Rapid assessment of drug abuse in Kenya

Sections

ABSTRACT
Historical background
Conduct of the needs assessment study
Reported needs of non-governmental organizations and voluntary organizations
Responses of specialists who treat drug abusers
Gender and age of drug abusers
Treatment
Responses of relevant ministries and departments
Responses of the community
Knowledge of sources of help for drug abusers
Responses of drug abusers
Commonly abused drugs
Why drugs are abused
How drugs are abused
Sources of drugs
Quantities and cost of drugs abused
Reported consequences of drug abuse
Scale of drug abuse and required countermeasures
Supply reduction activities
Treatment and rehabilitation
Demand reduction activities
Collection of drug data
Interdisciplinary collaboration
National and international implications
Summary of findings and recommendations

Details

Author: H. A. MWENESI
Pages: 65 to 78
Creation Date: 1996/01/01

Rapid assessment of drug abuse in Kenya

H. A. MWENESI Senior Research Scientist, Kenya Medical Research Institute, Medical Research Centre, Nairobi

ABSTRACT

A country-wide needs assessment study undertaken in 1994 by the Government of Kenya and the United Nations International Drug Control Programme (UNDCP) revealed that drug abuse has permeated all strata of Kenyan society, youth and young adults being the most affected groups.

The traditional cultural values and discipline of African society prescribed the circumstances under which drugs and intoxicants could be obtained, used and consumed. Perhaps as a result of the erosion of the powers of censure and control at the family and community levels, fewer stigmas are associated today with the use of intoxicants (especially alcohol and tobacco).

One of the main recommendations of the study is that the Government of Kenya should set up specific demand reduction programmes to enlighten and educate the public on the problem of drug abuse. The need for a reassessment of government policy on the treatment of addicts is stressed, and it is suggested that the establishment of non-stigmatizing treatment and rehabilitation centres should be considered. Intersectoral collaboration between different government departments and non-governmental organizations is also proposed.

Historical background

In precolonial days, drugs and alcohol were used and consumed as part of the cultural traditions of the community. The traditional rules and values of most African cultures strictly prescribed the circumstances under which drugs and intoxicants could be obtained, used and consumed. Drinking alcohol was generally the prerogative of the elders-more often than not, of the male elders. So was the use of tobacco. Restrictions were placed on youth, but both men and women elders were free to use it.

Alcohol was not readily available before the coming of foreigners. Although a cultural stigma attached to drunkenness, alcohol was liberally consumed on special occasions such as weddings, birthdays, harvest festivals, funeral ceremonies and other social events.

Drug abuse as a social problem did not exist because strong social cohesion acted as a mitigatory mechanism. The close-knit social communities were torn apart however, by the economic policies of colonialism, which emphasized individualism rather than the well-being of the communities. Colonialism thus eroded the powers of censure and control of the family, and weakened traditional family solidarity. The process of urbanization also led to social atomization, as the values of individualism took root and spread.

Conduct of the needs assessment study

A nationwide needs assessment study covering 22 districts and all divisions of Nairobi Province was undertaken by the Government of Kenya and UNDCP in August and September 1994. The areas covered by the study are shown in the figure below. During the study, 120 focus group discussions were held, with the participation of approximately 1,500 respondents. A total of 211 key informants were interviewed, and 590 in-depth interviews of participants from the various categories of respondents were conducted, the largest number (383) drawn from the drug abusers themselves. A total of 2,301 respondents, aged from 6 to 90, with a median age of 25, participated in the study.

Map of Kenya showing areas covered by the study

Full size image: 10 kB, Map of Kenya showing areas covered by the study

Reported needs of non-governmental organizations and voluntary organizations

Most of the organizations working with vulnerable groups, including drug abusers, identified funding as their main problem. A quarter said that they needed material assistance, especially food, while a smaller number mentioned the need for counselling.

Organization officials were aware of the consequences of drug abuse, but most had no idea what to do about them Most of the organizations appeared to assume that the provision of vocational training and food and shelter would automatically decrease drug abuse. In fact, some of the organizations could be perpetuating the problem by not addressing it directly.

Responses of specialists who treat drug abusers

Ninety-seven health workers of different disciplines were interviewed. The reported number of drug abusers attended to per week ranged from one to many. An average of four drug abusers were seen per month. Although only 13 workers reported having seen persons with problems of injecting drug use, this is a significant number in terms of its consequences.

