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Mass escape of patients from Butabika exposes law on drug abuse as flawed

Recently, Butabika National Referral and Teaching Mental hospital reported that at least 2,175 patients escaped from the facility over the past year. Most of the escapees were youths admitted for drug abuse rehabilitation.

In the wake of the development, TWAIBU WAMALA, a public health and human rights activist and the executive director of the Uganda Harm Reduction Network (UHRN), reasons that the reintegration of the escapees into society without completing full counselling and rehabilitation therapy may not only stifle efforts to restore them to responsible individuals but also expose other innocent but vulnerable youths to addiction to dangerous drugs.

He told Ashley Aine that government needs to promote counselling and education of youths about drug abuse/addiction rather than criminalizing drug use

What are the primary challenges faced by drug addicts when it comes to seeking help and rehabilitation?

UHRN works with the ministry of Health to provide treatment and rehabilitation under the Butabika National Referral and Teaching Mental hospital, and this treatment is free of charge, supported by PEPFAR/CDC and the Ugandan government.

However, challenges have manifested, especially for the communities in need of these services to overcome drug addiction. Long distances to and from the drug treatment center pose a significant hurdle. For instance, individuals enrolled on the drug treatment and rehabilitation programme must travel over 12 kilometres to and from Butabika to access medically assisted therapy (MAT) services, which are required on a daily basis.

This necessitates financial support to manage transport costs, yet the majority of those grappling with illicit drugs are unemployed and lack family support. Additionally, the lack of comprehensive services for people addicted to illicit drugs in rehabilitation centers deters many, especially women, who use drugs.

Butabika offers limited services for managing menstrual hygiene and STIs. Other issues include limited awareness and education of clients about the available services, leading to misconceptions and barriers to seeking treatment.

What are the strengths and weaknesses of Uganda’s strict legal regime against illegal drug use?

From my perspective, there is no evidence to support that the criminalization of people who use illicit drugs has ever worked. A war on illicit drugs is a failed approach, and it has created more harm than good.

The government of Uganda has positioned drug use as a criminal justice matter rather than a public health issue that needs to be addressed with a medical approach. Drug use is an addiction, not a criminal justice matter.

Drug use in Uganda is on the rise, and we need an open environment in which we can share information and talk about addiction. By further criminalizing drug use, this law pushes people into the shadows.

People are afraid to talk and seek much-needed medical help because the government has now definitively positioned drug use as a justice issue rather than a health issue. The implementation of the Narcotics and Psychotropic Substances (Control) Act 2023 has led to a rise in the number of youths in prisons.

How can counseling and rehabilitation programs be highly effective in helping youths overcome drug addiction?

Counseling and rehabilitation programs are effective in helping youths overcome drug addiction because they provide individuals with a safe and supportive environment to explore the underlying causes of their addiction, develop coping strategies, and learn healthier ways of managing stress and emotions.

Since the launch of the MAT program supported by PEPFAR/ CDC and the ministry of Health, over 700 people have been assessed for enrollment by UHRN, with 522 individuals (414 males and 108 females) starting the program. Of those who completed their treatment, 171 clients are now thriving and have successfully reintegrated with their families, and 269 clients have found employment again in Uganda.

How can harm reduction strategies be implemented in Uganda to better support youthful drug addicts?

Implementing harm reduction strategies to better support youthful drug addicts in Uganda requires a multi-faceted approach that addresses their unique needs and challenges.

These include: Implementing comprehensive education and awareness campaigns in schools, communities, and through mass media to provide accurate information about the risks associated with drug use, harm reduction strategies, and available support services; Establishing needle and syringe exchange programs to provide sterile injecting equipment to young people who inject illicit drugs, along with education on safer injection practices and referrals to healthcare and social services;

Substance-abuse patients have a tendency to relapse after escaping from rehabilitation centres
Substance-abuse patients have a tendency to relapse after escaping from rehabilitation centres

Developing youth-friendly harm reduction services that are accessible, non judgmental, and tailored to the needs of young people, including walk-in clinics, mobile van dispensing clinics or mobile outreach units, and online resources;

Training young people as peer educators and advocates to provide support, information and referrals to their peers who use illicit drugs,
as well as to advocate for the implementation of harm reduction and integrating harm reduction services with existing youth-focused healthcare, mental health and social services to ensure a holistic approach to supporting young people who use drugs.

On the other hand, what changes do you think are needed in Uganda’s drug policies to better address the issue of addiction among youths?

Shift from criminalization to a public health approach: Instead of focusing solely on punitive measures, Uganda’s drug policies should prioritize public health strategies, including harm reduction, prevention, treatment and rehabilitation.

This approach recognizes drug addiction as a health issue rather than a criminal offence and prioritizes support and treatment over punishment. Uganda should invest in prevention and education by implementing comprehensive drug prevention programs in schools and communities.

These programs should provide accurate information about the risks associated with drug use, build life skills and resilience among young people, and promote healthy lifestyles and positive coping mechanisms.

Additionally, Uganda should increase access to affordable and culturally appropriate treatment and rehabilitation services for youths struggling with addiction, including counselling, behavioural therapy, medication-assisted treatment, and support groups. It’s crucial to ensure that these services are youth-friendly, accessible, and integrated with other healthcare and social services.

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