26.02.2023 Article

The critical frontlines of drug policy in Africa

By Khalid Tinasti
The critical frontlines of drug policy in Africa
26.02.2023 LISTEN

“Do not repeat our mistakes, do not militarize your response to drug supply, do not try to police your way out of drug demand and consumption,” warned the Guatemalan government’s representative, José Briz Guttierez, at the launch of the West Africa Commission on Drugs by Kofi Annan and Olusegun Obasanjo in Dakar in 2014. Back then, he was reminding that West Africa and the Eastern Coast of the continent including South African points of entry, respectively hailed as the new cocaine and heroin trafficking routes, face the same drug-related problems Central America experienced in the 1980s. He insisted that rather than a repressive response that fueled violence, corruption and other illicit economies, African countries are the new forefront to design and adopt drug policies that are both respectful of human rights and more effective in reducing the illegal drug market. Where every other continent failed, Africa has the opportunity to design the 21st century drug control.

This assessment of the situation cannot be more current, as the situation only worsened in the last nine years. Beyond trafficking, local production of synthetic drugs, the grasp of criminal organizations and problematic consumption of drugs are all issues that are increasing at alarming rates in different parts of the continent. According to reported data, the estimated 60 million Africans who use drugs represent almost a third of all drug using people in the world. Correlated to demographic growth, Africans who use drugs are set to reach 86 million consumers by 2030.

Yet, African countries almost universally ratified and religiously implemented the international drug control regime and its three conventions (1961, 1971 and 1988), with its two pillar-objectives: fighting the ‘evil’ of dependency and addiction by eliminating recreational use, and ensuring ‘legitimate’ access to these same substances for medical purposes. Whilst the international and African community focused on eliminating the former through repression—mainly funded by and responding to security agendas of international donors concerned with their position as end consumers, significant collateral damages increased, including in relation to the latter.

The most devastating of these damages on our continent is the silent crisis of access to controlled essential medicines and precursors, mainly opioids and benzodiazepines classified simultaneously as illegal drugs and as medicines essential for anesthesia, pain relief, palliative care, mental health, maternal health and others. In Nigeria, it is estimated that less than 1 percent of the annual needs of morphine are covered, reaching 11 percent in Uganda, a country with a model program for palliative care. Moreover, South Africa’s highest access on the continent with 265 defined daily doses (DDD) of morphine consumed pale in comparison to the UK’s range between 5,000 and 10,000 DDD.

This dichotomy between fighting drugs and promoting medicines originating from the same substances highlights the imbrication of illegal markets of drugs and counterfeit medicines. For example, the complex public health crisis related to the diversion of Tramadol, a less potent opioid used for pain relief in hospitals without access to classified opioid analgesics, illustrates the incapacity of countries to control non-medical use while ensuring the medical one.

The international control regime, consolidated between 1961 and 1988, was established when a large number of African countries were accessing their independence from colonial rule. As their institutional frameworks and organizational capacity were nascent and limited, the strict and transnational drug control regime requested solid state responses to trafficking, corruption and illicit economies. Since this inequitable start, developing economies adopted a perpetual reactive position in front of a cash-based illegal market estimated at an annual turnover of USD 500 billion.

Solutions exist though: harm reduction services prevent overdoses and HIV transmission; decriminalization reduces over incarceration and prison overcrowding; infiltration and intelligence prove more efficient to reduce the violence related to criminal activity. Such a shift in drug control has the potential to create the environment to control the illegal market and to provide access to essential medicines, such as evidenced in the European experience, which relied on a public health approach and proportionate sentences to address its drug-related issues since the 1990s. On the opposite side, in its 50-year war on drugs, the United States spent an estimated USD 1 trillion to no avail with increasing consumption, trafficking and production.

Our continent is now at the frontline of drug control with increasing local, regional and international challenges and implications, and with limited response capacity. A large political debate in regional mechanisms and at the AU level becomes pressing, in order to define which best practice drug control models should be considered, adopted and adapted to our countries’ cultural and socioeconomic contexts.

By Khalid Tinasti
Author is a CCDP Research Associate at the Geneva Graduate Institute; David F. Musto Visiting Scholar at the International Centre on Drug Policy Studies at Shanghai University