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The Opioid Epidemic in Africa and Its Impact

  • Opioids (D Fiellin and J Donroe, Section Editors)
  • Published:
Current Addiction Reports Aims and scope Submit manuscript

A Correction to this article was published on 13 August 2019

This article has been updated

Abstract

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.

Recent Findings

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.

Summary

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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Change history

  • 13 August 2019

    The original article unfortunately contained a mistake. Under the section ���Funding,��� the following text should have been.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Manjiani D, Paul DB, Kunnumpurath S, Kaye AD, Vadivelu N. Availability and utilization of opioids for pain management: global issues. Ochsner J. 2014;14(2):208–15.

    PubMed  PubMed Central  Google Scholar 

  2. National AIDS Control Council (NACC). HIV prevention response and modes of transmission analysis. Nairobi, Kenya. 2009. Available at http://siteresources.worldbank.org/INTHIVAIDS/Resources/375798-1103037153392/KenyaMOT22March09Final.pdf.

  3. UNODC. World Drug Report 2018: opioid crisis, prescription drug abuse expands; cocaine and opium hit record highs 2018. Available at https://www.unodc.org/unodc/en/press/releases/2018/June/world-drug-report-2018_-opioid-crisis%2D%2Dprescription-drug-abuse-expands-cocaine-and-opium-hit-record-highs.html. Accessed 20 September 20 2018.

  4. • Tiberio J, Laurent YI, Ndayongeje J, Msami A, Welty S, Ngonyani A, et al. Context and characteristics of illicit drug use in coastal and interior Tanzania. Int J Drug Policy. 2018;51:20–6. https://doi.org/10.1016/j.drugpo.2017.09.012 Most studies about drug use in Tanzania are set in Dar es Salaam or Zanzibar, this is the first study that examined injection and non-injection drug use in 12 other regions in Tanzania.

    Article  PubMed  Google Scholar 

  5. Eluwa GI, Strathdee SA, Adebayo SB, Ahonsi B, Adebajo SB. A profile on HIV prevalence and risk behaviors among injecting drug users in Nigeria: should we be alarmed? Drug Alcohol Depend. 2013;127(1–3):65–71. https://doi.org/10.1016/j.drugalcdep.2012.06.013.

    Article  PubMed  Google Scholar 

  6. Charlson FJ, Diminic S, Lund C, Degenhardt L, Whiteford HA. Mental and substance use disorders in sub-Saharan Africa: predictions of epidemiological changes and mental health workforce requirements for the next 40 years. PLoS One. 2014;9(10):e110208. https://doi.org/10.1371/journal.pone.0110208.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. WHO Statistical Information System (WHOSIS). Global Health Observatory data. Country Statistics for Tanzania and the United Kingdom. 2014. Available at http://www.who.int/gho/countries/en/.

  8. Sonderup MW, Afihene M, Ally R, Apica B, Awuku Y, Cunha L, et al. Hepatitis C in sub-Saharan Africa: the current status and recommendations for achieving elimination by 2030. Lancet Gastroenterol Hepatol. 2017;2(12):910–9. https://doi.org/10.1016/S2468-1253(17)30249-2.

    Article  PubMed  Google Scholar 

  9. Zumla A, Petersen E, Nyirenda T, Chakaya J. Tackling the tuberculosis epidemic in sub-Saharan Africa—unique opportunities arising from the second European developing countries clinical trials partnership (EDCTP) programme 2015-2024. Int J Infect Dis. 2015;32:46–9. https://doi.org/10.1016/j.ijid.2014.12.039.

    Article  PubMed  Google Scholar 

  10. World Health Organization. Hepatitis C key facts, July 18, 2018. 2018. Available from: http://www.who.int/mediacentre/factsheets/fs164/en/. Accessed 14 August 2018.

  11. Polaris Observatory HCV Collaborators. Global prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study. Lancet Gastroenterol Hepatol. 2017;2(3):161–76. https://doi.org/10.1016/S2468-1253(16)30181-9.

    Article  Google Scholar 

  12. UNAIDS (2018). 90-90-90: an ambitious treatment target to help end the AIDS epidemic. Available at http://www.unaids.org/en/resources/909090. Accessed 20 September 2018.

