdose are also recommended.
Other suggested interventions include going beyond providing information and education to establishing Needle and Syringe Programmes (NSP), making Opioid Substitution Therapy (OST) available, and extending outreach services to people who use drugs (PWUD) and people who inject drugs (PWID).
The dissemination meeting enabled delegates to validate findings of the assessment and discuss activities to be included in the new National Drug Control Master Plan.
The Deputy Executive Director in the MOHSS, Petronella Masabane, said the previous National Drug Control Master Plan (2003/4-2007/8) was due for revision because of rising illicit drug trafficking and use in Namibia, and to align the country's drug control efforts with international, continental and regional drug policy directions.
In remarks made on her behalf by Helen Mouton also from MOHSS, Masabane expressed concern over misuse of medicines. She said there was evidence that drug users "may be ready to switch to other more potent substances, such as heroin or synthetic opioids, due to the diluted crack cocaine and Mandrax".
Masabane called for a public health-orientated approach to drug control.
"The point of departure should be to assist people who use drugs to develop health-seeking behaviors, including treatment, and this should be the mindset for integration of efforts between the law enforcement, public health and criminal justice sectors," she said.
Signe Rotberga, UNODC Regional Coordinator for Southern Africa, commended Namibia for developing the National Drug Control Master Plan, which she said was an important first step in a longer process. She also welcomed the rapid assessment, whose findings and recommendations had been incorporated.
"Data is needed to formulate responses. The research team managed to reach people who use drugs to gather information about their challenges and suggestions on the support needed for them to change the situation," Rotberga said.
She welcomed the active involvement of stakeholders beyond the MOHSS, especially representatives of the Office of the Ombudsman, given the need to make the National Drug Control Master Plan human rights-based.
She called for evidence-based responses that uphold human rights rather than excessive use of power, punitive approaches or coercive treatment and incarceration.
The assessment was conducted over four months and reached approximately 80 respondents through key informant interviews with stakeholders and service providers in drug control, prevention and treatment and HIV and AIDS response. Civil Society Organizations were also reached while data collection methods included in-depth interviews with PWUD and PWID as well as focus group discussions.
Delegates welcomed the assessment, which they said had generated a fresh perspective. The need to invest in prevention, treatment and harm reduction services was stressed.
*Moses Magadza is the Communications Officer at UNODC Regional Office for Southern Africa.