Purpose of Review
Opioid use disorder (OUD) is a global phenomenon and is on the rise in Africa, denoting a shift from historical patterns of drug transport to internal consumption. In contrast, opioids for clinical pain management in Africa remain among the least available globally. This region also has the highest HIV and HCV disease burden, and the greatest shortages of health workers and addiction treatment. We undertook a systematic review of the literature to describe opioid use in Africa and how it is being addressed.
A total of 84 articles from 2000 to 2018 were identified. Descriptions of country-specific populations and patterns of opioid misuse were common. A smaller number of articles described interventions to address OUD.
OUD occurs in sub-Saharan Africa, with attendant clinical and social costs. Evidence-based policies and health system resources are needed to promote OUD prevention and management and infectious disease transmission reduction.
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Papers of particular interest, published recently, have been highlighted as: • Of importance
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Myers B, Williams PP, Govender R, Manderscheid R, Koch JR. Substance abuse treatment engagement, completion and short-term outcomes in the Western cape province, South Africa: findings from the service quality measures initiative. Drug Alcohol Depend. 2018;185:278–84. https://doi.org/10.1016/j.drugalcdep.2017.12.033.
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Budambula V, Matoka C, Ouma J, Ahmed AA, Otieno MF, Were T. Socio-demographic and sexual practices associated with HIV infection in Kenyan injection and non-injection drug users. BMC Public Health. 2018;18(1):193. https://doi.org/10.1186/s12889-018-5100-y.
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Parry CDH, Carney T, Petersen-Williams P. Reducing substance use and risky sexual behaviour among drug users in Durban, South Africa: assessing the impact of community-level risk-reduction interventions. Sahara J. 2017;14(1):110–7. https://doi.org/10.1080/17290376.2017.1381640.
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Mmbaga EJ, Moen K, Makyao N, Leshabari M. Prevalence and predictors of human immunodeficiency virus and selected sexually transmitted infections among people who inject drugs in Dar es Salaam, Tanzania: a new focus to get to zero. Sex Transm Dis. 2017;44(2):79–84. https://doi.org/10.1097/olq.0000000000000555.
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Magidson JF, Gouse H, Burnhams W, Wu CY, Myers B, Joska JA, et al. Beyond methamphetamine: documenting the implementation of the matrix model of substance use treatment for opioid users in a south African setting. Addict Behav. 2017;66:132–7. https://doi.org/10.1016/j.addbeh.2016.11.014.
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Zamudio-Haas S, Mahenge B, Saleem H, Mbwambo J, Lambdin BH. Generating trust: programmatic strategies to reach women who inject drugs with harm reduction services in Dar es Salaam, Tanzania. Int J Drug Policy. 2016;30:43–51. https://doi.org/10.1016/j.drugpo.2016.01.012.
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Guise A, Rhodes T, Ndimbii J, Ayon S, Nnaji O. Access to HIV treatment and care for people who inject drugs in Kenya: a short report. AIDS Care. 2016;28(12):1595–9. https://doi.org/10.1080/09540121.2016.1191606.
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Rhodes T, Ndimbii J, Guise A, Cullen L, Ayon S. Navigating the poverty of heroin addiction treatment and recovery opportunity in Kenya: access work, self-care and rationed expectations. Glob Public Health. 2015;10(7):867–80. https://doi.org/10.1080/17441692.2015.1046385.
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Mwatelah RS, Lwembe RM, Osman S, Ogutu BR, Aman R, Kitawi RC, et al. Co-infection burden of hepatitis C virus and human immunodeficiency virus among injecting heroin users at the Kenyan coast. PLoS One. 2015;10(7):e0132287. https://doi.org/10.1371/journal.pone.0132287.
Messersmith LJ, Adjei R, Beard J, Agyarko-Poku T, Wondergem P, Falconer A, et al. Drug use and sexual behavior: the multiple HIV vulnerabilities of men and women who inject drugs in Kumasi, Ghana. J Acquir Immune Defic Syndr. 2015;68(Suppl 2):S124–30. https://doi.org/10.1097/qai.0000000000000445.
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Trenz RC, Scherer M, Duncan A, Harrell PT, Moleko AG, Latimer WW. Latent class analysis of polysubstance use, sexual risk behaviors, and infectious disease among South African drug users. Drug Alcohol Depend. 2013;132(3):441–8. https://doi.org/10.1016/j.drugalcdep.2013.03.004.
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Bowring AL, Luhmann N, Pont S, Debaulieu C, Derozier S, Asouab F, et al. An urgent need to scale-up injecting drug harm reduction services in Tanzania: prevalence of blood-borne viruses among drug users in Temeke District, Dar-es-Salaam, 2011. Int J Drug Policy. 2013;24(1):78–81. https://doi.org/10.1016/j.drugpo.2012.08.005.
Onifade PO, Somoye EB, Ogunwobi OO, Ogunwale A, Akinhanmi AO, Adamson TA. A descriptive survey of types, spread and characteristics of substance abuse treatment centers in Nigeria. Subst Abuse Treat Prev Policy. 2011;6:25. https://doi.org/10.1186/1747-597x-6-25.
Dos Santos MM, Trautman F, Kools JP. Rapid assessment response (RAR) study: drug use and health risk—Pretoria, South Africa. Harm Reduct J. 2011;8:14. https://doi.org/10.1186/1477-7517-8-14.
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McCurdy SA, Ross MW, Williams ML, Kilonzo GP, Leshabari MT. Flashblood: blood sharing among female injecting drug users in Tanzania. Addiction. 2010;105(6):1062–70. https://doi.org/10.1111/j.1360-0443.2010.02908.x.
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Dos Santos MML, Rataemane ST, Fourie D, Trathen B. An approach to heroin use disorder intervention within the south African context: a content analysis study. Subst Abuse Treat Prev Policy. 2010;5:13. https://doi.org/10.1186/1747-597x-5-13.
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We thank the colleagues engaged in opioid work and remediation in Africa.
This project was supported in part by award number R01MH085577 from the National Institute of Mental Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health or the National Institutes of Health.
Conflict of Interests
The authors declare that they have no competing interests.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
This article is part of the Topical Collection on Opioids
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Kurth, A.E., Cherutich, P., Conover, R. et al. The Opioid Epidemic in Africa and Its Impact. Curr Addict Rep 5, 428–453 (2018). https://doi.org/10.1007/s40429-018-0232-9
- Opioid use disorder
- Opioid agonist treatment
- People who inject drugs
- Health workforce