  13. Stengel CM, Mane F, Guise A, Pouye M, Sigrist M, Rhodes T. “They accept me, because I was one of them”: formative qualitative research supporting the feasibility of peer-led outreach for people who use drugs in Dakar, Senegal. Harm Reduct J. 2018;15(1):9. https://doi.org/10.1186/s12954-018-0214-1.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Rhodes T. The becoming of methadone in Kenya: how an intervention's implementation constitutes recovery potential. Soc Sci Med. 2018;201:71–9. https://doi.org/10.1016/j.socscimed.2018.02.007.

    Article  PubMed  PubMed Central  Google Scholar 

  15. • Oyaro M, Wylie J, Chen CY, Ondondo RO, Kramvis A. Human immunodeficiency virus infection predictors and genetic diversity of hepatitis B virus and hepatitis C virus co-infections among drug users in three major Kenyan cities. South Afr J HIV Med. 2018;19(1):737. https://doi.org/10.4102/sajhivmed.v19i1.737 This paper provides prevalence of co-infection of HIV, HCV and hepatitis B virus (HBV) among people who use drugs in Nairobi, Mombasa, and Kisumu and is only one of few studies to describe the genetic diversity of HBV and HCV in this population in Kenya.

    Article  PubMed  PubMed Central  Google Scholar 

  16. 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.

    Article  PubMed  Google Scholar 

  17. • Mburu G, Ayon S, Tsai AC, Ndimbii J, Wang B, Strathdee S, et al. “Who has ever loved a drug addict? It’s a lie. They think a ‘teja’ is as bad person”: multiple stigmas faced by women who inject drugs in coastal Kenya. Harm Reduct J. 2018;15(1):29. https://doi.org/10.1186/s12954-018-0235-9 This paper provides a good overview of the challenges that females who inject drugs face including gender and power inequalities, discrimination, and being a person who uses drugs and is HIV positive.

    Article  PubMed  PubMed Central  Google Scholar 

  18. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Bazzi AR, Yotebieng KA, Agot K, Rota G, Syvertsen JL. Perspectives on biomedical HIV prevention options among women who inject drugs in Kenya. AIDS Care. 2018;30(3):343–6. https://doi.org/10.1080/09540121.2017.1363369.

    Article  PubMed  Google Scholar 

  20. • Ayon S, Ndimbii J, Jeneby F, Abdulrahman T, Mlewa O, Wang B, et al. Barriers and facilitators of access to HIV, harm reduction and sexual and reproductive health services by women who inject drugs: role of community-based outreach and drop-in centers. AIDS Care. 2018;30(4):480–7. https://doi.org/10.1080/09540121.2017.1394965 This paper highlights the importance of integrating sexual and reproductive health services into community-based outreach and drop-in centers to address the unique needs of women who inject drugs.

    Article  PubMed  Google Scholar 

  21. Van Hout MC, Rich E, Dada S, Bergin M. “Codeine is my helper”: misuse of and dependence on codeine-containing medicines in South Africa. Qual Health Res. 2017;27(3):341–50. https://doi.org/10.1177/1049732315613764.

    Article  PubMed  Google Scholar 

  22. Semugoma NP, Rebe K, Sonderup MW, Kamkeumah M, De Swardt G, Struthers H, et al. Hepatitis C: a south African literature review and results from a burden of disease study among a cohort of drug-using men who have sex with men in Cape Town, South Africa. S Afr Med J. 2017;107(12):1116–20. https://doi.org/10.7196/SAMJ.2017.v107i12.12623.

    Article  CAS  PubMed  Google Scholar 

  23. Parry CDH, Rich E, Van Hout MC, Deluca P. Codeine misuse and dependence in South Africa: perspectives of addiction treatment providers. S Afr Med J. 2017;107(5):451–6. https://doi.org/10.7196/SAMJ.2017.v107i5.12242.

    Article  PubMed  Google Scholar 

  24. 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. • Mpanza DM, Govender P. Rural realities in service provision for substance abuse: a qualitative study in uMkhanyakude district, KwaZulu-Natal, South Africa. South African Family Practice. 2017;59(3):110–5. https://doi.org/10.1080/20786190.2016.1272232 Few studies focus on the mental health service delivery in rural communities. This study examines the challenges experienced by health providers in service delivery to people who use substances in a rural setting.

    Article  Google Scholar 

  26. 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.

    Article  PubMed  Google Scholar 

  27. • Michie G, Hoosain S, Macharia M, Weich L. Report on the first government-funded opioid substitution programme for heroin users in the Western Cape Province, South Africa. S Afr Med J. 2017;107(6):539–42. https://doi.org/10.7196/SAMJ.2017.v107i6.12140 This study reports findings from the first publicly funded opioid agonist treatment programs in South Africa. Study findings suggest that opioid agonist treatment for OUD should be scaled up, with longer treatment durations recommended.