Gender and age of drug abusers

In most communities, cultural traditions prohibit women from using drugs. The relatively few women who do abuse drugs are mostly depressed, and tend to take alcohol or prescribed drugs (such as tranqullizers), which are not readily available.

The informants reported differences in drug abuse based on age. Young men tend to abuse bhang, whereas the elderly abuse alcohol. The lowest age of reported abuse was six years (among street children). Teenagers and young adults were the most frequently reported patients with drug-related problems, while abusers 50 years of age or more somehow manage to cope with abused drugs, mostly alcohol and bhang.

Treatment

Counselling seems to be offered by most people dealing with drug abusers. Health workers deal with drug-related problems against a background of competing health needs. Drug abusers are unlikely to be given special attention in health facilities, most of them ending up in psychiatric units of provincial hospitals. Major problems are the lack of proper facilities for private counselling and the shortage of funds for drug-abuse-related treatment, especially patient follow-up activities. Patients usually share rooms with mentally ill persons, and respondents described the treatment offered to drug abusers as inadequate.

Responses of relevant ministries and departments

Government respondents highlighted the lack of specific policies on drug and substance abuse, except in the Police Department which has a clear mandate for supply control. The Prison Department is responsible for the detention of abusers and peddlers until they finish their terms. They are then released, and there is no follow-up.

A prison official said: "These people are sick ... I mean the users. Peddlers and traffickers are out for economic gains and ... require no sympathy. Government farms should be used as rehabilitation centres for drug abusers. When we mix them up with other criminals and just hope their drug problem will go away, we are cheating ourselves. They become habitual inmates, and some even learn other vices from the prisons."

In academic institutions, abusing students are punished or dismissed, actions that do not reduce the drug problem.

Responses of the community

A total of 153 respondents were interviewed.

Parents had this to say: "For the first time, someone is willing to talk to us without condemning us as parents. When they call you to inform you about your child's drug problem, they accuse you of unthinkable things."

Teachers were more observant of their charges. Most of them however, having never seen a cannabis plant or any drugs of abuse, could not identify such drugs if shown to them. Some teachers commented as follows:

  1. "You cannot tell what it is, especially when they come from home already high";

  2. "Parents who take alcohol deny that their children are on drugs. And it is children from rich families where they are given a lot of pocket money which they spend on drugs. When you inform them they claim you are tarnishing their name";

  3. "The drug-abusing pupils are fearless, destructive and always causing trouble. Parents whose children are expelled from urban schools because of drug- related problems bring them and their drug problems to our (rural) schools."

The 13 employers interviewed saw drug abusers as a liability, and most of them reportedly dismissed anyone found to be a drug abuser in order to forestall potential absenteeism and higher health costs. On the other hand, employers felt that taking cannabis was probably a good thing for workers on heavy-duty jobs, so long as they did not get caught, because it made them work longer and harder.

Discussions in Nairobi showed that pupils are fully aware of what drugs are, what they are called and where to find them. A question asked in a primary school in Nairobi evoked the following response: "We know of Mandrax, glue, bhang, petrol, miraa, cigarettes, heroin, cocaine. Miraa is available in Eastleigh, chang'aa right here in our estate, and bhang comes from other areas. Mandrax, heroin and cocaine come from outside Kenya with tourists and foreigners."

The same question was put to secondary school students. The list was similar to that of the primary school pupils. Moreover, the students viewed alcohol as a drug only when it was a local brew.

Rural students mentioned Piriton, Roche 5, khat and local brews, but not heroin or cocaine. The discussions also clearly showed that Mandrax is widely available in Kenya.

Outreach workers such as community volunteers and members of religious associations were also interviewed about their contacts and relationships with drug abusers. Almost all of them were working with abusers from charitable motives and out of concern for the problems of their communities. The problems they faced in dealing with abusers are those of denial, and often ignorance about what was being abused, except in the case of khat, alcohol or cannabis (because of the smell). Six of the nine respondents in this category reported knowing from 20 to 50 abusers in their communities, describing them as: "sick people who need love and care. Parents become too harsh and throw them out. This doesn't help them. Schools do the same thing. Where do they expect these abusers to go?"

Religious leaders especially felt that the breakdown of the social fabric was the problem. A sheikh from the coast lamented: "Within the community they are not concerned about drug abusers, especially if they are not from their own families. The schools expel them and those who are employed get the sack for drug abuse. The vicious circle is maintained."

