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Type of submission: Oral
Conference track: Policy
Topics: Drug Policy Reform and Advocacy; Punitive Laws and Law Enforcement
Presenting author: Dr Paul Ochieng'
Dr Paul Ochieng', Dr George Osanjo, Dr Javan Njau
Issue: Harm reduction approach in management of drug use has provided a paradigm shift in the fight against illicit drug use in developing countries. Previously, zero tolerance and incarceration of people who use drugs (PWUDs) were the main approaches employed. Opioids such as methadone used in MAT are the subject of the Narcotic Drugs and Psychotropic Substances (Control) Act 1994 (Cap 254). Their access, possession and use are strictly controlled, hindering their availability and subsequent use for medical purposes.
Setting: HIV prevalence for PWUDs in Nairobi and Mombasa was confirmed as 18% (higher than 6.3% for the general Kenyan population (KDHS 2008/09)). Females’ HIV prevalence was 44.5% compared to males’ 16.0%. MAT programs are functional in Nairobi, Mombasa and Malindi, but staff constraint is significant due to shortage of Medical practitioners and Pharmacists in the country.
Key Arguments: MAT is one of the critical and interrelated components of an effective response to drug and HIV epidemics. Current laws (Cap 254) and Pharmacy and Poisons Act (Cap 244) authorize medical practitioners, pharmacists and dental surgeons only to handle opioids. Likelihood of diversion of methadone for financial reasons by health professionals is minimal due to its low demand and market value given the ready availability and affordability of heroin. Imposing rigorous laws for handling opioids by health workers is unsubstantiated and impedes on the principle of balance between control and accessibility for medical reasons.
Outcomes and Implications: Developing countries like Kenya lack financial capacity to employ sufficient medical personnel and Pharmacists. Other cadres run most health facilities and hence blanket restrictions on opioid use hinder the achievement of goals of MAT. Existing laws require a repeal to widen the range of available health professionals authorized to prescribe or dispense methadone within a MAT clinic to allow for smooth scale-up of MAT services.