    Article  CAS  PubMed  Google Scholar 

  28. 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.

    Article  PubMed  Google Scholar 

  29. • Lambdin BH, Lorvick J, Mbwambo JK, Rwegasha J, Hassan S, Lum P, et al. Prevalence and predictors of HCV among a cohort of opioid treatment patients in Dar es Salaam, Tanzania. Int J Drug Policy. 2017;45:64–9. https://doi.org/10.1016/j.drugpo.2017.05.043 This is the first study to assesses the prevalence and predictors of HCV in East Africa among PWID enrolled into opioid treatment programs (OTP). It also demonstrates that the rate of HCV was higher than expected and highlights the need to address HCV in this population.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Khatib A, Matiko E, Khalid F, Welty S, Ali A, Othman A, et al. HIV and hepatitis B and C co-infection among people who inject drugs in Zanzibar. BMC Public Health. 2017;17(1):917. https://doi.org/10.1186/s12889-017-4933-0.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Cooke A, Saleem H, Mushi D, Mbwambo J, Hassan S, Lambdin BH. Convenience without disclosure: a formative research study of a proposed integrated methadone and antiretroviral therapy service delivery model in Dar es Salaam, Tanzania. Addict Sci Clin Pract. 2017;12(1):23. https://doi.org/10.1186/s13722-017-0089-6.

    Article  PubMed  PubMed Central  Google Scholar 

  32. • Balaji D, Mlunde LB, Tran OC, Lambdin B, Mbwambo J, Nyandindi C, et al. First report of gender based violence as a deterrent to methadone access among females who use heroin in Dar es Salaam, Tanzania. AIDS Behav. 2017;21(7):2093–100. https://doi.org/10.1007/s10461-016-1529-0 This is the first study to report gender-based violence and discrimination by health care providers as barriers to accessing HIV risk reduction services for females.

    Article  PubMed  Google Scholar 

  33. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Ubuguyu O, Tran OC, Bruce RD, Masao F, Nyandindi C, Sabuni N, et al. Improvements in health-related quality of life among methadone maintenance clients in Dar es Salaam, Tanzania. Int J Drug Policy. 2016;30:74–81. https://doi.org/10.1016/j.drugpo.2016.03.005.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Syvertsen JL, Ohaga S, Agot K, Dimova M, Guise A, Rhodes T, et al. An ethnographic exploration of drug markets in Kisumu, Kenya. Int J Drug Policy. 2016;30:82–90. https://doi.org/10.1016/j.drugpo.2016.01.001.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Scheibe A, Makapela D, Brown B, dos Santos M, Hariga F, Virk H, et al. HIV prevalence and risk among people who inject drugs in five south African cities. Int J Drug Policy. 2016;30:107–15. https://doi.org/10.1016/j.drugpo.2016.01.004.

    Article  PubMed  Google Scholar 

  37. Mokwena K. “Consider our plight”: a cry for help from nyaope users. Health SA Gesondheid. 2016;21(1):137–42. https://doi.org/10.1016/j.hsag.2015.09.001.

    Article  Google Scholar 

  38. Mlunde LB, Sunguya BF, Mbwambo JK, Ubuguyu OS, Shibanuma A, Yasuoka J, et al. Correlates of health care seeking behaviour among people who inject drugs in Dar es Salaam, Tanzania. Int J Drug Policy. 2016;30:66–73. https://doi.org/10.1016/j.drugpo.2015.12.012.

    Article  PubMed  Google Scholar 

  39. Mlunde LB, Sunguya BF, Mbwambo JK, Ubuguyu OS, Shibanuma A, Yasuoka J, et al. A mismatch between high-risk behaviors and screening of infectious diseases among people who inject drugs in Dar es Salaam, Tanzania. PLoS One. 2016;11(2):e0148598. https://doi.org/10.1371/journal.pone.0148598.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. • Mital S, Miles G, McLellan-Lemal E, Muthui M, Needle R. Heroin shortage in Coastal Kenya: a rapid assessment and qualitative analysis of heroin users’ experiences. Int J Drug Policy. 2016;30:91–8. https://doi.org/10.1016/j.drugpo.2015.08.010 This study qualitatively examines the impact of the shortage of heroin on people who use heroin and adds another dimension of opioid use.

    Article  PubMed  Google Scholar 

  41. 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.