All the respondents felt that a breakdown in the fabric of society, poverty, greed and the encroachment of foreign values in all spheres of life were to blame for the phenomenon of drug abuse.

Knowledge of sources of help for drug abusers

Respondents generally did not know any sources of help for drug abusers, but they were of the opinion that prisons and approved schools failed to meet their needs. Parents, in particular, were frustrated that apart from turning their offspring over to law enforcement agencies or taking them to mental health institutions, there was no other source of help. Pupils and students felt that schools where counselling was available provided some relief.

Responses of drug abusers

Through snowball sampling and social networking, a total of 383 drug abusers were interviewed, the largest of the subsamples studied (see tables 1-3). Although drug abuse is asensitive type of behaviour to investigate, the data obtained from the interviewed drug abusers were consistent, and there was no reason to doubt the honesty of the respondents. If there is any bias, it is assumed to be in the direction of underreporting. Estimates may thus be lower than their true value, and not vice versa.

Table 1. Incidence of drug abuse

(Size of sample: 383 males + 30 females)

Drugs Abused

Number of abusers

Cannabis
350
Tobacco
320
Alcohol
300
Solvents
200
Khat
100
Heroin
24
Cocaine
19
Mandrax
19
Hashish
7
Other a
100

a Other includes pethidine-aspirin, codeine, benzodiazepines and a host of barbiturates.

Table 2. Breakdown of drug abusers by age

(Size of sample: 383 males + 30 females)

Age group

Number of abusers

5-9
29
11-19
100
20-29
100
30-39
104
40+
50

Table 3. Status of drug abusers

(Size of sample: 383 males + 30 females)

Category

Number of abusers

Unemployed
123
Employed
80
Homeless
100
Student
80

A total of 58 prisoners convicted of various drug-related offences were interviewed for the project Of these, eight were non-Kenyans, including four from Nigeria, three from Pakistan and one from the United Republic of Tanzania. They were all imprisoned for trafficking in heroin and cocaine.

Commonly abused drugs

Among street children, the first drug of abuse is usually tobacco, followed by gasoline and then glue. When a little older, they start on cannabis "and are ashamed to be seen sniffing glue". Abuse of solvents, however, is not confined to street children. Adults also reported abusing gasoline and glue when "nothing else was available".

Khat has taken a hold in varying degrees throughout the country. Although herbal cannabis is widely abused, the abuse of resin or hashish was also found in the coastal region (see table 4).

Table 4. Commonly abused drugs by region

 

Number of abusers

Drug

Nairobi (65)

Coast (51)

Rip valley (46)

Eastern (76)

Western/Nyanza (77)

Central (68)

Alcohol
40 22 30 55 38 40
Amphetamine
29 18 15 30 4 21
Cannabis
45 30 29 24 77 32
Cocaine
5 7 2 1 2 2
Hallucinogins
7 7 5
..
..
1
Hashish
..
7
..
..
..
..
Heroin
13 10 1
..
..
..
Khat/miraa
42 47 20 59 22 10
Mandrax
8 4 2
..
..
5
Solvents
20 13 9 10 8 11
Tobacco
58 35 29 40 44 51
Other
20 9 5 2 1 4

Note: Figures in parentheses indicate size of regional sample. Total sample = 383.

Valium is frequently combined with khat in order to cancel out their opposing effects. Phenobarbital is also combined with alcohol for faster results. Other abused drugs include codeine-based painkillers and cough syrups that cause drowsiness". They are used as antidotes to khat.

The question about the approximate number of friends a respondent knew who abused drugs yielded interesting information. About 50 respondents said that the number was too large to estimate reliably, but the average figure given was between 5 and 10 friends whom the respondent could mention by name. One respondent commented: "This drug problem in Kenya is becoming a serious problem. When I first took heroin in Nairobi (in 1987) there were less than 20 addicts in all. Now, seven years later, there are close to 1,000 addicts in Nairobi. It has increased at a rate of approximately 100 to 150 (addicts) per year."

Why drugs are abused

After establishing who was abusing drugs and for how long, the study tried to determine why people abused drugs. The answers are given in table 5 below, in order of importance.

Table. 5. Aetiology of drug abuse

Reason of drug abuse

Number of respondents

To cope with problems
350
To feel good
300
To kill boredom
200
To gain strength and courage
200
To belong
152

A majority of those who said they were using drugs to cope with problems included the unemployed, street children and students at tertiary levels. The unemployed, commercial sex workers and street children said that they could cope better with their situation by not thinking about it. One said: "I take drugs to kill time. When you have no job you hang around certain joints and there are always drugs." Another lamented: "With the bad economy and no hope for some of us, one's only escape is in drugs, and you carry on as if nothing is happening." Commercial sex workers reported that they abused drugs to cope with their difficult occupation: "It makes you feel better," said one.

