x Abu Dhabi, UAESunday 23 July 2017

UAE facing up to the stigma and the challenge of drug abuse

The number of people seeking help for drug abuse is growing, while their age is decreasing – but are these simply the signs of a society more willing to address the problem?

Dubai Customs inspectors using a special canine unit search for drugs in Jebel Ali Port earlier this month. Sarah Dea / The National / Jun 2104
Dubai Customs inspectors using a special canine unit search for drugs in Jebel Ali Port earlier this month. Sarah Dea / The National / Jun 2104

Khalifa, an Emirati, was a heroin addict and alcoholic for 25 years.

His habit cost him his career in the army, his family, his friends and his health.

At the height of his addiction he would binge on drugs and alcohol, then spend two days sleeping it off.

“I used to spend most of my time with a group of old friends. Some travelled in pursuit of higher education and made a success; now they hold good positions, company managers, school principals or deputy principals, et cetera. The others, including me, chose drugs pursuit.”

Now 46 years old, Khalifa is in recovery. He was treated for more than seven months at the National Rehabilitation Centre (NRC) in Abu Dhabi, undergoing a combination of detoxification, counselling and moral guidance. The NRC now uses his story as a warning about the dangers of drugs and alcohol, and also to encourage other Emiratis to seek help.

So what triggers such addictions? “It’s peer pressure for young people, travelling abroad, life stresses, problems at home, family complaints,” says Dr Hamad Al Ghaferi, the general director of the NRC.

“Some students say that ‘it helps us to study’, so they go for a stimulant. But the majority of our people… it is peer pressure, life stresses and family conflicts.”

Over the past few years, the NRC has grown from an 18-bed ­inpatient clinic in a five-storey building in a residential area of Abu Dhabi, to a network of ­inpatient, outpatient and social reintegration programmes operating throughout the country. But while its main inpatient centre in Khalifa City A has 120 beds, staff shortages mean only 70 are operational. Land has also been set aside in Ajman to build another NRC clinic for those living farther from Abu Dhabi, on the request of the Ruler of Ajman.

Dr Al Ghaferi, an Emirati himself, is adamant that the UAE is heading in the right direction in its drug-prevention policies and that seeking help for addiction has become easier.

“I remember when we started with 18 beds. We had [only] one patient for almost six months. It was a challenge at that time, all the people didn’t know the NRC. The awareness about the drug problems wasn’t of the standard to allow them to go and seek help. And people were afraid to go to these kinds of facilities because of the stigma itself. That picture has diminished.

“People started to know there were services and they knew about the law and their rights, and how to seek help.”

The NRC has worked hard over the past four or five years to build an expert staff, he says. Many have received specialised training in the US, from groups like the National Institute on Drug Abuse, International Society of Addiction Medicine, and McLean Hospital, one of America’s top psychiatry hospitals.

While proud of the work being done, Dr Al Ghaferi admits the number of drug users appears to be on the rise – or at least the numbers of people admitting they have a problem and seeking treatment is increasing. More worryingly, the average age of patients is decreasing and the centre now operates separate services for under 18s. In all, the NRC receives 15 to 20 new patients a month, some of whom are forced into treatment, often by the courts as a condition of sentence to avoid being imprisoned; Dr Al Ghaferi describes the overall number as “alarming”. All of the NRC’s patients are UAE nationals. Expatriates arrested on drug crimes are deported after serving their sentences. The vast majority seeking treatment are men, but the number of women is also slowly increasing.

“In 2002 men hesitated from coming … there was social stigma, they are rejected from their families,” says Dr Al Ghaferi. “The women are at this stage now, but in another five years’ time I think we will be having plenty of females.”

Without adequate data, it is impossible for authorities to know the scale of the problem they are facing.

The United Nations Office on Drugs and Crime (UNODC), which set up an office in Abu Dhabi four years ago, is currently working with the NRC to produce a comprehensive “situation assessment” to make sure the needs of drug users are being met. The project has been running for almost two years now and will be the most comprehensive drug data collection the country has ever had. It looks at everything from the age of onset of use to the triggers for relapse.

“It’s really important to know what you are facing,” says Dr Asma Fakhri, a UNODC drug control expert. “Once you have these numbers, what do you do with them? If you know there are certain months of the year when you have a larger seizure of heroin, why is it these specific months you have a high seizure and why is it other months you have a low one? Is it around a time of summer vacations and people are not really working? Or when you are seizing less, is it really that there’s less production around that time?

