Making drug use safer for those who are hooked

The lakeside town of Kisumu is perhaps best known for its vibrant night life, laid-back people and hot weather.

But against this backdrop lies an issue that is talked about in hushed tones, or not talked about at all. In fact,  it might come as a surprise to some that in this town there are about 1,000 people who abuse drugs. Young men and women — and a few older ones — whose bodies have been pricked countless times with needles in a desperate bid to get their daily fix of heroin, their dose of the “H” stuff or,  kujitibu (to treat oneself), as they call it.

With each dawn some battle their shaky hands to find a matchbox to light and puff their morning dose of heroin, a master that has enslaved some for more than 15 years.

Take Mr Abdi Ismail*, for instance. He has been using heroin for about 20 years. His salt-and-pepper hair indicate he’s no longer young, and his hands and drowsy look are testimony tothe addiction that started 360 kilometres away, in Nairobi.

The former hockey player — his drug habit forced him out of the game — says he was introduced to drugs by a relative. 

“I was introduced to drugs by my brother-in-law and even became a peddler while living on Chai Road in Pangani in Nairobi.”

He desperately tried to stop and in one of his three attempts to quit,  relocated to Kisumu in 2000, got married, and started a family.

“I discovered that a few people were supplying it [heroin]here but it was not enough, so I asked acquaintances in Nairobi to send some to me wrapped up like parcels. I continued smoking, then got into injecting and relapsed,” he says pensively. 

SHARING SYRINGES

He would share a syringe, which costs between Sh10 and Sh20 on the black market, with a friend to inject heroin.

“I did not know or care about the risk of contracting HIV, for instance,” he told DN2.

Mr Ismail revealed with a hint of regret that his wife had learnt about his addiction.

“She was bound to know. She runs a small business and when I wake up in pain, I cry and beg her to give me some money for my dose. She is tired,” he says, adding, “Whenever I make any money as a part-time driver, I rush to the dens to get drugs. I spend a minimum of Sh800 daily. I have tried to stop but always end up going back.”

Sometimes he is given adulterated heroin, which has serious side effects, as had happened when DN2 visited him.

“I’m not sure why my hand is swollen today. I think I am allergic to something they added to the drug; they add piriton, sometimes chalk, glucose, aspirin and many other things,” he says, then reveals that he has lost three friends to adulterated drugs.

But that risk is the least of his worries; his greatest worry is his children finding out.

“They don’t know that I am using drugs. What if they get to know, or end up using drugs like me?” he stutters. “I want out before they are old enough to know what their father does. It would break me if they got into drugs. I need help.”

HARD HABIT TO BREAK

For many drug users, the withdrawal symptoms kick in 12 hours after the last dose, and include nausea, stomach pain, shivering, cold sweats, vomiting and diarrhoea, among others. An addict in the throes of such effects will do anything to get the drug back into their system. They will beg, steal, or lie their way into getting money for the heroin and, if desperate, will even get blood from a fellow addict who has just received a shot.

Perhaps that is why HIV prevalence among injectable drug users (IDUs) is 18.3 per cent, nearly three times that of the general population.

But that is changing. Drug users in Kisumu who inject themselves receive 14 to 21 new syringes and other injecting paraphernalia (needle, alcohol swab, tourniquet, cotton wool and sterile water for dissolving the heroin) each per week from Impact Research and Development Organisation (IRDO). On average, IRDO distributes about 5,000 syringes every month in exchange for used ones.

The idea is to reduce the harm caused by drugs without necessarily stopping drug use. This is under a harm-reduction programme that seeks to prevent HIV and Hepatitis B and C infections in Kisumu East in Kisumu County, and Rongo, Awendo and Uriri sub counties in Migori County.

IRDO also carries out the needle and syringe exchange programmes in Nairobi, Central Kenya, and the Coast (Kwale, Kilifi, Mombasa, Lamu).

However, even though it is a well-intentioned concept, not everyone sees it that way; some people feel that giving people who inject drugs syringes is tantamount to supporting the habit indirectly.

There is a similar cry for help nearly 160 kilometres away in Awendo, Migori County, by a group of about 30 injecting drug users. Most of them say they started using heroin and bhang while living in Mombasa County, some 840 kilometres away.

Christopher Maero* has been using heroin since 2000, shortly after he completed high school.

“I started using drugs while living in Ukunda, Mombasa, with my sister and her husband. My sister died in 2003 but I continued living with my brother-in- law, who gave me a lot of money, which I gradually started using to  buy drugs.”

He wanted to be a soldier but is now addicted to heroin, for which he needs Sh1,000 daily,  yet he is jobless.

“The experience has not been rosy. I would rather fall sick than experience withdrawal symptoms. You can’t eat, you drink only water and I guess the fear of arosto these withdrawal symptoms, makes us go back. It is painful. We are sick and need help,” he says.

He says it is a struggle that is complicated by the fact that the local community sees drug users as criminals rather than  sick people. This is because heroin is banned, and also because, to get their fix, they sometimes resort to crime.

'BUSTED!'

Mr Maero panics whenever he sees police officers.

“I think to myself, ‘Leo wamenipata (Today, I’ve been busted)’”.