Students believe that reading all night for examinations will improve their grades. "Most of us take khat to remain awake. We all feel we are gaining more, but it leaves one very fired, so then we take Roche 5 to be able to sleep." In institutions of higher learning, drug abuse has become the order of the day, because of the high level of tolerance among comrades.

The most graphic explanation of why drugs are seen as a crutch was given by street people, adults and children, who emphasized that drugs were not a problem, but a solution to their problems. They reported that their major problems were food, shelter, harassment and disease. Their comments echoed a common theme: "We abuse drugs to be able to cope with street life. Hunger and cold are especially bad." And "All of us on the streets use drugs. If you refuse, you will starve. There is no mother to go to. Our money is for food and drugs."

Respondents who reported taking drugs to "feel good", especially those using tobacco, alcohol and cannabis, felt that they were not addicted, and that their drug consumption was "just a habit". That was noted even among heroin and cocaine abusers, who did not see themselves as such, but as social users. "I take brown sugar when I want to. In fact I sniff it with my wife. We get it only when we need it because it is expensive. We harm nobody."

How drugs are abused

The traditional mode of use for each drug is smoking, chewing, sniffing, inhaling and drinking. Injecting drug use was reported in very few cases, by medical workers (five cases), by persons who abused valium and pethidine, and in two other cases of heroin injection.

Sources of drugs

Traffickers and peddlers have sophisticated ways of transporting drugs. Cannabis poses the biggest problem for traffickers, because it is bulky and has a strong smell. To circumvent this problem it is transported in loads of fish or, while still green, in bundles of vegetables from western Kenya to Nairobi and other towns. Local brews are disguised and transported to their destinations.

In general, the data show that it is the most widely and easily available drugs that are abused. These include "social drugs" such as tobacco and alcohol and, increasingly, miraa, which is legal, and cannabis, which is illegal. The most disturbing finding of the study is that children and youth on the street obtain solvents, paint thinners and glue from shoe repairers all over the country.

Mandrax is peddled on the streets by women and by middlemen who obtain it, from chemists.

Quantities and cost of drugs abused

The reported expenditure to support the habit varies from 50 to 2,000 Kenya shillings (K Sh) (1 to 5 United States dollars) per week, depending on the drug abused. One respondent, without saying how much he pays for heroin, reported: "I started using heroin when I was in India. Now I get it in Nairobi at a discotheque. I spend K Sh 50 per day for Mandrax and K Sh 30 for LSD (lysergic acid diethylamide). I take an ounce of brown sugar per day."

One young girl of 14 years said: "I take bhang but I have never bought any. I'm given it by my friends or by those for whom I sell. We pretend to be begging from drivers, but some of them are buying the drugs at the street lights when cars stop."

Reported consequences of drug abuse

Almost 50 per cent of the abusers have had an encounter with the law as a result of their drug abuse, most having been in prison for between one and three months. They have been incarcerated for possession, but more often for violence and petty crimes such as stealing from people on the streets. Some of the continents made on the consequences of drug abuse are given below.

"Using drugs is a symptom not a disease. It is a very expensive habit to support. I have seen very wealthy people turn into paupers because of their use of drugs. At the same time, you also make the dealer very rich."

"I know just too many people who have died as a direct or indirect result of using drugs. Seven of them were my friends; they all died very young."

"The most difficult thing to do is to stay off drugs once you have become addicted. The physical and mental agony of withdrawing is usually too much for people to bear. People often find that they can only stop in a hospital and this problem has only just begun in Kenya. That has happened in the last few years, so doctors here are only just learning how to deal with cases of drug addiction."

Scale of drug abuse and required countermeasures

Since the study was unable to cover the higher strata of society and other nationalities living in Kenya, the current findings are biased towards the middle class and lower income strata of Kenyan society. This by no means implies,that the upper strata are not affected by the problem.

The key finding of the study is that Kenya falls squarely under the category of "apparently endangered country". The term refers to a country where the number of seizures and the amount of seized drugs, reports from health and social workers and prison and other statistics indicate a rising trend in drug abuse. The available literature confirms that trend.

