Drug Court sending addicts to jail after detox centres reach capacity

With government detox facilities at capacity the Drug Court is sending addicts to jail in the interim, prompting the Maldives’ National Drug Agency to call on private businesses and NGOs to fill the gap.

Twenty-four men have been sent to prison for 90 days, or until space becomes available for treatment, in accordance with the Drug Act which states the court has the authority to do so if “rehabilitation centers are unable to facilitate treatment”, according to local media.

All emergency medical detox centers are full nationwide – the Himmafushi Island, Villingili Island, Fuvamulah and Addu, National Drug Agency (NDA) Chairperson and State Health Minister Lubna Mohamed Zahir Hussain confirmed to Minivan News today (May 1).

“Rehab is not full, however detox is full for the next 14 days. Demand is so high that clients are waiting in prison,” said Zahir.

“The Drug Court is sentencing too many people every day. There are so many – too many – cases. The court doesn’t want to delay sentencing, so people eligible for rehab must wait in prison – for a maximum of three months,” she added.

Zahir stated that 24 men currently in jail – awaiting the first phase of rehab, which is detoxification – will be moved to the drug rehabilitation center on Himmafushi island within two weeks. No women are awaiting detox, claimed Zahir.

“We are calling for help”

Zahir emphasised that current government regulations allow for the privatisation of rehabilitation centers and the NDA has requested bids for private companies in the government gazette, however no applications have been submitted thus far.

“We are looking forward to receiving applications. It’s time the government opened international bidding to do so,” declared Zahir.

“[The NDA] is open for discussions about opening a rehabilitation resort. A similar program to cabins in Chiang Mai, Thailand, which is a really good program.

“For example, foreigners can come to the island destination [for drug rehabilitation], the profits of which could be used to subsidise treatment for Maldivians,” Zahir explained.

The private rehabilitation centers would be supplementary to the national treatment center for men and women, which is required by law, according to Zahir.

She also highlighted the need to strengthen aftercare programs in partnership with local communities. This is a particular challenge for NGOs who are working with drug addicts.

“Communities fail to understand the work NGOs are doing with drop-in clients. Awareness and education are needed, because NGOs are running into lots of problems with communities,” said Zahir.

Political polarisation and the focus on the upcoming presidential elections seems to be preventing this work from occurring, claims Zahir.

“It is easy [for NGOs] to apply for and get community [drug] rehab licences to conduct relapse prevention. And we are really calling for help,” she implored.

NDA has also issued requests for qualified people to apply for councillor positions with NDA to support their outpatient community rehabilitation programs.

There are between 200 and 400 clients, but very few councilors, Zahir explained.

Facilities lacking

The limited space within the Himmafushi rehabilitation center becomes available on a revolving basis – as clients complete their treatment – however capacity to conduct the three day emergency medical detoxification is extremely restricted.

The Himmafushi center has space to detox about 20 people at any given time, however it only has the capacity to manage about 10 individuals. The center is able to conduct drug rehabilitation for 150 men and 12 women maximum. Additionally, 12 detox spaces are available on each of the islands of Villingili, Fuvamulah and Addu.

“Two years ago we used a detox dorm for women on Himmafushi, however they were shifted to the female specific unit established on Villingili June 26, 2011,” explained Zahir.

“The NDA and Gender Department – under the Health Ministry – ran the rehabilitation center for women on Villingili. But it was closed in 2012 when the Gender Department became the Gender Ministry and took over the building.

“We requested from [former Gender, Family and Human Rights Minister] Diyana Saeed to keep center. Demand is high, we need a unit always,” she added.

Subsequently, women in need of drug treatment did not have a center for seven months until the original female dorm located on Himmafushi was reopened.

The NDA is planning to add three additional units to the Himmafushi drug treatment center and had requested government funds for the project, according to Zahir.

“NDA lacks implementation capacity”

“Drug abuse is too much money for the government to bear, because the problem is so wide-spread and the cost is so high,” an expert in holistic drug prevention, treatment, and aftercare told Minivan News today.

“The government is doing almost nothing for drug prevention, which then puts a huge burden on the government, including the public health sector. There is also a dire need for early intervention,” claims the source.

“NDA lacks the capacity and staff to do everything. They are not able to handle prevention, inpatient or outpatient treatment. Currently, they do not even have a CEO and are operating outside of the law,” the source continued.

“NDA should act as a governing body and watchdog only. Otherwise they cannot handle the demand,” added the source. “There is only one rehabilitation centre and it’s always full because there are so many people in need.”

The source suggested that the state-run detox and treatment centers should be outsourced to private or civil society institutions, leaving room for the NDA to oversee and regulate. Additionally, building NGO capacity to address drug abuse would “benefit the entire nation”.

“There is no one to monitor and make them responsible if NDA is the implementing body,” said the source.

A “clear cut” country strategy – similar to the recently released 2013-2020 European Union drug strategy – needs to be developed in the Maldives, the source believes. The entire sector in Maldives works at cross-purposes and is not aiming for one particular prevention, treatment, or aftercare goal.

“Addiction is a lifelong chronic, relapsing brain disease. A person will relapse six to eight times or more before they completely stop using and live a sober life,” explained the source.

“Relapse is not failure, rather it’s due to the treatment program or person lacking some kind of support. Addiction is a very complex disease and affects each person differently.

“Often addiction is accompanied by another disease, such as depression or other mental health issue, but treatment in the Maldives does not address this. Thus, people relapse easily, which adds to the stigma surrounding drug users.

“This concept needs to be internalized in the Maldives and a continuum of care must be provided. This includes environment based intervention, evidence based and client focused treatments, as well as continuing guidance, education and support programs,” said the source.

The source further recommended referring to the US National Institute on Drug Abuse to structure these programs.

“The government spends so much money and this is such a small place, they should be able to do something,” concluded the source.

Nationwide drug abuse controversy

The United Nations Office on Drugs and Crime (UNODC) and NDA published a survey in February, claiming there are 7496 drug users in the Maldives.

Informed sources who participated in the survey process previously expressed serious concerns about the “flawed methodology” of the data collection process, which they claimed had produced a final report that inaccurately and grossly underestimates drug use in the Maldives. Key populations such as those in jail, women, and users of ‘party drugs’ were left out of the survey.

The NDA subsequently refuted criticisms over the drug report’s methodology in a letter sent to Minivan News.

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