Besides, the police always ask him, “But if I find you with a gun (the syringe), where do you get your bullets (drugs) from?”

Drug users are caught up in the middle of a policy gap: if they are found with needles and syringes. they are arrested because the narcotic laws stipulate that anyone found with drugs or related paraphernalia should be  arrested. In fact, sometimes even community health workers are arrested if found distributing needles and syringes to drug users.

 “I have tried to quit. It is taboo to say I inject myself with drugs. People would rather I were a drunkard sleeping in trenches rather than having this Western kind  of behaviour,” Maero adds.

IRDO Director Dr Kawango Agot concurs, adding  that not many people understand that their children inject the drugs rather than smoke them, as commonly assumed. 

The organisation distributes clean needles and syringes to prevent needle sharing, offers health services and organises the drug users into support groups.

 “As part of our programme, we are bringing in their family members because the more you reject them, the deeper they get into drugs. We understand it is not easy and are creating an avenue to discuss the issue,” Dr Agot asserts.

Mr Maero pities those who want to experiment with drugs.  “Don’t do it; it will not end well. It will leave you broke, in pain, isolated and the legal implications are dire. I have wasted more than 18 years in drugs but all is not lost,” he says.

James Khalimwa, 25, had dreams of being a police officer, but has used heroin and bhang for eight years, while living in Mombasa, Tanzania, Nairobi and before returning to Awendo, where he hopes he will stop.

 “I have used the huge syringes used to inject cows to get my heroin fix. A syringe that was shared with my 20 other friends in Kongowea Market, Mombasa.”

He dropped out of school twice and even escaped from the Asumbi Rehabilitation and Treatment Centre in Homa Bay County. 

 “I was so desperate for heroin that I would send ask conductors from Mombasa to bring me some. I would pay between Sh300 and 500 for a consignment,” he reveals.

He says heroin has made their lives move in “slow motion”, and they cannot eat because their stomachs cannot hold anything.

Mr Khalimwa and most of the heroin users see their road to recovery as beginning when they are signed up for the medically assisted therapy involving the use of syrup called methadone. It helps suppress withdrawal symptoms and helps limit risky behaviour such as sharing contaminated needles,thereby reducing the chances of  HIV infections.

“We all want methadone, we want our lives back,” he says.                                                

* The names have been changed to protect the individuals’ privacy.

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THE KISUMU DRUG MARKET

A hidden, erratic operation mainly between friends and colleagues

A single dose measured using a fingernail, which is about the length of a matchstick, costs Sh200.

Unlike Mombasa and Nairobi, the drug market in Kisumu is “comparatively hidden, erratic, and expensive”, according to a study published in the International Drug Policy on the drug market in Kisumu. It is disorganised and between friends and associates, and the price is dependent on availability.

According to one of the study’s authors, Jennifer Syvertsen, the “Focus on urban and mostly coastal locations, even in countries such as the US, has often ignored injection use in smaller and rural communities such as Kisumu.”

“This addiction cuts across socio-economic circles. It is not just a concern of the poor but even the rich, whose addiction might not be necessarily made public,” she added.

NEEDLE EXCHANGE PROGRAMME VIS-À-VIS ART TREATMENT.

The director of the Kenya Aids NGOs’ Consortium (Kanco), Mr Allan Ragi, says preventing HIV is more cost-effective than treating it.

“The average cost for ARVs is about $248 (Sh24,800) annually. While the cost of issuing needles and syringes to an injecting drug user for a year is $100 (Sh10,000) that will prevent HIV and Hepatitis C infections,” he told DN2.

Nyanza has the highest HIV prevalence rateof  15.1 per cent. Drug users are known to be at high risk of sexual behaviour that puts them at risk of getting  infections such HIV.  “By supporting these people to wean themselves off heroin, we will reduce the demand for the drug and the benefits of this are numerous. The police arrest drugs users who are considered criminals while in essence the criminals are the drug lords and suppliers,” he added.

MEDICALLY ASSISTED THERAPY (MAT)

Currently nearly 1,000 heroin addicts at the Coast General Hospital, Kisauni Health Centre, Malindi Hospital and Mathari Hospital in Nairobi, are benefiting from the MAT programme that involves a syrup called methadone, which began in 2014. The treatment is free and Kisumu is lined up to be the next location for MAT. The programme is voluntary, but those under treatment must take the syryp for at least two years for their brains to begin functioning normally. The total number of people enrolled for MAT are Mombasa (169), Mathare (571) and Malindi (257).

INJECTING DRUG USERS

According to the Kenya national Aids and STI Control Programme (Nascop) data, there are about 18,000 to 30,000 injecting drug users countrywide. About 92 per cent are addicted to heroin, while 8 per cent are addicted to other drugs such as cocaine, and prescription medication. Women make up 8 per cent of all the injecting drug users.

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HOW THE DRUG HABIT BEGINS

Most injecting drug users start off by sniffing or smoking heroin but with time, they cannot get the same “kick” or “high”, so they resort to injecting themselves.

The preferred site for injections is the arm, but due to repeated pricking, their veins collapse and they resort to injecting themselves on the thigh, neck and other parts of the body.