NDA talks national drug studies, prevention policies and budget difficulties

The National Drug Agency (NDA) has defended the accuracy of a recent national survey into the scale of narcotics abuse and addiction in the Maldives, claiming the prevalence model used by researchers was the most efficient method presently available.

Some sources who participated in the survey process have expressed serious concerns about the “flawed methodology” of the data collection process, which they claim produced a final report that was inaccurate and had grossly underestimated the extent of drug use in the Maldives. The NDA has previously refuted criticisms over the drug report’s methodology in a letter sent to Minivan News.

NDA Chairperson and State Health Minister Lubna Mohamed Zahir Hussain has since claimed that on the back of a reduced state budget for its prevention and treatment programs in 2013, the findings would play a key role in helping authorities devise its future strategic action plan.

Lubna’s comments followed the publication by the NDA and the United Nations Office on Drugs and Crime (UNODC) last month of a prevalence survey based partly on primary data obtained from atolls capitals and almost two dozen randomly selected islands across the country. The survey concluded there were a total of 7,496 drug users in the Maldives, with the highest proportion among those aged between 15 and 19 years old.

To gather the findings, the team behind the study said they had used a scientific methodology combining secondary data from the state, such as police and prison services, with survey information gathered from 35 of the country’s inhabited islands.

Representatives from the team involved in compiling the study added that the data provided risked being “skewed” if its researchers had focused specifically on islands with known drug problems, rather than random parts of the country.

The NDA was among one of three key agencies working on the report that also included the (UNODC) and Inova Pvt Ltd – a national research organisation.

Sources who had worked on the report have alleged that the number of drug users identified in the survey was extremely low compared to the number of actual users, claiming that previous studies had estimated that the number of local users ranged between 20,000 and 30,000 people.

The report’s authors contend that there had been little scientific study to confirm such figures beyond anecdotal evidence in the past, with the latest figures better reflecting the scale of the problem in the country.

“Significant drug problem”

Criticisms were also raised by sources involved in the survey process over the scope of testing, which was alleged to have excluded women and the country’s prison population.

The charges were denied by the state organisations and civil society groups behind the report, who added that the latest figures indicated a significant drug problem in the country, with the study providing the first such data of its kind on drug use in the Maldives at a national level.

As part of the methodology used for the report, the survey team told Minivan News that respondents aged between 15 to 64 years of age were questioned across 35 of the country’s inhabited islands.

According to the report’s producers, two islands per atoll were focused on in the study. These included the capital of every atoll and another randomly selected island.

Asked whether such a system could provide an accurate reflection of the number of drug users around the country, the survey team claimed that prevalence studies were favoured by some experts as they allowed for greater control of perceived error limits that might affect the outcome of findings.

A similar methodology used to in the report’s calculations had also used to compile national data for the World Drug Report, according to the research team.

“The methodology [used in the national drug report] is in line with information gathered in the World Drug report. The is the first such information of its kind [for the Maldives],” a member of the team who compiled the report claimed.

“Skewed” figures

A source who has worked in the Maldives NGO sector for the last two years also accused the NDA, UNODC and other stakeholders behind the report of using a methodology that was not relevant to assessing the true scale of drug addiction across the country’s often isolated island communities.

However, a civil society representative involved with the study told Minivan News that the formula used in the report would have been “skewed” if researchers had singled out islands suspected of having more severe levels of drug use and addiction.

Under the same rationing, the survey team claimed that directly including the country’s prison population, 80 percent of whom are claimed to have been imprisoned on suspected drug offences, would again have adversely impacted the formula used to compile its most recent findings.

Rather than omit prison populations entirely, the report’s authors said they had turned to secondary information such as prison data and arrest figures from the police to help “indirectly estimate” the number of drug users using a specially devised methodology.

Researchers behind the survey added that the only other alternative to this model would have been to conduct a census-style test. They claimed such a model would have been too costly for the nation considering the economic challenges facing the country in recent years amidst heightened calls for reduced state spending.

The NDA also added that the study had been independently monitored by the EU and UNODC during the survey period that was conducted across various atolls for a period of two to three months, starting in October 2011. The study period was said to have run for slightly longer in the capital of Male’, according to the research team.


With the findings now released, Afiya Ali, a clinical psychologist working on the study said that the findings had shed new light on the reasons why people were turning to drugs in the country, with young people between 15 to 19 years of age being particularly susceptible.

