Delivery Systems for Delivery Systems for Substance Abuse Treatment Substance Abuse Treatment

ininMAURITIUSMAURITIUS..

DR. FAYZAL SULLIMANDR. FAYZAL SULLIMAN

COORDINATORCOORDINATOR

MEDICAL & RESEARCH UNITMEDICAL & RESEARCH UNIT

NATReSANATReSA

MAURITIUS

Situation: 2.400 km off the East Coast of South Africa, in the Indian Ocean

Area:- 1860 sq.Km.

Inclusions: 1 Small Island – Rodrigues – 563 km East of

Mauritius. 2. Tiny Islands – Agalega – 920 km North. A group of Multiple Islands – Cargados Carajos Archipelago 1200 km North-West.

MAURITIUS

HISTORYHISTORY• DISCOVERED BY THE ARAB SAILORS DISCOVERED BY THE ARAB SAILORS

(15 (15THTH CENTURY). CENTURY).

• PORTUGESE & DUTCH SETTLEMENT PORTUGESE & DUTCH SETTLEMENT (16(16THTH & 17 & 17THTH CENTURY). CENTURY).

• FRENCH SETTLEMENT FRENCH SETTLEMENT (17(17THTH & 18 & 18THTH CENTURY). CENTURY).

• BRITISH OCCUPATION BRITISH OCCUPATION (18(18THTH century till 1968). century till 1968).

MAURITIUS OVERVIEW.MAURITIUS OVERVIEW.

INDEPENDENC : 12INDEPENDENC : 12THTH MARCH MARCH

19681968

Capital:Capital: PORT-LOUIS. PORT-LOUIS.

General Overview General Overview ContinuedContinuedPopulationPopulation 1,233,000. (2004)1,233,000. (2004)

Birth RateBirth Rate 15.6 births per 100015.6 births per 1000

Death rateDeath rate 6.9 deaths per 10006.9 deaths per 1000

Median Age Median Age 31.9 Years31.9 Years

Life ExpectancyLife Expectancy 68.7 Years (M) 75.6(F)68.7 Years (M) 75.6(F)

LITERACY 89.6 %LITERACY 89.6 %

General Overview General Overview ContinuedContinuedAGE STRUCTURE :AGE STRUCTURE :

< 15 Years 19.4%< 15 Years 19.4%

15-59 Years 60.3%15-59 Years 60.3%

60-64 Years 5.9%60-64 Years 5.9%

> 65 Years 14.4%> 65 Years 14.4%

Distribution for Major Distribution for Major ReligionsReligions

• HINDU-50.3 %HINDU-50.3 %

• CHRISTIAN-28.6 %CHRISTIAN-28.6 %

• MUSLIM-18.1 %MUSLIM-18.1 %

• BUDDHIST-3.0 %BUDDHIST-3.0 %

EconomyEconomy G.D.P per Capita-USD :10,400.G.D.P per Capita-USD :10,400.

Labour Force: Labour Force: 351,000(M) 180,300(F) 351,000(M) 180,300(F)

Unemployment Rate : Unemployment Rate : 7.6% (2004) 7.6% (2004)

Major Industries:Major Industries: TEXTILES, SUGAR CANE, TEXTILES, SUGAR CANE, TOURISM, I.C.T.TOURISM, I.C.T.

Agriculture products:Agriculture products: SEA SEA FOOD,VEGETABLES,TROPICAL FRUITFOOD,VEGETABLES,TROPICAL FRUIT

Approximate Number of Approximate Number of Drug UsersDrug Users

HeroinHeroin 18,000 – 20,000. 18,000 – 20,000.

IDU 16,000 – 17,000.IDU 16,000 – 17,000.

MarijuanaMarijuana 25,000 – 30,000. 25,000 – 30,000.

Substance Abuse Related Substance Abuse Related ProblemsProblems

Living with HIV/AIDSLiving with HIV/AIDS3,700.3,700.

HIV/AIDS related deathsHIV/AIDS related deaths 130.130.