Many respondents thought that there was not as much danger in beer and spirits as in local brews. All contended that preventive drug education might serve to remedy the lack of knowledge about drugs and to reverse the current trends. Some of the views expressed included the following: "Employment opportunities should be created for youth who are idle ... Guidance, counselling and education on dangers of drugs should start right from primary level onwards ... Anti-Drug films should be shown both to the public and in school ... (with the) creation of more recreational facilities throughout the country."

The Government was requested to set up national rehabilitation centres that are nondenominational and independent of psychiatric hospitals. It was suggested that "... educating parents, teachers and the community on (the) dangers of drugs will be helpful ... There should be more approved schools to train and counsel the abusers ... (and) more recreational centres to occupy those idle and unemployed ... Activities like involving street children in cleaning the town and estates will reduce drug abuse."

The urban demand for bhang has led to its large commercial production in rural areas and its discovery as a source of income by a rural population which in the past never regarded bhang as a commercial community.

Supply reduction activities

The Government is urged to reinforce and encourage officers of the Anti- Narcotics Unit who are currently overwhelmed by work, stress, constant anxiety, the threat of corruption by drug dealers and public suspicion. At a time when the consequences of drug abuse are more serious than ever, the total of only 100 officers for the Unit is inadequate. Respondents were concerned that the Unit should be well paid and motivated in order to sustain its integrity.

Treatment and rehabilitation

There is an urgent need to create treatment centres for drug abusers. Successful treatment also helps to curb vice related to drug abuse, and facilitates smooth entry of abusers into rehabilitation programmes. Drug-abuse treatment centres, which are critically needed to counter increasing drug abuse, should be set up in major hospitals. In Kenya, drug abusers are currently treated in the psychiatric units of provincial hospitals. Those units are staffed by medical doctors, nurses, clinical psychologists, health educators and counsellors who need specialized training in the use of the modem techniques available to treatment centres. Each province should have at least one trained person to serve as a referral point. A national policy on treatment approaches for drug-dependent persons should be established and periodically evaluated.

The awareness of the community should be raised through preventive education to promote its involvement in rehabilitation activities, thereby contributing to the prevention of relapses. To enable them to perform their tasks more confidently and competently, staff of non-governmental organizations and other community organizations already working with drug abusers should receive in-service training to enhance their skills in dealing with drug abusers.

While teachers can reach those in schools and other institutions of learning, non-governmental organizations would be the entry points into the communities, and would help those out of school and those with special needs, such as street children commercial sex workers, the homeless and socially deprived persons. They can also form the basis for training of trainers in preventive drug education.

Demand reduction activities

Although drug abuse is widespread in Kenya, the problem tends to be downplayed. The general belief is that the Government is only interested in the control of hard drugs and not social drugs such as tobacco, alcohol and miraa. Attempts have been made to highlight the consequences of drug abuse, especially accidents and deaths due to drunken driving, but not much else has been done to reduce demand. When information on drugs is available, it usually relates to supply activities, the public being reminded of the stiff penalties incurred for such offences. In a nutshell, demand reduction activities in the country are grossly inadequate.

Public enlightenment

Messages should focus on promoting awareness that drugs are dangerous, that they do not enhance personal well-being and self-esteem, and that it is possible to deal with daily stress without depending on them.

Different target groups will require different information. Details about the sources of drugs should be avoided in the messages. Information can be conveyed to the public by means of posters, books and pamphlets, films and the mass media (television, radio and newspapers). For those channels of information to be successful, they must convey simple, clear and intelligent messages. They should also at all times complement one another. Disseminating information will involve the use of trained health and community educators.

Preventive education should be targeted at families, women, workers in their workplaces, youth institutions, pupils in school and out-of-school children. Self- assertiveness training permits children to develop a positive image of themselves and learn to say "No" to drugs.

It is proposed that drug education should form an integral part of the regular school curriculum. Counselling masters would be the focal point for drug-related activities in schools. Supplying youth early in life with drug information may determine the trend of drug abuse in the future. It has been said that it is much easier to influence attitudes than to influence behaviour.

Non-governmental organizations and community organizations

Non-governmental organizations are well placed to undertake activities aimed at reducing demand for drugs. The performance of most of them, however, leaves much to be desired. They come face to face with the drug problem on a daily basis, but very few of them take it seriously enough to focus on it. Those that try in a small way to deal with the problem are handicapped by a lack of trained manpower and clear objectives. The majority of the organizations lack funds, and few have assured sources of income.

