On March 5 Lamu opened the doors of its first methadone clinic. The facility is at King Fahd hospital, Lamu Island.
The county has about 1,000 drug abusers, with the commonly abused drugs being cocaine and heroin.
The medically assisted therapy clinic uses methadone to help wean addicts off the hard stuff at a pace that gives their brains a chance to adjust to the lack of heroin.
Methadone is used as a medical substitute for opioids.
It is one of the components used to help alleviate opioid cravings and ease withdrawal symptoms with minimal risk of tolerance and compulsive opioid use.
The clinic is a programme by the Muslims Education and Welfare Association sponsored by UNODC, through USAID in partnership with the Lamu and national governments.
Since its inception five months ago, the clinic has reached more than 300 addicts urging them to avail themselves for therapy, according to Juma Mwamvyoga, the facility’s addiction counsellor.
Lamu has about 500 heroin injecting users out of whom 192 are under the MAT programme. Their ages range from 19 to 60.
“With time, those who have yet to enrol for the therapy will see just how well the former addicts have recovered and will yearn for the same. We however keep on with the outreach programmes. We want as many addicts as possible on board,” Mwamvyoga said.
He explains that under the MAT programme recovering addicts, who are referred to as clients or patients, are given a daily dosage of methadone that acts as a substitute for heroin.
Methadone gives a feeling similar to heroin but keeps the addict from having withdrawal symptoms and cravings.
The daily dosage has to be religiously taken for a period of between one and a half to two years to completely kill the addiction.
Mwavyoga explains that the major objective of the clinic is to induce harm reduction through promoting the health and dignity of those impacted by drug use.
“This means we help reduce their chances of them infecting each other by providing condoms, hygiene kits, clean NSP-Needle and Syringe Exchange Programme to prevent them from sharing needles and infecting themselves with HIV and other viral diseases," he says.
Methadone treatment was introduced in Kenya as part of policy responses to control HIV transmissions linked to drug injecting by addicts.
Systematic reviews proffer such treatment as one of the best-evidenced interventions for HIV prevention, linked to reductions in HIV infections and drug-injecting risk practices as well as overdose and acquisitive crime.
“That is how the harm reduction part comes in. Under the programme, apart from weaning them off heroin, they are able to reduce their dependence on other harmful practices like needle sharing and so on,” Mwavyoga says.
Like any other drug, methadone too has its side effects, which we make sure to explain to our patients before we begin treatment. We tell them it would be a waste of time for them to take the methadone and still abuse drugs. It won’t work
The Process
MEWA, which has similar clinics in Mombasa and Kilifi, majorly deals with health and harm reduction.
The Lamu clinic however majorly focuses on harm reduction, Mwavyoga explains. The addicts receive a comprehensive package that starts with outreach officers pursuing the addicts in their dens and selling them the idea of recovery.
“We started mapping Lamu in January once we got authority from NASCOP (National Aids and STI Control Programme) last year. We have registered 320 but only 192 responded to the MAT. So as to [encourage] the others, we still turn up to offer medical help whenever they fall sick or need any other help, wherever they are,” he says.
The counsellor explains that once an addict shows interest in undergoing therapy, they undergo at least five psychosocial sessions about the programme. They are informed about the MAT process, the side effects and the changes expected to the body once treatment starts.
Mwavyoga says at this stage they make it clear to the intending patients that they are never to consume any drugs once they commence therapy so as to allow for the effectiveness of the methadone.
“Like any other drug, methadone too has its side effects, which we make sure to explain to our patients before we begin treatment. We tell them it would be a waste of time for them to take the methadone and still abuse drugs. It won’t work,” he says.
Once the patient is psychologically prepared, they are referred to the facility’s laboratory where they undergo HIV, TB and hepatitis tests, among others. This is to establish whether they have any underlying conditions they might have exposed themselves to in the course of their drug abuse life.
Once the test results are ready, the patient is then referred to the clinic where they are officially registered to begin their daily methadone journey.
The facility opens from 8am to 12pm on weekdays.
Mwamvyoga explains that often the starting dose is 30ML of methadone after which the dosage is reduced or increased depending on the needs of each person and how committed they are to the recovery journey.
The methadone is distributed by NASCOP with the help of Kemsa while MEWA is funded by UNODC.
“If they tell you they still have cravings for heroin even after taking the methadone for weeks we may choose to increase the dosage. If they say the cravings are reducing, we lower the dosage. The reviews are vital as they enable us to keep tabs on how they are faring,” he says.
Addiction is a progressive disease and one has to be educated on the risk factors or benefit of methadone so that when they blunder, they have no one to blame
At this stage, the patient is encouraged to cut down on related stimulants like muguka, which reduces the effectiveness of the methadone.
“Muguka is a stimulant while methadone is a depressant. Mixing makes it difficult for us to know whether a client is at their steady state and whether or not to reduce the dosage," Mwamvyoga says.
Using other drugs while on methadone can get one stuck on the MAT for eternity. It requires utmost discipline to overcome temptation.
“We have had cases at our Mombasa clinic where people were on methadone for over five years. We will know if one is using other drugs because it shows in the frequent urine tests we conduct,” he says.
Humanistic Approach
Abdulkadir Ahmed, who works as a clinician at the Lamu clinic, explains that meditations form a major part of the therapy.
“We use the Humanistic Theory Approach where the clients sit at a round table and come up with solutions to whatever hurdles they are facing in their recovery journey," he explains.
Addiction is mostly psychological and patients are encouraged to hold group meditation sessions and encourage each other through personal testimonies.
The approach, according to Ahmed, is spiritual but not religious so that clients from all religions can look at each other as just patients and focus their energies on the journey ahead.
During the sessions, the patients are encouraged to speak about their experience while on methadone and are encouraged to stay on course.
They also get to share personal issues they might be going through after which a counsellor reassures them.
The addicts are encouraged to accept that they are patients and must follow up the treatment guidelines to be able to heal.
Peer educators, mostly reformed addicts, are periodically dispatched to drug dens to woo more patients to the clinic.
“Addiction is a progressive disease and one has to be educated on the risk factors or benefit of methadone so that when they blunder, they have no one to blame,” Ahmed says.
“We ensure clients use methadone on daily, unless there is an emergency such as travel where we issue a letter that enables them to get the methadone at any clinic in the country.”
At the clinic the patients are also provided with hygiene kits and sanitary towels.
Edited by Josephine M. Mayuya