Modes of transmission among new cases in 2002

59%24%

6%

4%2%

5%

Hetero Hetero/IDU IDU Homo/Bisexual MTCT Unknow n

Modes of transmission among new cases in 2003

22%

29%

1%

41%

3%4%

Hetero Hetero/IDU IDU Homo/Bisexual MTCT Unknown

Modes of transmission among new cases in 2004

10%

3%

87%Hetero Hetero/IDU 1DU

26%

13%56%

2%

1%

2%

HETEROSEXUAL HETERO/IDUIDU HOMO/BISEXUALMTCT UNKNOWN

MODES OF TRANSMISSION AMONG HIV POSITIVE MAURITIANS(87 – 04)

Number of new cases HIV infection Republic of Mauritius 1996-2004-Jan/Feb 2005

16 24 23 2850 55

98

225

525

189

0

100

200

300

400

500

600

96 97 98 99 2000 2001 2002 2003 2004 Jan-Feb 2005

Year

To

tal n

um

ber

Number of new cases1000

estimated

The most urgent substance The most urgent substance related problems include related problems include HIV/AIDS, hepatitis C, HIV/AIDS, hepatitis C, injecting drug use and injecting drug use and HIV/Aids in the prison.HIV/Aids in the prison.

Available Substance Abuse Available Substance Abuse TreatmentTreatment

Inpatient DetoxInpatient Detox Outpatient DetoxOutpatient Detox Physician CounselingPhysician Counseling Outpatient CounselingOutpatient Counseling Residential RehabilitationResidential Rehabilitation Therapeutic CommunitiesTherapeutic Communities Treatment for WomenTreatment for Women Faith/Religious-based treatmentFaith/Religious-based treatment Treatment in JailTreatment in Jail PsychotherapyPsychotherapy Other pharmacotherapies, including antabuse, Other pharmacotherapies, including antabuse,

acamprosate, nicotine replacement , zyban and codein for acamprosate, nicotine replacement , zyban and codein for heroin users. heroin users.

Treatment System HistoryTreatment System History• 1974 - Psychotropic Act.1974 - Psychotropic Act.

• 1986 – Dangerous Drug Act.1986 – Dangerous Drug Act.

• 1986 – Setting up of a Trust Fund.1986 – Setting up of a Trust Fund.

• 1986 – Birth of several NGOs in the fight 1986 – Birth of several NGOs in the fight against drug against drug

• 1996 – Transformation of the Trust fund 1996 – Transformation of the Trust fund into a National Agency.- more Gvt. Support into a National Agency.- more Gvt. Support to NGOs.to NGOs.

• 2000 – New DDA – treatment alternative to 2000 – New DDA – treatment alternative to sentencing.sentencing.

• 2003 – Amendments of DDA 2000.2003 – Amendments of DDA 2000.

• 2004 – First RSA.2004 – First RSA.

• 2004 – 5-year NDCMP.2004 – 5-year NDCMP.

FUNDINGFUNDING

• TOTAL BUDJET FOR DEMAND TOTAL BUDJET FOR DEMAND REDUCTION: REDUCTION: I MILLION USD (2005-2006) I MILLION USD (2005-2006) (TRIPPLED OVER LAST 5 YEARS)(TRIPPLED OVER LAST 5 YEARS)

• TREATMENT FOR SUBSTANCE TREATMENT FOR SUBSTANCE ABUSE IS 100% GOVERNMENT ABUSE IS 100% GOVERNMENT FUNDED.FUNDED.

UNIQUE CHALLENGEUNIQUE CHALLENGE• IMPLEMENTION OF EFFECTIVE IMPLEMENTION OF EFFECTIVE

TREATMENT INTERVENTIONS IN TERMS TREATMENT INTERVENTIONS IN TERMS OF SUBSTITUTION THERAPY WITH OF SUBSTITUTION THERAPY WITH METHADONE & BUPRENORPHINE.METHADONE & BUPRENORPHINE.

• IMPLEMENTION OF HARM REDUCTION IMPLEMENTION OF HARM REDUCTION STRATEGIES TO LIMIT THE SPREAD OF STRATEGIES TO LIMIT THE SPREAD OF HIV & HEPATITIS.HIV & HEPATITIS.

• DEFINING A CLEAR-CUT STRATEGY ON DEFINING A CLEAR-CUT STRATEGY ON THE ISSUE OF HIV IN THE PRISONS. THE ISSUE OF HIV IN THE PRISONS.