It is recommended that non-governmental organizations should be identified in each province of Kenya, that they should be well equipped, and that the staff should be properly trained to serve as models for others. They could also be used as referral half- way houses for the proposed treatment and rehabilitation centres. Funds could thus be put to proper use, and programme monitoring and evaluation would be facilitated.

While teachers can reach those in schools and other institutions of learning, nongovernmental organizations would be the entry points into the communities, and would help those out of school and those with special needs, such as street children, commercial sex workers, the homeless and socially deprived persons. They can also form the basis for training of trainers in preventive drug education.

Collection of drug data

The collection of drug data is essential for policy formulation and for drawing up programmes to reduce demand for drugs. No meaningful programmes can be set up without proper data. For example, the data provided by the present study indicate that the worst-affected areas are urban centres, such as Mombasa and Nairobi, and areas close to Nairobi, such as Murang'a and Nakuru. Clearly, these areas should be targeted for immediate interventions.

Data should be continually collected from health institutions, schools, the general population and law enforcement agencies, in order to produce annual reports identifying trends. The data to be collected would routinely include information cases of addiction, drug-related psychosis and drug-related indiscipline in institutions of learning. The Anti-Narcotics Unit should be encouraged to continue its good work of record-keeping.

Interdisciplinary collaboration

Interdisciplinary and departmental collaboration is critical. Officials working in health services, childrens' departments, probation, education, law enforcement and other areas should collaborate in order to minimize compartmentalization and fragmentation of efforts. Collective responsibility is the key to dealing with drug problems. All the above-mentioned programmes designed to reduce demand for drugs need to be coordinated by an independent body, an interministerial drug committee, possibly under the Office of the President. Communities must be involved from the onset. Partners who understand the problem, the solutions and what is expected of them achieve much better results in the long run.

National and international implications

There is an urgent need to formulate policies that effectively address the drug problem and to implement them with a minimum of delay. Issues pertaining to the licensing and advertising of social drugs must also be dealt with. Drug abuse is global, and effort to deal with the problem transcend national borders. It may prove futile for one country to implement programmes to reduce demand and supply, when its neighbours are not doing the same. For instance, several respondents mentioned Uganda and the United Republic of Tanzania as sources of certain drugs. In view of the recent call for the restoration of the East African Community, the countries concerned should be encouraged to work together towards the common goal of eradicating the scourge of drug abuse.

Summary of findings and recommendations

The study revealed that the problem of drug abuse in Kenya is larger than expected, having permeated all strata of society, youth and young adults being the most affected groups. The other main findings of the study are as follows:

  1. The abuse of "social" (alcohol, tobacco, miraa) and illicit (cannabis, heroin, cocaine, Mandrax) drugs is rising perceptibly;

  2. Solvents are being increasingly abused, and not only by youth. They are used, for example, to increase the potency of illicit local brews;

  3. The increasing abuse of miraa is contributing to greater abuse of so-called downers, as abusers of miraa take depressants to counteract the insomnia induced by khat;

  4. Cough mixtures have entered the list of drugs being abused by youth;

  5. Easy availability of dependence-producing drugs is one of the main causes of the upward trend in drug abuse in Kenya;

  6. No special facilities exist for treatment and rehabilitation of drug abusers, and the country has few specific demand reduction programmes;

  7. Existing governmental and non-governmental organizations attempting to deal with the drug problem need greater financial resources, more trained manpower and better knowledge of the problem of drug abuse;

  8. Both government departments and non-governmental organizations have failed to collaborate in dealing with the drug problem, leading to duplication of efforts and dilution of resources;

  9. Existing organizations have great potential for undertaking demand reduction programmes. Non-governmental organizations already engaged in general rehabilitation of disadvantaged persons (street children the handicapped etc.) are best placed to carry out such programmes.

One of the main recommendations of the study is that Government of Kenya should urgently set up specific demand reduction programmes to enlighten the public on the problem of drug abuse. That goal could be achieved through preventive drug education, drug-abuse counselling services and continuous data collection and dissemination of information. It is further recommended that: current policy on detoxification facilities should be reassessed; drug abusers should be treated more humanely; the setting-up of non-stigmatizing treatment and rehabilitation centres should be considered; imprisonment should not be viewed as an acceptable treatment procedure for drug abusers; the crucial role of treatment and rehabilitation facilities in reintegrating drug abusers into society should be recognized, and interdisciplinary collaboration between different departments and non-governmental organizations should be forged.