    Article  PubMed  Google Scholar 

  42. Gouse H, Magidson JF, Burnhams W, Remmert JE, Myers B, Joska JA, et al. Implementation of cognitive-behavioral substance abuse treatment in sub-Saharan Africa: treatment engagement and abstinence at treatment exit. PLoS One. 2016;11(1):e0147900. https://doi.org/10.1371/journal.pone.0147900.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Derbel I, Ghorbel A, Akrout FM, Zahaf A. Opiate withdrawal syndrome in buprenorphine abusers admitted to a rehabilitation center in Tunisia. Afr Health Sci. 2016;16(4):1067–77. https://doi.org/10.4314/ahs.v16i4.24.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Bouscaillou J, Evanno J, Proute M, Inwoley A, Kabran M, N’Guessan T, et al. Prevalence and risk factors associated with HIV and tuberculosis in people who use drugs in Abidjan, Ivory Coast. Int J Drug Policy. 2016;30:116–23. https://doi.org/10.1016/j.drugpo.2016.02.010.

    Article  PubMed  Google Scholar 

  45. Bassiony MM, Youssif UM, Hussein RA, Saeed M. Psychiatric comorbidity among Egyptian patients with opioid use disorders attributed to tramadol. J Addict Med. 2016;10(4):262–8. https://doi.org/10.1097/adm.0000000000000231.

    Article  CAS  PubMed  Google Scholar 

  46. • Tun W, Sheehy M, Broz D, Okal J, Muraguri N, Raymond HF, et al. HIV and STI prevalence and injection behaviors among people who inject drugs in Nairobi: results from a 2011 bio-behavioral study using respondent-driven sampling. AIDS Behav. 2015;19(Suppl 1):S24–35. https://doi.org/10.1007/s10461-014-0936-3 This is the first study to provide population-based estimates of characteristics of PWID and HIV and sexually transmitted infection prevalence in this population in Nairobi, Kenya.

    Article  PubMed  Google Scholar 

  47. • Tran OC, Bruce RD, Masao F, Ubuguyu O, Sabuni N, Mbwambo J, et al. Linkage to care among methadone clients living with HIV in Dar es Salaam, Tanzania. J Acquir Immune Defic Syndr. 2015;69(2):e43-e8 This study provides a descriptive overview of the first methadone treatment clinic in Tanzania, launched to address the developing HIV epidemic among PWID.

    Article  Google Scholar 

  48. Tan AX, Kapiga S, Khoshnood K, Bruce RD. Epidemiology of drug use and HIV-related risk behaviors among people who inject drugs in Mwanza, Tanzania. PLoS One. 2015;10(12):e0145578. https://doi.org/10.1371/journal.pone.0145578.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. • Syvertsen JL, Agot K, Ohaga S, Strathdee SA, Camlin CS, Omanga E, et al. Evidence of injection drug use in Kisumu, Kenya: implications for HIV prevention. Drug Alcohol Depend. 2015;151:262–6. https://doi.org/10.1016/j.drugalcdep.2015.02.037 This study provides the first descriptive analysis of injection drug use and HIV prevalence in western Kenya; this study is important because this region has the highest HIV prevalence.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Sorsdahl K, Stein DJ, Corrigall J, Cuijpers P, Smits N, Naledi T, et al. The efficacy of a blended motivational interviewing and problem solving therapy intervention to reduce substance use among patients presenting for emergency services in South Africa: a randomized controlled trial. Subst Abuse Treat Prev Policy. 2015;10:46. https://doi.org/10.1186/s13011-015-0042-1.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. 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.

    Article  PubMed  Google Scholar 

  52. • Rhodes T, Guise A, Ndimbii J, Strathdee S, Ngugi E, Platt L, et al. Is the promise of methadone Kenya’s solution to managing HIV and addiction? A mixed-method mathematical modelling and qualitative study. BMJ Open. 2015;5(3):e007198. https://doi.org/10.1136/bmjopen-2014-007198 Opioid agonist treatment is promoted globally as an evidence-based intervention to treat heroin addiction among PWID and prevent HIV infection. This study mathematically models different levels of opioid agonist treatment intervention coverage, and the impact on HIV prevention in Nairobi, Kenya.

    Article  PubMed  PubMed Central  Google Scholar 

  53. 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. 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.

