Community and contextual analysis on drug use and drugs policies in Liberia

By Jerome Evanno / Paroles Autour de la Santé (PAS)

Between 4000/6000 “problematic / precarious” drugs users (DU's), frequent at least a hundred open consumption scene (in Monrovia). There are between 10 to 20% of women, the average age is 32/36 years and it has been noted the presence of children. The main illegal drug consumed remains cannabis. However, we were able to observe and confirm a significant consumption of cocaine in the form of crack, heroin (white) smoked with aluminum foil (the most common way of use is smoking), and non-prescription drugs (tramadol, valium, diazepam, etc.). At first, it was easy to see that in Liberia, and more particularly the capital Monrovia, that interventions related to the use and abuse of drugs (from a global health point of view), will require a multisectoral and holistic approach. The analysis of the data collected revealed a strong will on the part of all stakeholders to reform the current law « obsolete and very repressive » and strong expectations and needs on the part of the DU's.

Regarding the recommendations, they have been classified into 5 parts. Firstly, addictology, it will be more precise to reflect on the implementation of a « national rehab center », a « therapeutic community », « capacity building » of medical staff (more specifically for health staff and prescribers), « promote the prescription of methadone and OST », and « create self-support groups and / or support groups ». Then, for the aspects of Harm Reduction, it's recommended to carry out a « community and participatory diagnosis » of the needs and assessments of the DUs, to create « adapted tools », « self-support groups » and to promote « socio-economic reintegration activities ». It will also promote the activities and the Harm Reduction approach during the next funding requests and more particularly with the Global Fund (GF) and PEPFAR.

Regarding health care, we must support and validate the relevance of the implementation of « specific services », « TB / HIV adapted services », « food activities », « mobile health care service » and give « primary medication » without forgeting the mental health approach. Regarding drug policy, the organization of a « symposium for NGO » (position paper, recommendations, etc.), « promote the West African drug model law », support a « technical group » and drug policies / advocacy / lawyers team, a better knowledge of the current law, purpose of « alternatives of incarceration », and fostering participation and « regional / international technical/High level/experts groups ». Finally, for the community approach, although transversal, it is recommended to strengthen them in capacities and promote empowerment and support the implementation of the first community based organization.