Afiya said that the findings had indicated that a large number of people turning to drugs in the country found to come from regular backgrounds as opposed to common perceptions of drug takers coming from criminal or troubled backgrounds.

Experimentation was highlighted as a major driver to encouraging young people experiment with alcohol and drugs.

“It is only recently that life skills have been introduced to schools as their has been reluctance from parents and senior figures in the schools to accept these topics,” Afiya explained.

However, she added that that work was being undertaken within the national curriculum, even with young children to indirectly teach them about peer pressure that could lead to such experimentation.


The team behind the report told Minivan News that a high level of social stigma among Maldivian females of being associated with drugs had limited the overall effectiveness of understanding narcotics use among women and girls – despite maintaining that users in the country remained predominantly male.

Further study specifically around the amount of females using or addicted to drugs in the Maldives was highlighted by Lubna and the survey team as an area potentially requiring a greater focus in the next few years.

“There will always be limitations to such studies, this include the difficulties in capturing data on females using drugs,” the report authors claimed, adding that similar challenges faced researchers around the world, with drugs widely accepted to be a male-orientated problem.

“There is a social perception that for a guy to be labelled a drug user is less taboo than for a woman. We need to conduct targeted research on women only [concerning drug use].”

Also highlighted among limitations that would impact the final report by the team was the prevalence of drug use among teenagers and children below 15 years of age. However, the NDA claimed that it would be possible to replicate such a study using a similar methodology used in its most recent report.

In terms of the report methodology researchers were sent to 35 of the country’s inhabited islands, where it used four separate questionnaires to try and screen interviewees to ascertain if they may have had experience using drugs

According to researchers these included an initial questionnaire with lighter questions such as whether a respondent knew anyone who had been a drug user. For subjects anticipated of having used drugs, picture cards depicting various drugs available in the country, along with both their English and Dhivehi names, were distributed in order to try to gage familiarity among respondents with the drug scene.

“We had a 90 percent response rate, people wanted to give us information,” said the researchers.

Respondents were also asked to sign a confidentiality agreement and consent form expressing that findings would not be shared with law enforcement authorities, with no individual records said to have been kept.

Future focus

With the report now complete, NDA Chair Lubna Mohamed Zahir Hussain stressed that a heightened focus on corporate social responsibility (CSR) programmes and greater coordination between state and civil society bodies had been highlighted as key aims for its efforts during 2013.

Lubna highlighted “budget difficulties” as a key challenge going forward, particularly in terms of providing placements and work opportunities as part of rehabilitation programmes.

“The budget will be difficult for 2013, so we are looking for possible CSR partners. This is something that we started back in June 2012 with groups like John Keels by providing opportunities in the hospitality sector,” she said.

According to the NDA, thirteen individuals last year undertook the programme, which was based around the food and beverage sector.

Lubna added that authorities were increasingly seeking corporate partners to assist with the programme, not just in terms of providing work experience for recovering addicts, but to also provide potential financial assistance to sponsor placements assisting with the rehabilitation of others.

Providing support to users undergoing Methadone Maintenance Therapy (MMT) was among the key areas where support was being sought, however the state budget was deemed insufficient to do so, according to Lubna.


Experts lambast results of US$170,000 million National Drug Use Survey

A survey published by the United Nations Office on Drugs and Crime (UNODC) and Maldivian National Drug Agency (NDA) has claimed there are 7496 drug users in the Maldives.

According to the findings of the nationwide survey, 6.64 percent of people aged 15-64 in Malé and 2.02 percent in the atolls are currently using drugs, with the highest proportion of drug users aged between 15 and 19 years old.

The study also sought to determine drug use patterns, assess behavioral characteristics, and identify “community knowledge, attitudes and perceptions towards the drug problem”.

According to the study, being unmarried is considered a “risky behavior among drug users”.

Non-governmental organisations (NGOs), community based organisations (CBOs), and other stakeholders were also found to “heavily emphasise law enforcement and faith-based value systems,” as opposed to treatment and rehabilitation.

“A strong endorsement of Sharia’h law was apparent. In words of a key stakeholder, ‘Treatment alone will not yield results. It must be in conjunction with proper punishment’,” the report stated.