    Article  PubMed  Google Scholar 

  55. Meade CS, Towe SL, Watt MH, Lion RR, Myers B, Skinner D, et al. Addiction and treatment experiences among active methamphetamine users recruited from a township community in Cape Town, South Africa: a mixed-methods study. Drug Alcohol Depend. 2015;152:79–86. https://doi.org/10.1016/j.drugalcdep.2015.04.016.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Matiko E, Khatib A, Khalid F, Welty S, Said C, Ali A, et al. HIV prevalence and risk behaviors among people who inject drugs in two serial cross-sectional respondent-driven sampling surveys, Zanzibar 2007 and 2012. AIDS Behav. 2015;19(Suppl 1):S36–45. https://doi.org/10.1007/s10461-014-0929-2.

    Article  PubMed  PubMed Central  Google Scholar 

  57. • Lepretre A, Ba I, Lacombe K, Maynart M, Toufik A, Ndiaye O, et al. Prevalence and behavioural risks for HIV and HCV infections in a population of drug users of Dakar, Senegal: the ANRS 12243 UDSEN study. J Int AIDS Soc. 2015;18:19888. https://doi.org/10.7448/ias.18.1.19888 This study provides data on drug use, HIV and HCV and HBV infection in Senegal and is important because data from the West Africa region is often lacking.

    Article  PubMed  PubMed Central  Google Scholar 

  58. • Kurth AE, Cleland CM, Des Jarlais DC, Musyoki H, Lizcano JA, Chhun N, et al. HIV prevalence, estimated incidence, and risk behaviors among people who inject drugs in Kenya. J Acquir Immune Defic Syndr. 2015;70(4):420–7. https://doi.org/10.1097/qai.0000000000000769 This study is one of the first to describe baseline PWID risks prior to evaluation of the potential effect of NSP in this population. In addition, this is the only study to discuss NSPs in detail.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Guise A, Dimova M, Ndimbii J, Clark P, Rhodes T. A qualitative analysis of transitions to heroin injection in Kenya: implications for HIV prevention and harm reduction. Harm Reduct J. 2015;12:27. https://doi.org/10.1186/s12954-015-0061-2.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Bassiony MM, Salah El-Deen GM, Yousef U, Raya Y, Abdel-Ghani MM, El-Gohari H, et al. Adolescent tramadol use and abuse in Egypt. Am J Drug Alcohol Abuse. 2015;41(3):206–11. https://doi.org/10.3109/00952990.2015.1014959.

    Article  PubMed  Google Scholar 

  61. Adebajo S, Eluwa G, Njab J, Oginni A, Ukwuije F, Ahonsi B, et al. Evaluating the effect of HIV prevention strategies on uptake of HIV counselling and testing among male most-at-risk-populations in Nigeria; a cross-sectional analysis. Sex Transm Infect. 2015;91(8):555–60. https://doi.org/10.1136/sextrans-2014-051659.

    Article  PubMed  Google Scholar 

  62. Were T, Wesongah JO, Munde E, Ouma C, Kahiga TM, Ongecha-Owuor F, et al. Clinical chemistry profiles in injection heroin users from Coastal Region, Kenya. BMC Clin Pathol. 2014;14:32. https://doi.org/10.1186/1472-6890-14-32.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  63. Saban A, Flisher A, Laubscher R, London L, Morojele N. The association between psychopathology and substance use: adolescent and young adult substance users in inpatient treatment in Cape Town, South Africa. Pan Afr Med J. 2014;17(Suppl 1):8. https://doi.org/10.11694/pamj.supp.2014.17.1.3044.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Lambdin BH, Masao F, Chang O, Kaduri P, Mbwambo J, Magimba A, et al. Methadone treatment for HIV prevention-feasibility, retention, and predictors of attrition in Dar es Salaam, Tanzania: a retrospective cohort study. Clin Infect Dis. 2014;59(5):735–42. https://doi.org/10.1093/cid/ciu382.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  65. Jhugroo A, Ellayah D, Norman A, Hulse G. Naltrexone implant treatment for buprenorphine dependence—Mauritian case series. J Psychopharmacol. 2014;28(8):800–3. https://doi.org/10.1177/0269881114528592.

    Article  CAS  PubMed  Google Scholar 

  66. Gupta A, Mbwambo J, Mteza I, Shenoi S, Lambdin B, Nyandindi C, et al. Active case finding for tuberculosis among people who inject drugs on methadone treatment in Dar es Salaam. Tanzania Int J Tuberc Lung Dis. 2014;18(7):793–8. https://doi.org/10.5588/ijtld.13.0208.