“You can know so much from that first baseline and first collection of data. You get a piece of the puzzle, but when you start collecting the information year after year after year, you start seeing the trends and that’s where the real picture starts to appear.”

Dr Philip Robins, the author of a new study Narcotic Drugs in Dubai: Lurking in the Shadows, paints a less rosy picture of the authorities’ response to the increase in circulation of narcotics, a response which he says has been slow and largely ineffectual. For example, he describes the arrest and deportation of expatriates for drug crimes as counterproductive: “As far as the supply side goes, expatriates are fearful of being ejected from the country if they are seen to have knowledge of illicit drugs, even if this knowledge could be volunteered for use by the authorities,” he told The National via email. “I would add that it would be better for the credibility of the authorities if they were not so fixated with minuscule amounts of soft drugs brought in by mistake.”

For expatriates, drug treatment or rehabilitation takes place inside prisons. Little is known about the quality of prison rehab services and the Dubai Police did not respond to interview requests from The National. Dr Robins, who is university reader in the politics of the Middle East and a faculty fellow at St Antony’s College, University of Oxford, said his own efforts to speak to them for his academic research were ignored.

According to Dr Robins’s report, published in the British Journal of Middle Eastern Studies, efforts to collect reliable research data are hampered by the “closed nature” of Emirati society, the essential ­illegality of drugs and the extensive surveillance techniques put in place by the state.

It’s fair to say that collection of data about drugs has been quite fragmented and sporadic in the UAE until now. Figures are collated by individual agencies and rarely combined or examined as a whole.

But because the drug issue in the UAE is relatively new and the scene changing so rapidly, it is difficult for authorities to keep up.

“We can really go back to the 1980s and to be fair, many other regions and countries have been at this for a long time: collecting data, setting up observatories in their countries where different ministries – health, social services, youth and sport – collaborate and share information and data,” says Dr Fakhri, who disputes that the country has been in a state of denial about drugs.

“You can’t really expect the same thing from the UAE where the collection of data in the first place has only recently started.”

The most accurate public information on drug use in the country is contained in the annual World Drug Report, produced by the head office of the UNODC in Vienna.

The report gives at least some indication of what is going on in the UAE and the wider region. In 2012, for example, it reported increases in opiate seizures in many countries in the Middle East but states that “a lack of data makes it difficult to define whether these increases imply an increase in heroin use in the region, or whether traffickers are seeking alternative routes”.

The UAE has also registered an increase in seizures of cocaine and other drugs. It also refers to new trafficking routes through Iraq and the Middle East, particularly of heroin, but says it remains to be seen whether this indicates an increase in heroin abuse. The UAE was also cited by Uganda, Poland and Thailand as being a transit country for seized cocaine that reached their territories in 2011.

“You could imagine how classically vulnerable the UAE and other Gulf countries are to illegal trafficking,” says Dr Hatem Fouad Aly, the representative and head of office at the Abu Dhabi UNODC, “not only in drugs but in illegal trafficking in general, which takes a lot of advantage from the political, economic and social stability in the country.

“And its high connectivity to the rest of the world … makes it vulnerable as a transit country.”

Prior to the 1980s, Dr Robins writes, most of the drug use was limited to the Indian, Iranian and Pakistani communities and a few older UAE nationals. After the 1980s, the types of drug users diversified, shifting from hashish to the much more potent and addictive heroin.

“We used to see cannabis, heroin and alcohol and the past five or six years the majority of patients come with a combination, mainly those who have been on prescribed medication. Most are medicated prescription tablets because it gives the same effect as opiates.”

According to Dr Robins’s report, the illegal use of prescription drugs is fuelled by pharmacies who issue them without a prescription, by repeated use of the same prescription and by prescriptions being submitted to multiple pharmacies.

The Health Authority – Abu Dhabi sends out circulars to pharmacies alerting them to controlled prescription forms that are “unaccounted for”.

The abuse of prescription drugs is linked to the market for trafficked drugs such as heroin: opium harvested in Afghanistan has a one or two month shelf-life so it lands quickly on the UAE market. The activities of border control also impact the market, as one large seizure of trafficked drugs can have an effect on prescription drug abuse almost immediately.

“For example, if the drug enforcement agencies are highly activated and catch a lot of smuggling, there will be a decrease in that amount of heroin or cannabis or whatever, and the use of medicated prescriptions will be high,” says Dr Al Ghaferi. The smugglers’ methods are always changing in an attempt to evade the authorities, and the Ministry of Interior only recently noticed a “dramatic increase” in smugglers using small shipping vessels, according to the UNODC.

