The Opioid Crisis in Kenya
The narrative of the opioid crisis portrayed in the news is often through a North American lens, failing to reflect the diversity in the sources and contributors to this crisis in other countries. While prescription opioid use might be a catalyst for the opioid crisis in high-income countries, the story of rising rates of opioid use disorder (OUD) and opioid consumption unfolds differently in low-income countries (LICs) like Kenya (1).
A country in East Africa, Kenya has experienced a rise in opioid use and OUD over the past decade.1 However, the sources of the crisis in Kenya are different from the sources in Western countries. LICs like Kenya only account for approximately 6% of global prescription opioid consumption.1 Moreover, prescription opioids for clinical pain management are not readily available in Kenya.1 As such, the majority of the opioid usage that leads to OUD and rising rates of opioid consumption is illicit.1 In addition to heroin, an illicit opioid whose use has been on the rise in Kenya, illicit pharmaceutical opioid consumption is also a major contributor to the crisis (1). Historical and current patterns of drug transport have helped establish opioid markets in countries like Kenya (1). These markets distribute opioids, with 87% of global illicit pharmaceutical opioid seizures occurring in Africa (1). These markets promise wealth, further fueling the crisis (1). Heroin trafficking and shortages over the past decade have also impacted drug usage, with people with OUD resorting to desperate measures during shortages, increasing the risk of mortality and morbidity (1).
In Kenya, the high rates of injected drug use make transmission of infectious diseases a factor to consider (1,2). Transmission of diseases such as Human Immunodeficiency Virus (HIV) and Hepatitis B and C virus (HBV and HCV) can increase alongside opioid consumption (1,2). Approximately 18,000 individuals inject drugs and the HIV prevalence in this population is 18.3% (2). More specifically, the prevalence of HIV and HCV in people who inject heroin is 87.5% and 16.4% respectively (3). There is also a 17.9% risk of coinfection (3). People who inject drugs (PWID) most commonly inject heroin, which has coincided with rising rates of HIV in Kenyan coastal cities.1 Barriers and challenges that perpetuate the risks of OUD in Kenya include stigma, persecution by law enforcement and subsequent incarceration, religious and community condemnation, and treatment accessibility issues (1). The heavy burden of infectious disease on the Kenyan population has led to limited availability of OUD treatment, needle and syringe programs (NSPs), and mental health and addiction health care workers (1). Women also faced increased barriers, with many studies not including women in sample populations and a lack of women-specific harm reduction interventions (1).
In 2018, Kenya became one of the only African countries to attempt to implement OUD harm reduction programs (1,2). A 2018 study by Rhodes et al. found that implementing methadone treatment programs helped with OUD recovery (4). Furthermore, a 2019 study by Guise et al. also found that methadone treatment could both prevent and facilitate the treatment of HIV (2). Methadone treatments effectively treat opioid dependence, mitigating HIV risk factors in these individuals (2). Additionally, methadone treatment was found to enable access and engagement with antiretroviral therapy for HIV, effectively addressing the disease (2). Finally, a 2015 mathematical model on managing HIV and opioid addiction found that opioid agonist treatments such as methadone can reduce HIV incidence (5).
The rise of opioid use in Kenya combined with the success of recent efforts such as NSPs and medications for OUD like methadone makes it an interesting case study that highlights the need for multidisciplinary approaches and increased access to solutions in LICs. The contributors to the opioid crisis in LICs like Kenya are distinct, and individuals facing the crisis in this country face additional barriers in accessing care. As a result, it is important to continue to implement harm reduction programs and dismantle barriers to mitigate both OUD and infectious disease transmission.
References
Kurth AE, Cherutich P, Conover R, Chhun N, Bruce RD, Lambdin BH. The Opioid Epidemic in Africa And Its Impact. Curr Addict Rep. 2018 Dec;5(4):428–53.
Guise A, Ndimbii J, Igonya EK, Owiti F, Strathdee SA, Rhodes T. Integrated and differentiated methadone and HIV care for people who use drugs: a qualitative study in Kenya with implications for implementation science. Health Policy Plan. 2019 Mar;34(2):110–9.
Mwatelah RS, Lwembe RM, Osman S, Ogutu BR, Aman R, Kitawi RC, et al. Co-Infection Burden of Hepatitis C Virus and Human Immunodeficiency Virus among Injecting Heroin Users at the Kenyan Coast. PLoS One [Internet]. 2015 Jul 24 [cited 2021 Apr 3];10(7). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4514798/
Rhodes T. The becoming of methadone in Kenya: How an intervention’s implementation constitutes recovery potential. Soc Sci Med. 2018 Mar;201:71–9.
Rhodes T, Guise A, Ndimbii J, Strathdee S, Ngugi E, Platt L, et al. Is the promise of methadone Kenya’s solution to managing HIV and addiction? A mixed-method mathematical modelling and qualitative study. BMJ Open. 2015 Mar 1;5(3):e007198.