    Article  CAS  PubMed  Google Scholar 

  67. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Mirzoyan L, Berendes S, Jeffery C, Thomson J, Ben Othman H, Danon L, et al. New evidence on the HIV epidemic in Libya: why countries must implement prevention programs among people who inject drugs. J Acquir Immune Defic Syndr. 2013;62(5):577–83. https://doi.org/10.1097/QAI.0b013e318284714a.

    Article  PubMed  Google Scholar 

  69. Lambdin BH, Bruce RD, Chang O, Nyandindi C, Sabuni N, Zamudio-Haas S, et al. Identifying programmatic gaps: inequities in harm reduction service utilization among male and female drug users in Dar es Salaam, Tanzania. PLoS One. 2013;8(6):e67062. https://doi.org/10.1371/journal.pone.0067062.

    Article  PubMed  PubMed Central  Google Scholar 

  70. 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.

    Article  PubMed  Google Scholar 

  71. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  72. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  73. Brodish PS, Singh K, Rinyuri A, Njeru C, Kingola N, Mureithi P, et al. Evidence of high-risk sexual behaviors among injection drug users in the Kenya PLACE study. Drug Alcohol Depend. 2011;119(1–2):138–41. https://doi.org/10.1016/j.drugalcdep.2011.05.030.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Atkinson JM, McCurdy SM, Williams M, Mbwambo J, Kilonzo G. HIV risk behaviours, perceived severity of drug use problems, and prior treatment experience in a sample of young heroin injector s in Dar es Salaam, Tanzania. Afr J Drug Alcohol Stud. 2011;10(1):1–9.

    PubMed  PubMed Central  Google Scholar 

  75. Soliman CR, Rahman IA, Shawky S, Bahaa T, Elkamhawi S, El Sattar AA, et al. HIV prevalence and risk behaviors of male injection drug users in Cairo, Egypt. AIDS. 2010;24(Suppl 2):S33–8. https://doi.org/10.1097/01.aids.0000386731.94800.e6.

    Article  PubMed  Google Scholar 

  76. Parry CD, Petersen P, Carney T, Needle R. Opportunities for enhancing and integrating HIV and drug services for drug using vulnerable populations in South Africa. Int J Drug Policy. 2010;21(4):289–95. https://doi.org/10.1016/j.drugpo.2009.11.008.

    Article  PubMed  Google Scholar 

  77. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  78. Johnston LG, Holman A, Dahoma M, Miller LA, Kim E, Mussa M, et al. HIV risk and the overlap of injecting drug use and high-risk sexual behaviours among men who have sex with men in Zanzibar (Unguja), Tanzania. Int J Drug Policy. 2010;21(6):485–92. https://doi.org/10.1016/j.drugpo.2010.06.001.

    Article  PubMed  Google Scholar 

  79. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  80. Williams MLM, McCurdy SA, Bowen AM, Kilonzo GP, Atkinson JS, Ross MW, et al. HIV seroprevalence in a sample of Tanzanian intravenous drug users. AIDS Educ Prev. 2009;21(5):474–83. https://doi.org/10.1521/aeap.2009.21.5.474.

    Article  PubMed  PubMed Central  Google Scholar 

  81. Parry CD, Carney T, Petersen P, Dewing S, Needle R. HIV-risk behavior among injecting or non-injecting drug users in Cape Town, Pretoria, and Durban, South Africa. Subst Use Misuse. 2009;44(6):886–904. https://doi.org/10.1080/10826080802487028.

    Article  PubMed  Google Scholar 

  82. Ross MW, McCurdy SA, Kilonzo GP, Williams ML, Leshabari MT. Drug use careers and blood-borne pathogen risk behavior in male and female Tanzanian heroin injectors. Am J Trop Med Hyg. 2008;79(3):338–43.

    Article  PubMed  Google Scholar 

  83. Pluddemann A, Parry CD, Flisher AJ, Jordaan E. Heroin users in Cape Town, South Africa: injecting practices, HIV-related risk behaviors, and other health consequences. J Psychoactive Drugs. 2008;40(3):273–9. https://doi.org/10.1080/02791072.2008.10400642.

    Article  PubMed  Google Scholar 

  84. Parry C, Petersen P, Carney T, Dewing S, Needle R. Rapid assessment of drug use and sexual HIV risk patterns among vulnerable drug-using populations in Cape Town, Durban and Pretoria, South Africa. Sahara J. 2008;5(3):113–9.

