Senegal Leading The Way on Methadone Provision in West Africa
Over a year into its pilot methadone program, Senegal is paving the way for harm reduction in West Africa.
The Centre for the Integrated Management of Addiction in Dakar (CEPIAD) opened in December 2014 and is the first publicly funded opioid substitution treatment (OST) program in West Africa. Located in Fann, a low-income arrondisement in the capital Dakar, the OST program provides a needle exchange program, skills training programs, anti-retroviral therapy and counseling, among other services.
In its first seven months of operation, some 250 people accessed the center’s services, three quarters of whom use heroin, reported Radio France Internationale, while around 100 people currently utilize the OST on offer with more on the waiting list.
The provision of methadone (an opioid substitute often administered at OST programs) and needle exchange programs could help combat HIV and hepatitis C rates among injecting drug users in Senegal, which were at 9.4 percent and 38.9 percent respectively, according to a 2011 study. Not only does the HIV rate in particular sit well above the national average -- 0.5 percent among the adult population (15-49 year olds) – the 2011 study also found that 33.9 percent of people had last injected outside of their homes, thus lacking a safe and potentially sterile environment, and over 10 percent of people had shared needles. Both of these practices significantly increase the spread of blood-borne viruses.
By providing funding for OST, the Senegalese government has joined just a handful of similar initiatives in Sub-Saharan Africa, namely those based in Kenya, Tanzania and Mauritius. Elsewhere in Africa, such as in Burkina Faso and South Africa, people can only access OST privately, according to the 2014 Global State of Harm Reduction.
However, while Dakar’s program is a positive anomaly, it is still too early to determine its impact. In a private conversation, some service users commented that the center’s location, as well as the travel time and cost to CEPIAD, meant that they were not always able to access the OST program during opening hours. Arguably these barriers make it more difficult for all CEPIAD service users to stick to a daily OST provision, and increases the risk that people will instead use heroin if OST isn’t available.
Senegal will hopefully continue to pave the way for harm reduction in West Africa through continual evaluation of its program so as to best serve the people who need it most.