The survey findings also “confirmed that drug use in Maldives is predominantly a male phenomenon” and claimed the most common drugs are hash oil and brown-sugar (a heroin derivative) – known locally as theyo and hakaru, respectively.

However, key populations such as those in jail, women, and users of ‘party drugs’ were left out of the survey.

Controversial findings

Informed sources who participated in the survey process have 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.

The number of drug users reported by the survey was extremely low compared to the number of actual users, the sources said, which previous studies had found ranged between 20,000 and 30,000 people.

“The methodologies used are flawed and do not work in the Maldivian context because of social stigmas surrounding drug use. There was no effort to develop a methodology that would be appropriate for this country context,” said a source.

The enumerators used to conduct interviews for the survey were “very young, inexperienced kids” while those with “extensive experience” in drug abuse prevention and with surveying were marginalised, sources claimed.

“No one in the Maldives will openly admit ‘I’m a drug user’ – it’s seen as a moral issue because of religious beliefs,” the sources stated.

“The survey team was getting zero numbers from some atolls. But they insisted they were using a scientific methodology and this would be corrected at a later date,” the sources explained.

“All these young people who just finished school who were used as supervisors, they were useless,” the sources alleged.

“Teenage interviewers would go to houses and ask elders if there were any drug users in the household, and of course they said no. Additionally, drug users are also very manipulative,” the sources said.

Production of the report involved 50 enumerators surveying 3500 households, 762 people, and 72 focus group discussions.

“The incentives used – 20 MVR for completing a questionnaire – targeted heroin users only. Additionally, 80 percent of incarcerated population uses drugs and they were not included in this survey,” informed sources stated.

“Furthermore, the differentiation between male and female addicts, and the exclusion of women from the survey, is not something normally done,” the sources added.

The sources claimed the National Drug Agency (NDA) was informed about the methodological flaws, however no action was taken to correct the problem.  Moreover the NDA did not set policy standards or engage in oversight and instead conduct implementation without any monitoring, they claimed.

“When this survey started two years ago, the government was informed about all these problems, but they did not give a damn about this. The purpose of all this manipulation is for political reasons. They want to show the public that the [drug abuse] problem is improving,” the sources alleged.

“The government should know what they are doing in this sector. They should know better than to use drug addiction as a political tool,” the sources stated.

Flawed findings

Expert sources involved in the survey process had strong negative reactions to many of the report’s findings.

“Being unmarried is not a risky behavior related to drug use. How did they come to this conclusion? It’s crazy!” said one informed source.

“NGOs, CBOs, and stakeholders are not in favor of punishment over treatment. NGOs changed the law to have drug abuse recognised as a disease,” they said.

New trends in drug use were excluded from the report’s focus as well.

“There are drugs that are not even mentioned in this survey coming in now, like meth, and most of the party drugs are available in the Maldives now, such as speed, ecstasy, and LSD.

“Older users are going for the heroin, while youth that are to use hashish oil are now also going for party drugs,” the sources explained.

More harm than good

The survey’s findings were “commendable”, said National Drug Agency Chairperson and State Minister for Health, Uza Lubna Mohammed Zahir Hussain, in the report’s foreword.

“The information provided by this survey without a doubt contributes to a better understanding of the nature and extent of the impact of drug abuse and this understanding will help decision makers to identify appropriate strategies to combat the problem of drug abuse in the Maldives,” Lubna stated.

However, the informed sources were distraught by the possible ramifications of the report’s “flawed” findings.

“Future plans, policies, and interventions will be designed based on this survey, which is not accurate. We know very clearly the results are wrong,” they said.

“Now for another 10 years there will not be enough funds for drug prevention and treatment. Donors will refer to the survey and think the Maldives doesn’t need any prevention or treatment programs, because the reported prevalence rate is so low,” said sources.

For example, expert sources explained there was only one rehabilitation center in the Maldives and that it is “inappropriate” for the Maldivian context, as well as understaffed. No experts in drug abuse treatment staffed the rehabilitation centre, the NDA or Health Ministry, they added.

“The NDA is running the rehab center, which employs a behavior-based program for heroin users. It doesn’t work for other types of addicts and there is no oversight. There are no beds and all the toilets are broken.

“There was a marijuana user sent for treatment. Every other day he tried to swim away from the rehab island and nearly drowned because he has  mental problems. The program didn’t match his needs,” sources stated.