According to Dr Robins’s paper, Dubai’s drugs policies focus too much on breaking the supply of drugs, rather than reducing the demand. “Dubai is institutionally and experientially poorly placed to develop an effective strategy on demand-side activism,” he writes, citing a chronically underdeveloped voluntary and non-governmental sector.

He cites the example of Lebanon, whose “lively” NGO sector in the drugs field has been successful at helping its government stay up to date with global best practices on drugs policy and also effective public awareness campaigns. “In Dubai, such matters are old-fashioned in their treatment and likely ineffectual in practice, such as periodically requiring imams to sermonise on the moral threat posed by drugs.”

He is also critical of the country’s zero-tolerance approach, given the perceived increase in drug use. “The draconian measures that operate in Dubai have acted as a disincentive to foreign workers to cooperate with the authorities over the illicit aspects of trafficking,” he writes.

Speaking at a conference in March, Lt Col Juma Al Shamsi, of the Dubai Police’s general department of anti narcotics, urged drug users to come forward and seek help as part of a campaign called “Hand in hand to protect our children”.

A month before this, Dubai Police announced the success of a social rehabilitation programme. It said it had helped more than 500 nationals recover from drug addiction since 2010. Participants involved in the programme were given random drug tests and those who tested positive would be subject to legal action.

It is this type of zero-tolerance approach that Dr Robins says does more harm than good. He describes the effect of the police’s random testing as “intimidatory”.

Dr Aly, a former criminal judge in Egypt who went on to work with the UN in Vienna, says it is wrong to dismiss this approach. “The zero-tolerance approach is only one of the instruments,” he says. “It would never work on its own. It could work only when you put together a comprehensive set of instruments.

“You have to give an alternative and that’s what the country is trying to do. Yes we are going to prevent you from taking drugs again, but yes we are going to help you to recover from drugs, we are going to help you give up drugs, we are going to help you improve your social situation and we are going to help you through the rejection of the society and the work environment and the study environment. This is the only way we think that zero tolerance could work, within a bunch of other instruments.”

One of the main instruments Dr Aly refers to is social reintegration and aftercare services, such as legal aid to help with the criminal justice system, and vocational training to help addicts get back into work.

“In Dubai, the bottom line is that drug addiction ‘remains a taboo in many circles’. Within society at large there is a strong social stigma attached to drug dependence,” says Dr Robins’s report. Former drug addicts and other people involved in illegal activity can find it hard to reintegrate back into society.

Earlier this month the NRC announced a new partnership with the Abu Dhabi Tawteen Council, a body responsible for getting UAE nationals into employment. The Council agreed to offer nominated former NRC patients training and job opportunities. This type of public declaration to support former drug users would have been unheard of 10 years ago when the social stigma was at its worst.

Dr Al Ghaferi well understands the important role social stigma plays in people suffering from addiction. “As nationals, normally we get a little bit scared of irregular behaviours. Why do people go and drink? Why do they go and abuse? The social life here is very nice and the government helps us with many issues… when I was a kid, we had free homes, free education and still now there is free education and health. So we were surprised when people went to these behaviours. There was a kind of dissatisfaction with the behaviour. The family would normally try to seek help by taking them to the normal hospitals.

“Even now people may ask to go out [of the country] because of the social stigma. Nowadays the social stigma varies. For example, people from a certain class say, ‘we better go and treat our sons outside the country’, afraid of the stigma. Other people say, ‘we have no problem, let’s be treated’.”

Both the NRC and the UNODC cite high-level approval from the Government as being the driving force behind the advances in drug treatment and rehabilitation.

“The most important step to solving a challenge is to recognise that there is a challenge,” says Dr Aly. “The most difficult part of the drug challenge is usually the stigma, and when the stigma is lifted, as is the case here, it is much easier to work with the national authorities on responding to the challenge.”

The past 18 months have seen something of a shift to a more flexible approach to the drugs issue, Dr Robins writes. One of the reasons, he says, is the realisation that keeping discussion and acknowledgement of the growing levels of drug use suppressed is untenable. He calls on policymakers to better address the physiology and psychology of addiction, which would require more facilities for recovering drug users and outreach workers to support those at risk of relapsing.

But according to the authorities, this is exactly what is happening and the future for targeted and well-organised drug prevention looks brighter.

Mitya Underwood is a senior features writer at The National.

munderwood@thenational.ae