The Opioid Epidemic in Africa and Its Impact

Kurth, Ann; Cherutich, Peter; Conover, Rosabelle; Chhun, Nok; Bruce, R. Douglas; Lambdin, Barrot H.

doi:10.1007/s40429-018-0232-9

Cited by 39 publications

(27 citation statements)

References 97 publications

(20 reference statements)

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“…Although females are increasingly recognised as at risk of OUD, there are important differences in their pattern of use compared to males. Opioid use in women in South Africa and the sub-Saharan African region also includes the use of OTC and prescription opioids such as codeine and tramadol (Ann E. Kurth, CN, Peter Cherutich, Rosabelle Conover, 2018;Dada et al, 2019). Local research has also described important barriers that women with drug use disorders have to overcome to access treatment, which is rarely provided in a gender appropriate manner (Rigon, 2021;UNODC, 2019).…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and treatment of opioid-related disorders in a South African private sector medical insurance scheme: a cohort study

Tlali¹,

Scheibe

Ruffieux³

et al. 2022

Preprint

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BackgroundThe use of opioids is increasing globally, but data on opioid use disorder (OUD) in South Africa are scarce. This study examines the incidence of diagnosed OUD, opioid agonist use, and excess mortality among persons with OUD in South Africa’s private healthcare sector.MethodsWe conducted a cohort study of beneficiaries (≥ 11 years) of a South African medical insurance scheme using reimbursement claims from Jan 1, 2011, to Jul 1, 2020. Beneficiaries were classified as having OUD if they received opioid agonists (buprenorphine or methadone), an ICD-10 F11 diagnosis for a mental and behavioural disorder due to opioid use, or an ICD-10 T40 diagnosis for opioid poisoning. We calculated adjusted hazard ratios (aHR) for factors associated with OUD, estimated the cumulative incidence of opioid agonist use after receiving an ICD-10 F11 diagnosis, and examined excess mortality among beneficiaries with OUD.ResultsOf 1,251,458 beneficiaries, 1,313 (0.1%) had OUD. Between 2011 and 2020, the incidence of OUD increased by 12% (95% CI 9%-14%) per year. Men, young adults in their twenties, and beneficiaries with co-morbid mental health or other substance use disorders were at increased risk of OUD. The cumulative incidence of opioid agonist use was 10.6% (95% CI 8.3-13.2) at 3 years after receiving an F11 diagnosis. After adjusting for age, sex, year, medical insurance coverage, and population group, OUD was associated with an increased risk of mortality (aHR 2.29, 95% CI 1.85-2.82). OUD was associated with a 7.63-year shorter life expectancy (95% CI 4.08-10.70).ConclusionsThe incidence of patients diagnosed with or treated for OUD in the private sector is increasing rapidly. People with OUD in the private sector are a vulnerable population with substantial psychiatric comorbidity who often die prematurely. Evidence-based management of OUD is urgently needed to improve the health outcomes of people with OUD.

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Section: Discussionmentioning

confidence: 99%

Diagnosis and treatment of opioid-related disorders in a South African private sector medical insurance scheme: a cohort study

Tlali¹,

Scheibe

Ruffieux³

et al. 2022

Preprint

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“…Opioids for clinical pain management in Africa remain at among the lowest levels in the world (Kurth et al., 2018; Usman, 2020). Consequently, the scale of the problem pales in comparison with the situation in the United States.…”

Section: The Opioid Problem Elsewherementioning

confidence: 99%

Opioids: A ‘crisis’ of too much or not enough – or simply how rich you are and where you live?

Miyachi

Ozaki

Saito

et al. 2021

European Journal of Pain

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The ‘Opioid Crisis’, which originated in Western countries, has been misrepresented and is misinforming the global public. For 20 years, since the advent of the synthetic opioids, 25,000 Americans, on average, have died annually from opioid‐related overdoses. The United States produces and consumes by far the greatest amounts of opioids. National regulations introduced to curb overdoses and restrict opioid availability have condemned many Americans, such as cancer patients or those in need of palliative care, to a life of extreme pain due to lack of access to adequate pain management. As is often the case, US‐driven laws have informed and guided international regulations. Worldwide, 83% of countries have low or non‐existent access to opioids for pain relief. Over 25 million people are at the end‐of‐life stage, with eight million people dying annually in unnecessary pain and distress. Ineffectively controlled pain is a global public health issue blighting the lives of billions of people worldwide with immeasurable human and socioeconomic costs. International conventions regulate the trade and use of controlled medications, including many opioids. The goal is to balance widespread access to optimal forms of pain management with restrictions to govern the use and prevent the misuse of controlled substances. Those conventions are failing to meet their goals. International guidelines to inform national legislation have been compromised and withdrawn, thanks to undue interference from US‐based opioid manufacturers. The new goal must be to ensure equitable access, for all, to opioids and ensure that optimal pain management becomes a central component of Universal Health Coverage. Significance The opioid crisis is, more accurately, a multicomponent global crisis and one that is not fully apparent or well understood. Regulations of the wealthy and powerful to control a surfeit of opioids, which encourages misuse, cannot be allowed to govern legislation in the majority of countries worldwide where citizens have little or no access to opioids to reduce pain and suffering. International conventions must be revised to ensure an optimal balance that allows access to opioids for all those who need them.

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“…Opioid use is increasingly prevalent worldwide, with past-year prevalence of 1.2% globally with a trend of increasing use in Africa [ 1 , 6 ]. In Kenya, prevalence of opioid use is 0.3% in the general population aged 15-65 years, and 1.6% among secondary school students [ 7 , 8 ], while among inpatients with substance use disorders the prevalence is even higher [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

The prevalence and pattern of cannabis use among patients attending a methadone treatment clinic in Nairobi, Kenya

Ngarachu

Kiburi

Owiti

et al. 2022

Subst Abuse Treat Prev Policy

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Background Cannabis use during methadone treatment may negatively impact treatment outcomes. The aim of this study was to determine the prevalence and pattern of cannabis use among patients attending a methadone treatment clinic in Nairobi, Kenya. Methods This was a retrospective study of 874 patients on methadone therapy at a methadone maintenance treatment clinic in Nairobi, Kenya from December 2014 to November 2018. Data on sociodemographic characteristics and drug use patterns based on urine drug screens was collected from patient files. Data was analyzed using Statistical Package for the Social Sciences (SPSS) for windows version 23.0. Results Point prevalence of cannabis use was 85.8% (95% CI, 83.3 – 88.0) at baseline and 62.7% (95% CI, 59.5 – 65.8) during follow-up. A pattern of polysubstance use was observed where opioids, cannabis and benzodiazepines were the most commonly used drugs. The mean age of the patients was 35.3 (SD 9.0) years with the majority being male, unemployed (76%), (51.4%) had reached primary level of education, and (48.5%) were divorced or separated. University education was associated with reduced risk for cannabis use OR = 0.1 (95% CI, 0.02-0.8, p = 0.031). Conclusion Cannabis use is prevalent among patients attending a methadone treatment clinic in Kenya, suggesting need for targeted interventions to address the problem of cannabis use during methadone treatment.

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The Opioid Epidemic in Africa and Its Impact

Cited by 39 publications

References 97 publications

Diagnosis and treatment of opioid-related disorders in a South African private sector medical insurance scheme: a cohort study

Diagnosis and treatment of opioid-related disorders in a South African private sector medical insurance scheme: a cohort study

Opioids: A ‘crisis’ of too much or not enough – or simply how rich you are and where you live?

The prevalence and pattern of cannabis use among patients attending a methadone treatment clinic in Nairobi, Kenya

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