Sources explained there were numerous such problems which will now be greatly exaggerated by the survey’s “false” findings.

“Already there are next to no prevention efforts, supply reduction policies, or harm reduction programs; nothing comprehensive.

“Customs and the Maldives Port Authority have no container scanning machines and no drug-sniffing dogs. Anyone can bring drugs into the country,” they said.

“Meanwhile, government policies are changing almost every day. Whenever the government involves themselves in this sector they do harm, not good,” the sources lamented.

Sources claim that government policies under the last three administrations have been “ad hoc” and worsened drug abuse within the Maldives. Multiple international consultants have conducted drug use assessments and their recommendations are nearly identical, yet these recommendations are never enacted as policies, the sources stated.

Minister of Health Dr Ahmed Jamsheed Mohamed also voiced concern regarding drug abuse policies. During his speech at the survey’s launch, he stated that drug abuse was the “worst enemy of development” and based on the survey’s findings, it is necessary to “take a break, take stock, and strategise”.

The National Drug Use survey was conducted between 2011 and 2012, by the UNODC, NDA, INOVA Pvt Ltd, All India Institute of Medical Sciences (AIIMS), in partnership with five civil society organisations. The European Union and Swedish government provided US$2,180,200 in funding.

Download the National Drug Use Survey

Clarification: The National Drug Agency (NDA) has responded to this article in a letter, published on Minivan News. According the NDA, the US$170,000 budget for the survey was “a small amount of the overall budget of expenditure pertaining to the NDUS research”, and therefore the reference in this article’s prvious headline to the total funding of US$2 million was misleading. Minivan News has clarified the headline to avoid confusion.


Maldives to sign UN convention against organised crime

The Majlis’ National Security Committee has agreed to the Maldives becoming signatory to the United Nations (UN) Convention against Transnational Organised Crime, reports Sun Online.

The convention, adopted by the UN General Assembly in 2000, has been signed by 147 states before Maldives.

The UNODC website states that country’s which sign and then ratify this convention commit themselves to the following:

  • The creation of domestic criminal offences (participation in an organized criminal group, money laundering, corruption and obstruction of justice)
  • The adoption of new and sweeping frameworks for extradition, mutual legal assistance and law enforcement cooperation
  • The promotion of  training and technical assistance for building or upgrading the necessary capacity of national authorities

The committee agreed that the Maldives becomes a party to the convention provided it does not contain protocols that run contrary to the constitution or the tenets of Islam.


“Overdue” national drug survey active across Maldives

The first “scientifically robust national survey” of drug use in the Maldives is kicking off with training for employees and volunteers this week. The survey was contracted by national research organisation Inova Pvt Ltd, in partnership with the Ministry of Health and Family.

The survey examines the drug use habits of Maldivians ages 15 to 64, and is a contributing factor of the program, “Strengthening the National response to Combat Drug Abuse in the Maldives”, which began in July under the remit of the United Nations (UN) and the Maldivian government.

United Nations’ Office on Drugs and Crimes (UNODC), the All Indian Institute and the European Union are providing funding and expertise, and 13 local NGOs are assisting the project, particularly within island communities.

International Project Coordinator for UNODC, Sarah Waller, said the survey would add structure to the Maldivian government’s sparse drug policy.

“The survey should generate a better understanding of where treatment gaps in the community are, in order for the government and civil society to target appropriate evidence-based treatment and interventions in their drug-treatment planning. At the moment, it’s a bit of a guess how services are set up. This will enable to the government to provide a much more targeted response to the issue.”

The survey is being conducted according to two methods.

On islands, ‘enumerators’ employed by Inova will gather and process data by conducting household interviews.

Waller said many enumerators come from the recovering community, and staff from Journey are providing specific training to those who have little to no experience in drug use and abuse.

“Many have likely never interacted in the past with drug users. The first few days of training are about building awareness and sensitisation around drug users, around the Maldives’ treatment systems, and around the patterns and trends of drug abuse here,” Waller said.

Another method will be applied on Male’. Volunteer ‘respondents’ will serve as the middle man, gathering survey participants from Male’s more dense and urban community and connecting with them enumerators.

“The methodology for Male’ is quite different from what is given out on the islands,” said Waller. “The method, Respondent Driven Sampling (RDS), is more appropriate to the community on Male’. This approach identifies initial seeds in the community, and those seeds generate additional seeds. So you’re really generating responses through one initial seed.”

