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Middle East

Tunisia drug use grows amid economic stress

Thousands face social stigma over an addiction to Subutex, an opiate-replacement drug that helps heroin users get clean.

Last updated: 28 May 2014 10:40
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Users of Subutex crush the pill and dissolve it in water before injecting it [Robert Joyce/Al Jazeera]

Tunis, Tunisia - Samir Ben Fatoum was 15 years old when he started using drugs. Studying in France, he was living a dream held by many Tunisians. But soon, he said, things fell apart.

"The neighbourhood where I lived in France was full of drug dealers and users. I was living in my aunt's house, I was young with no parental supervision and I was curious to try it," he told Al Jazeera. He spent 20 years as an addict, first to heroin and then to a subtler and more readily available drug.

Back in his native Tunisia in 2000, Ben Fatoum started using Subutex, an opiate-replacement drug that is marketed as a substitute for methadone to help heroin users get clean. Subutex, the brand name of buprenorphine, was first seen in France in 1996. Cheaper than heroin and harder to detect in drug tests and physical searches, it had previously swept through parts of southern Asia and Eastern Europe.

While Subutex has been around for years in Tunisia, treatment workers say its use has increased since the 2011 revolution forced out autocrat Zine El Abidine Ben Ali. An uptick in cross-border smuggling with neighbouring Algeria and Libya, combined with a depressed economy, are driving the addiction. Now, thousands are left further impoverished, ostracised from their families and dying from syringe-spread disease.


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"Subutex addiction is a disaster in Tunisia," Zied Douiri, counsellor at the Chems Centre in downtown Tunis, told Al Jazeera. Chems provides basic services to drug addicts, including giving clean needles to users. While Douiri spoke to Al Jazeera he attended to two users, giving them a handful of hermetically sealed syringes and alcohol wipes.

There are 12,000 Subutex users in Tunisia, according to a 2012 survey by the centre; a new survey is currently under way.

Douiri, himself a recovering heroin addict, demonstrated how Subutex is normally used. One pill costs around 30 dinars ($18.50), but addicts commonly cut them into fourths. One-quarter of a pill is crushed and mixed with water. The mixture is then injected. Needle sharing has made hepatitis C and, to a lesser extent, HIV, prevalent among users. Douiri said 60 percent of all Tunisian drug users have hepatitis.

"The first time, you feel ecstasy," Ben Fatoum told Al Jazeera. "The second and third time, your body starts to get used to it. The third or fourth time you become dependent and feel the pain of dependence. Subutex addicts feel pain in their back. Sometimes you feel too hot or too cold. You can't eat, you can't think. The addict uses Subutex to feel normal again and ease the pain, [it is] no longer for pleasure," he said, adding that he often used the drug twice a day.

 

Douiri said the high can last about 12 hours, longer than heroin. And unlike other drugs, users can usually function normally, going to work and even driving without detection, he said.

Addicts buy the pills on the street. They are smuggled in from Algeria, Douiri said, making the price and availability unstable. While prison sentences are equally harsh for Subutex and other drugs in Tunisia, it is easier to avoid police suspicion with the pills.

"Addiction rates have increased since the revolution," Dr Adel Ben Mahmoud, from the Ministry of Health, said. "There is a war between the Ministry of Interior and smugglers." The government is planning to launch new efforts to fight addiction, Ben Mahmoud said, including the establishment of a national drug authority, a collaboration between the ministries of health, interior and justice and with help from NGOs.

Drug use remains heavily stigmatised in Tunisia, and Douiri said Subutex users fear isolation from their families. In a failing economy, with an unemployment rate at over 15 percent, users do whatever they can to support the habit. "I spent all my money on drugs and some family money too," Ben Fatoum, the former addict, said.

Douiri estimated that one in five of Tunis' illegal street vendors are on Subutex, saying some people also collect plastic bottles out of the trash and sell them to buy pills.


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Exacerbating the problem is that rehabilitation centres are stretched thin. The Chems Centre is run by an organisation known by its French acronym, ATIOST, which aims to raise awareness not only about addiction, but also about HIV.

I'm a symbol for other addicts. They see me and learn about my experience and say, counsellor he can quit after 20 years of addiction, I can too.counsellor

- Samir Ben Fatoum, ATUPRET counselor and former addict

Meanwhile, ATUPRET centre runs a residential rehabilitation programme for drug and alcohol addicts in Sfax, Tunisia's second-largest city, according to Osama Alyangiri, a counselor in the programme. The centre receives funding from international sources, including the Global Fund to Fight AIDS, Tuberculosis and Malaria, and USAID.

Neither ATUPRET nor ATIOST receive government money, which Ben Mahmoud suggested could change as the government develops a new strategy to combat the problem.

Ben Fatoum is now a counsellor at ATUPRET. "The centre has helped me a lot to quit addiction and reconstruct my life and help others," he said. Ben Fatoum said he has been clean since 2008 and is now married and has a daughter.

"I'm a symbol for other addicts," he said. "They see me and learn about my experience and say, 'If he can quit after 20 years of addiction, I can too.'"

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Al Jazeera
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