Rapid assessment of drug abuse in Cameroon

Sections

ABSTRACT
Introduction
Study sites and methods
Results
Discussion
Recommendations
Conclusion

Details

Author: E. WANSI , A. SAM-ABBENYI , R. BEFIDI-MENGUE , F. N. ENYME , F. N. NTONE
Pages: 79 to 88
Creation Date: 1996/01/01

Rapid assessment of drug abuse in Cameroon *

E. WANSI Chief Service of the health Statistics, Ministry of Public Health, Yaoundé, Cameroon
A. SAM-ABBENYI Sub-Director of Epidemiology, Ministry of Public Health
R. BEFIDI-MENGUE Executive Secretary, National Epidemiology Board, Ministry of Public Health
F. N. ENYME Sub-Director of Mental Health, Ministry of Public Health
F. N. NTONE Divisional Chief, Service of Public Health for Wouri, Delegation of public Health for Littoral, Wouri, Cameroon

ABSTRACT

The present paper describes a rapid assessment that was carried out in Cameroon from March to November 1994 and presents a summary of the findings and recommendation. It was the first rapid assessment study conducted by Cameroon in collaboration with the Economic Community of Central African States, with technical assistance from the World Health Organization and the support of the United Nations International Drug Control Programme. It was hoped that the study would help to fill gaps in the information available on drug abuser profiles, the types of drugs abused and the response of the community to drug abuse in Cameroon. In focus group discussions, key informant interviews and interviews with drug abusers, it was revealed that Cameroon was not only used by drug traffickers as a transit country, but was also a drug-consuming country. The drug consumers were both males and females from all age groups. The drugs consumed ranged form traditional drugs to imported cocaine and heroin. Cannabis was the most frequently consumed drug, followed by arnphetamine-type tablets and a broad range of pharmaceuticals. Solvents were mainly consumed by street children in northern Cameroon. Local beer and gin also held a special place in society. In order to tackle the existing problems, programmes offering preventive education and alternative forms of recreation for youth were necessary, and national policies on demand and supply reduction should be harmonized.

*The authors wish to acknowledge the collaboration of the following social scientists: Dr. E. Ewane, Lecturer, Faculty of Medicine and Biomedical Sciences; P. Awah, Researcher, World Health Organization Centre for Research in Human Reproduction; and Dr. C. B. Bikoi, Director of Cooperation, Ministry of Scientific and Technical Research, Yaoundé, Cameroon.

Introduction

In Cameroon, there was a need for information to provide baseline assessments of new trends in drug abuse. The information would be used in making decisions on allocating resources to tackle drug abuse problems. The United Nations International Drug Control Programme, in collaboration with the Economic Community of Central African States (ECCA) and the World Health Organization, decided to choose a country in central Africa in which to carry out a rapid assessment of drug abuse. In the end, Cameroon was chosen because it had ratified all the international drug control treaties.

The ECCA technical commitee for the control of drugs is in charge of the coordination of drug control activities within central Africa. This technical committee coordinates its activities at the national level by inteministerial committees for drug control. This, the first of four such studies in central Africa, was coordinated by the National Drug Control Committee of Cameroon, which had been established by decree No. 92/456/PM on 24 November 1992. The rapid assessment was carried out in four study zones between March and November 1994. Those four zones were identified by the Government during a central ministerial seminar held at Kribi from 19 to 22 April 1994 to review a report based on existing data on the drug situation.

The objectives of the rapid assessment were as follows: (a) to determine the profile of drug use and abuse; (b) to explore the feasibility of applying a rapid assessment methodology in drug research in central Africa; and (c) to propose demand reduction strategies to policy makers based on the findings. Once the objectives had been established, a list was drawn up of activities to be carried out in order to meet the objectives. The activities were planned in phases. For each phase, outputs were clearly defined and methods for gathering the required information were determined.

Study sites and methods

Cameroon is situated in the western part of central Africa and extends north-east from the Gulf of Guinea to Lake Chad. It is bordered by Nigeria on the west, Chad on the north, the Central African Republic on the east and the Congo, Equatorial Guinea and Gabon on the south. The borders are permeable.

The country was divided into four study zones as follows:

  1. The northern semiarid zone of Maroua, which is predominantly Moslem and enjoys free movement and trade with the Central African Republic, Chad and Nigeria;

  2. The central rainforest zone, including Mbalmayo, Mfou, Nkoteng and Yaoundé;

  3. The Douala zone, which is the economic centre and a port of entry by sea and by air;

  4. The Kumba rainforest zone, which has English-speaking inhabitants.

The eastern province was initially considered as one of the study sites but was eventually excluded due to time and financial constraints.

The sampling method used, called snowballing, involved identifying drug abusers in the communities studied and expanding the sample group to include previously unidentified drug abusers in their social circles. Males and females of different age groups were included in the sample group and a questionnaire was used to establish their knowledge, attitudes and experience concerning drugs. Consent was obtained from the subjects before they were interviewed. A total of 454 drug abusers were interviewed.

Key informants from the community were identified and interviewed to gauge community perception and responses to drug abuse. The key informant interviews and focus group discussions were conducted among members of associations or organizations, including persons from religious groups working with youth in drug abuse prevention programmes, and other members of the community who did not use drugs but were exposed to drug problems in their daily lives or in their occupations. Those persons included soldiers, prison guards, police and custom officers and doctors, representing the law enforcement, social service and lay sectors. A total of 36 key informants who were not drug abusers were interviewed separately and 96 persons participated in the 12 focus group discussions covering the four study zones.