    Article  PubMed  Google Scholar 

  85. Needle R, Kroeger K, Belani H, Achrekar A, Parry CD, Dewing S. Sex, drugs, and HIV: rapid assessment of HIV risk behaviors among street-based drug using sex workers in Durban, South Africa. Soc Sci Med. 2008;67(9):1447–55. https://doi.org/10.1016/j.socscimed.2008.06.031.

    Article  PubMed  Google Scholar 

  86. Williams ML, McCurdy SA, Atkinson JS, Kilonzo GP, Leshabari MT, Ross MW. Differences in HIV risk behaviors by gender in a sample of Tanzanian injection drug users. AIDS Behav. 2007;11(1):137–44. https://doi.org/10.1007/s10461-006-9102-x.

    Article  PubMed  Google Scholar 

  87. McCurdy SA, Ross MW, Kilonzo GP, Leshabari MT, Williams ML. HIV/AIDS and injection drug use in the neighborhoods of Dar es Salaam, Tanzania. Drug Alcohol Depend. 2006;82(Suppl 1):S23–7.

    Article  PubMed  Google Scholar 

  88. Beckerleg S, Telfer M, Sadiq A. A rapid assessment of heroin use in Mombasa, Kenya. Subst Use Misuse. 2006;41(6–7):1029–44. https://doi.org/10.1080/10826080600667193.

    Article  PubMed  Google Scholar 

  89. Parry CDP, Plüddemann A, Myers BJ. Heroin treatment demand in South Africa: trends from two large metropolitan sites (January 1997-December 2003). Drug Alcohol Rev. 2005;24(5):419–23. https://doi.org/10.1080/09595230500290841.

    Article  PubMed  Google Scholar 

  90. McCurdy SA, Wiliams ML, Kilonzo GP, Ross MW, Leshabari MT. Heroin and HIV risk in Dar es Salaam, Tanzania: youth hangouts, mageto and injecting practices. AIDS Care. 2005;17(Suppl 1):S65–76. https://doi.org/10.1080/09540120500120930.

    Article  PubMed  Google Scholar 

  91. Myers B, Parry CD, Plüddemann A. Indicators of substance abuse treatment demand in Cape Town, South Africa (1997-2001). Curationis. 2004;27(2):27–31.

    Article  CAS  PubMed  Google Scholar 

  92. Parry CD, Bhana A, Pluddemann A, Myers B, Siegfried N, Morojele NK, et al. The South African community epidemiology network on drug use (SACENDU): description, findings (1997-99) and policy implications. Addiction. 2002;97(8):969–76.

    Article  PubMed  Google Scholar 

  93. Othieno CJ, Kathaku DM, Ndetei DM. Substance abuse in outpatients attending rural and urban health centres in Kenya. East Afr Med J. 2000;77(11):592–5.

    CAS  PubMed  Google Scholar 

  94. Beckerleg S, Telfer M, Hundt GL. The rise of injecting drug use in East Africa: a case study from Kenya. Harm Reduct J. 2005;2:12. https://doi.org/10.1186/1477-7517-2-12.

    Article  PubMed  PubMed Central  Google Scholar 

  95. Mathers BM, Degenhardt L, Phillips B, Wiessing L, Hickman M, Strathdee SA, et al. Global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. Lancet. 2008;372(9651):1733–45. https://doi.org/10.1016/S0140-6736(08)61311-2.

    Article  PubMed  Google Scholar 

  96. United Nations Office on Drugs and Crime (UNODC), International Centre for Health Intervention and Research in Africa (ICHIRA). Rapid situational assessment of HIV prevalence and risky behaviours among injecting drug users in Kenya. Nairobi: UNODC/ICHIRA; 2012.

    Google Scholar 

  97. Tanzania National AIDS Control Programme (NACP). Consensus estimates on key population size and HIV prevalence in Tanzania. Ministry of Health and Social Welfare: Dar es Salaam, Tanzania, July 2014. 2018. Available at https://www.healthpolicyproject.com/pubs/391_FORMATTEDTanzaniaKPconsensusmtgreport.pdf. Accessed on 19 August 2018.

  98. Reid SR. Injection drug use, unsafe medical injections, and HIV in Africa: a systematic review. Harm Reduct J. 2009;6:24. https://doi.org/10.1186/1477-7517-6-24.

    Article  PubMed  PubMed Central  Google Scholar 

  99. Sullivan LE, Levine BG, Chawarski MC, Schottenfeld R, Fiellin D. Addiction and HIV in Kenya: a description of treatment services and integration. Afr J Drug Alcohol Stud. 2007;6(6):17–26.