Respondents will be rewarded with coupons according to their efforts gathering participants. Waller emphasised that the compensation had been carefully designed to protect the survey’s validity.

“The evidence base suggests that incentivizing the driving of seeds to identify more individauls to take part in the study can enable a much more representative and accurate sample. When it comes to incentivizing recovering or abusive populations, there are ethics that need to be considered regarding that incentive. In particular with doing research amongs drug users, there have to be ethics whereby monetary incentives aren’t sufficient enough to encourage the workers to use them on drugs.”

Minivan News spoke to Journey volunteer member Imlaaq Shareef about the survey’s methods.

“It’s an advanced form of snowballing. First, the respondents will bring one or two and give a reward, maybe three coupons. Then they’ll bring another three addicts, and get a reward for that. So from one respondent the team will get more and more samples,” said Shareef.

When asked if the survey was likely to be accurate, Shareef doubted that all participants would initially be honest.

“But in the survey there are a lot of recovering addicts who are volunteering, and they’ll be able to identify the community here,” Shareef observed. “This is a small place, so, even the person who is doing drugs the most secretively somehow some people will know about it. So we can reach for them. I think by this survey, we can get a good estimate.”

In Shareef’s opinion, the survey is overdue.

“It should have been done earlier. Day by day, the number of IV users is getting high, and drug users are getting high, the number of sex workers are increasing. And in most cases, sex workers are addicts because it’s the easiest way for a girl addict to get money to buy her drugs. There is no choice for these girls, and most do not enjoy it,” said Shareef.

In addition to having an information shortage, the Maldives is struggling to plug the gaps between drug rehabilitation and law enforcement.

“There are very few rehabilitation service providers here,” said Shareef. “The problem is, once people get out of rehab they have to sign up for community service and stay here for a year or so. If they relapse during that period, it’s a big case. They might end up in court or jail. So most people are afraid of taking a treatment, because of the loopholes in the law.”

Shareef complained that a drug reform bill has been stalled in Parliament.

“Even very recently, at Journey, we put out a petition that was signed by nearly 8,000 people and sent it to the Majlis to pass the drug bill. But they don’t give a damn about it. They are just concerned about the Rf20,000 they are getting. I wonder what kind of risk they are taking,” said Shareef.

Parliament accepted the bill in March 2010 and sent the legislation to committee for further review.

Shareef said the bill would significantly improve drug addicts’ recovery process.

“A user should never end up in jail. It has been scientifically proven that addiction is a chronic brain disease. So why should they end up in jail? It’s a big problem,” Shareef said.

Waller said the survey could provide a base line for developing a sufficient drug management infrastructure.

“The data can assist government in how and where to apply the information, and what communities need in terms of service. There is certainly an affinity between the two,” she said.

The project’s final report is due for release in February 2012.


EU’s anti-drug money will go towards rehabilitation

The Maldives has signed a memorandum of understanding between the European Union (EU) and United Nations Office on Drugs and Crime (UNODC).

The deal includes an aid package worth €1.5 million over two and a half years to strengthen the country’s response to drug abuse.

Foreign minister Dr Ahmed Shaheed said the money, which comes from the EU and would be in the hands of UNODC, will mostly be used to help with the rehabilitation of drug addicts, make people aware of the relationship between HIV and drug use.

Dr Shaheed signed the agreement at a ceremony yesterday with EU Ambassador Varnerd Savage and representative of the UNODC Regional Office South Asia, Cristina Albertin.

Speaking at the ceremony, Varnard said the program would strengthen the national response to combating drug abuse in the Maldives, and would target the major problem areas of drugs and crime.

Albertin said 10 per cent of the Maldivian population is affected by drug abuse, and that UNODC hoped the program would assist  in the country’s enforcement of drug laws.


Chairperson of the Society for Women Against Drugs (SWAD) Fathmath Aafiya said she hoped the project would not end up like the government’s previous ‘WAKE-UP’ program.

”The government does not do sufficient work to reduce the number of drug importers,” she said, criticising the government’s lenient treatment of dealers by placing some under house arrest and letting others go free.

Aafiya said the government had “a lot of work to do” to reduce the importation of drugs into the country.

SWAD was expecting the new program to be beneficial, she added, as it would increase the aftercare and rehabilitation of drug users.