Adopt public health approach in drug abuse fight

Uganda is losing the fight against drug use.  We have turned drug use and injection which should have been a public health issue into a matter for the criminal justice system. This in-turn has forced drug users underground, and made efforts to rehabilitate users and protect them against HIV/Aids a struggle for both guardians and the rest of us involved in the fight against drug use, and trafficking.

A recent survey we did as the Uganda Harm Reduction Network around Makerere University, uncovered many shocking statistics, however what stood out for us and showcased the dangers that come with forcing drug users underground, was a group of seven university students we found, who shared one syringe for the purposes of injecting themselves with narcotic drugs.

The most recent Uganda Population Based HIV impact assessment survey released in 2019 shows that the level of HIV prevalence among people who use drugs is at a disturbing 17 per cent, this is almost three times the national HIV prevalence rate which stands at six per cent. 

Forced underground, drug users as seen in the example of the university students, are sharing syringes, putting themselves in danger, while the laws of the land like the Narcotics Drugs and Psychotropic Substances Act of 2015 criminalise them and makes it hard for them to seek help. The law goes further and also threatens to penalise those who harbour drug users.

 As the rest of the world uses this week to create awareness about the Drug Abuse and Illicit Trafficking in effort to combat the effects of drug use, injection and trafficking on health and society,  I want to use this week to remind Ugandans who have relatives who are drug users, and those struggling to quit,  that it is not your fault, and help is on the way, and could be able to reach everyone in time if government stepped up its involvement.

We are piloting a couple of ideas mainly directed at harm reduction, this approach attacks the problem that is drug use through the prism of a public health epidemic, the focus would be on positive change, offering help to drug users without judgement, coercion, discrimination, or requiring that they stop using drugs as a precondition of support.

From 2017 to 2019, we did a survey on investment in harm reduction programmes in the country, and out of over Shs1.3 billion invested in 2019, the government made a limited contribution. However, the  Narcotics Drugs and Psychotropic Substances Act of 2015 mandates government to create rehabilitation centres using a fund funded through Parliament appropriations and proceeds from the forfeiture of assets owned by convicted drug traffickers.

As it stands now, access to rehabilitation for drug users seeking help must go through the criminal justice system,  and help is at the discretion of the magistrate or judge.

As the fight against drug use, and trafficking intersects with the fight against the HIV/Aids pandemic, we must not let the harm reduction programmes piloted by the donor funded civil society players go to waste. Government should as a matter of urgency, amend the Narcotic Drugs and Psychotropic Substances Act, to decriminalise individual drug use, and get underground users out of hiding. Decriminalising individual drug use will also keep vulnerable youth out of the prison system .

We must also invest in job creation programmes that target at-risk groups that may end up being used as drug mules and errand boys by drug traffickers, this will put them out of their reach: there is also hope that government will keep the promise it makes in the Narcotic Drugs and Psychotropic Substances Act, and actually invest in rehabilitation centres around the country.

Fixing the approach to the drug use fight will humanise what is clearly a public health problem, reduce expenditure on costly enforcement operations targeting drug users and save families a lot of pain and anguish.

Mr Twaibu Wamala is the executive director of the Uganda Harm Reduction Network.