    Google Scholar 

  100. Salm-Reifferscheidt L. Tramadol: Africa’s opioid crisis. Lancet. 2018;391(10134):1982–3. https://doi.org/10.1016/S0140-6736(18)31073-0.

    Article  PubMed  Google Scholar 

  101. World Health Organization (WHO). Expert Committee on Drug Dependence. 39th Meeting Agenda Item 5.3. 2017. Available at http://www.who.int/medicines/access/controlled-substances/PreReview_Tramadol.pdf. Accessed on 26 August 2018.

  102. Shalaby AS, El-Hady Sweilum OA, Ads MK. Does tramadol increase the severity of nicotine dependence? A study in an Egyptian sample. J Psychoactive Drugs. 2015;47(3):197–202. https://doi.org/10.1080/02791072.2015.1050534.

    Article  PubMed  Google Scholar 

  103. Csete J, Gathumbi A, Wolfe D, Cohen J. Lives to save: PEPFAR, HIV, and injecting drug use in Africa. Lancet. 2009;373(9680):2006–7. https://doi.org/10.1016/S0140-6736(09)61092-8.

    Article  PubMed  Google Scholar 

  104. Harm Reduction International. n.d. Sub-Saharan Africa Regional Overview. Available at https://www.hri.global/sub-saharan-africa. Accessed August 26, 2018.

  105. Petersen Z, Myers B, van Hout MC, Pluddemann A, Parry C. Availability of HIV prevention and treatment services for people who inject drugs: findings from 21 countries. Harm Reduct J. 2013;10:13. https://doi.org/10.1186/1477-7517-10-13.

    Article  PubMed  PubMed Central  Google Scholar 

  106. Ratliff EAM, McCurdy SA, Mbwambo JK, Lambdin BH, Voets A, Pont S, et al. An overview of HIV prevention interventions for people who inject drugs in Tanzania. Adv Prev Med. 2013;2013:183187–6. https://doi.org/10.1155/2013/183187.

    Article  PubMed  PubMed Central  Google Scholar 

  107. Ndimbii J, Guise A, Ayon S, Kalama M, McLean S, Rhodes T. Implementing needle and syringe programmes in Kenya: changes, opportunities and challenges in HIV prevention. Afr J Drug Alcohol Stud. 2015;14(2):95–103.

  108. WHO, UNODC, UNAIDS. WHO, UNODC, UNAIDS technical guide for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users—2012 revision. 2013. Available at http://www.who.int/hiv/pub/idu/targets_universal_access/en/. Accessed 19 August 2018.

  109. WHO. Effectiveness of sterile needle and syringe programming in reducing HIV/AIDS among injecting drug users. 2004. Available at http://www.who.int/hiv/pub/prev_care/effectivenesssterileneedle.pdf. Accessed 19cAugust 2018.

  110. UNAIDS, WHO (2007). Guide to starting and managing needle and syringe programmes. Available at http://www.who.int/hiv/idu/OMSEA_NSP_Guide_100807.pdf. Accessed 19 August 2018.

  111. CDC (2018). Syringe Service Programs. Available at https://www.cdc.gov/hiv/risk/ssps.html. Accessed on 19 August 2018.

  112. Wodak A, Maher L. The effectiveness of harm reduction in preventing HIV among injecting drug users. N S W Public Health Bull. 2010;21(3–4):69–73. https://doi.org/10.1071/NB10007.

    Article  PubMed  Google Scholar 

  113. Bruce RD. Methadone as HIV prevention: high volume methadone sites to decrease HIV incidence rates in resource limited settings. Int J Drug Policy. 2010;21(2):122–4. https://doi.org/10.1016/j.drugpo.2009.10.004.

    Article  PubMed  PubMed Central  Google Scholar 

  114. O'Connor PG, Shi JM, Henry S, Durante AJ, Friedman L, Selwyn PA. Tuberculosis chemoprophylaxis using a liquid isoniazid-methadone admixture for drug users in methadone maintenance. Addiction. 1999;94(7):1071–5.

    Article  CAS  PubMed  Google Scholar 

  115. McNeil Jr. DG. ‘Opiophobia’ has left Africa in Agony. 2017. Retrieved from https://www.nytimes.com/2017/12/04/health/opioids-africa-pain.html.

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Acknowledgments

We thank the colleagues engaged in opioid work and remediation in Africa.

Funding

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.

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AEK wrote the first draft, RC conducted the literature review, and all authors contributed to writing, editing, and responsibility for the final manuscript.

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Correspondence to Ann E. Kurth.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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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

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