Pioneering methadone programme in Dar es Salaam gives hope to thousands
In a discreet corner of the Mwananyamala District Hospital grounds, in the United Republic of Tanzania’s largest city Dar es Salaam, a group of young people queue outside a small window for their daily dose of methadone. Others are taking refuge from the intense heat in the few shady spots available in the dusty yard behind the low building housing the clinic.
In recent years, Dar es Salaam has seen an increase in illicit drug use, particularly heroin, as the large port city has become a pit stop for smugglers en route from Afghanistan to Europe and the rest of Africa. The heroin sold is poor quality but is cheaply available, with one dose costing as little as 1 US dollar.
The most effective therapy for heroin users
Mwananyamala is 1 of 2 hospitals in Dar es Salaam that now make methadone available as treatment for addiction. Methadone maintenance treatment is regarded by WHO as the most effective therapy for heroin users, and methadone was added to WHO’s model essential medicines list in 2005. In combination with psychosocial support, it can help to reduce addiction to opioids such as heroin, prevent infection with HIV and other diseases transmitted by sharing needles, and reduce the criminal behaviour that often accompanies illicit drug use.
Due to stigma, many countries, including a number of high-income ones, have not yet accepted the use of methadone to curb heroin addiction. Globally, opioid replacement therapies such as methadone are used in less than 30% of countries, and less than 10% of the world’s heroin users can access it.
In 2009, WHO published guidelines to help countries treat dependence on opioids and prevent the transmission of HIV and other blood-borne infections.
"We are among the first and the most successful methadone programmes on the continent," says Dr Pilly Sahid Mutoka, the clinic’s Assistant Medical Officer. "We have had other countries, like Kenya, Mozambique and Zambia come over to learn from our experience."
Yusuf Ahmed Mzitto, who goes by the name Kessy, says methadone has turned his life around, after 3 years of addiction and several failed attempts at giving up heroin. Timid and innocent-looking for his 33 years, Kessy began to use drugs in 2013 to cope with the stress of a demanding IT job.
"What drug users fear most is the horror of withdrawal symptoms," he says. "Nothing is worse than that – not the fear of HIV or death. I tried to give up by myself, even locking myself in a room. But nothing worked until I started methadone."
From HIV prevention to rehabilitation
Tanzania’s methadone programme was first piloted at Muhimbili National Hospital, the country’s largest health facility, with funding from the United States of America, in an effort to curb HIV transmission in the country. A year later it was extended to Mwananyamala District Hospital to service people in Kinondoni, a district with a lot of drug users. Now it is seen as a programme whose usefulness goes beyond HIV prevention and can truly rehabilitate young people whose lives have fallen prey to the city’s cheap drug market.
But while Muhimbili and Mwananyamala are able to access methadone easily thanks to donor funds, other health facilities in the Dar es Salaam region cannot. Dr Pilly says that only about 3000 of the city’s 25 000 injecting drug users have so far benefited from the methadone programme.
Kessy also says that there is a lot of fear and stigma linked to methadone. "Drug users say that it is another drug, so they’re scared they will develop another addiction. Drug dealers spread creepy stories about it because they don’t want to lose clients." But the benefits of methadone treatment speak for themselves.
Over time, Kessy has gradually reduced his daily dose of methadone and is now close to stopping treatment altogether.
"I had lost it all – friends, family, job," he says. "My life was miserable. Now I can start living again."