Results

User profile

The age of drug abusers ranged from 11 to 60, the mean age being 29. Fifteen per cent of drug abusers were under 20 years of age and 10 per cent were over 40 years of age. Unmarried drug abusers comprised 60 per cent of the group while 32 per cent were married. Among those who were married, 76 per cent were monogamous and 21 per cent polygamous. Seventeen per cent of the drug abusers were women and 17 per cent were prisoners. Table 1 shows the age at which persons first experimented with drug use; the data have been analysed according to the drug abusers' sex. Females experimented with drugs at an older age than males. The age of initiation to drugs was lower in smaller towns than in big cities such as Douala and Yaoundé. By the age of 20, 60 per cent of drug abusers in smaller towns had consumed drugs, compared with 40 per cent of drug abusers in cities.

Table 1. Age at which respondents first experimented with drug use, by sex

 

Age group (years)

Sex
11-15
16-20
21-40
41-61
Share (percentage)
Male
75 126 78 53 332 (83)
Female a
6 22 19 23 70 (17)
Total
81 148 97 76 402 (100)

aFemales experimented with drugs at an older age than males

A large proportion of the drug abusers (74 per cent) were Christian and 17 per cent were Moslem. The northern semi-arid study zone of Maroua was Moslem and the remaining three study zones were predominantly Christian. Most of the drug abusers had finished primary school (42 per cent), 31 per cent had finished secondary school, 13 per cent had university degrees and 13 per cent had never gone to school. Despite the small size of the sample, the data indicate an inverse association of experimentation with drugs at an early age and the attainment of university education. The relation between levels of education and age at first experience with drug consumption is shown in table 2. In terms of their employment status, the drug abusers included the unemployed, labourers and white-collar workers. At least 21 per cent of the respondents had had accidents or injuries and had lost an average of seven days of work during the-preceding 12 months. Of the 454 respondents, 136 reported having health problems but only 50 per cent were receiving treatment. The treatment included antibiotics (46 per cent), anti-inflamatory medication (20 per cent), traditional medicine (17 per cent) and other (unspecified) treatment (17 per cent).

Table 2. Age at first experimentation with drug use, by educational level

 

Age group (years)

Total

Education
11-15
16-20
21-40
41-61
Number
Proportion (%)
None
13 10 15 9 47 13
Primary school
39 65 32 31 167 45
Secondary school
22 51 28 18 119 32
University
3 11 17 7 38 10
Total
77 137 92 65 371
100

Knowledge of drugs

Of those who abused drugs, most were aware that substance abuse caused mental, behavioural, respiratory and other problems. However, 22 per cent of the respondents stated that they had not yet experienced any problems. A large proportion (46 per cent) had been introduced to drugs by their friends and most shared their drugs. Thirtythree per cent had tried drugs out of curiosity, 11 per cent wanted to enhance their performance, 11 per cent had tried drugs because of peer pressure and 9 per cent had been given drugs to sell. A larger proportion of women (18 per cent) than of men (7 per cent) had been offered drugs to sell.

The reasons given by respondents for drug consumption could be categorized into three groups. In the first group were psycho-social reasons. For example, drug abuse was believed to provide stimulation to perform better; to provide courage to increase sexual desire; to be a habit; to be hereditary; to be useful in forgetting problems; to be a means of exhibiting wealth; to be useful in gaining social approval from friends; to be a way of imitating certain personalities; to be useful in keeping a person warm; to be caused by coming from a broken family; to be caused by laxity in drug law enforcement; and to be a behaviour highly regarded in the milieu where drug abusers spent most of their time.

In the second group were economic reasons. For example, some persons abused drugs because of unemployment or boredom or in response to advertisements. In the third group were therapeutic or medical reasons. Most respondents felt that cannabis was of therapeutic value. In addition, they believed that cannabis had supernatural effects and could protect its users against witchcraft and could increase their chances of success.

The respondents stated that the main reasons that drug abusers did not seek treatment for drug-related health problems were fear of repression, drug dependence, ignorance, mental disorders, ignorance of the effects that drugs had on health, lack of financial resources, the shame of being identified as drug abusers and lack of confidence in society.

According to respondents, the following factors contributed to the increase in drug consumption: the inefficient legal system; the involvement of some law enforcement officers in drug trafficking; the relationship between drug abuse and criminality; the heightened political awareness of the 1990s, and the economic crisis. The economic crisis was considered to have contributed to the increase in crime, particularly armed robbery associated with drug consumption. As for increased political awareness, it was believed that, by taking drugs some people found the courage to express their political opinions and to defy perceived political obstacles. It was noted that disabled people, very old people and single mothers were used in drug trafficking, which made arresting such people for their action "morally difficult".

Drug types and modes of consumption

The types of drugs consumed and the recency of their consumption are shown in table 3.

Table 3. Drugs offered, ever consumed and currently being consumed, by drug type

 

Recency of consumption (number of respondents)

Type of drug
Offered
Ever consumed
Currently being consumed
Cannabis
252 392 326
Amphetamines
36 91 22
Cocaine
27 49 11
Solvents
20 49 14
Benzodiazepine
9 25 7

Of those who abused cannabis, most (80 per cent) smoked it, while 16 per cent ingested it. The inhalation of solvents was reported by 3 per cent of drug abusers. Of those who abused cocaine, 2 per cent reported injecting it. Cannabis was used as an enema and was also rubbed onto freshly scarified skin to ease the pain. Nine (12 per cent) of the 75 women who consumed cannabis used it as a pessary. Those women were between 21 and 41 years of age.

There was an inverse correlation between age and the perceived case with which drug consumption could be stopped (see table 4). Youth were more likely than older people to believe that it was easy to stop drug consumption.

Table 4. Relationship between age and perception of the ease with which drug consumption could be stopped

 

Age group of respondent

Total

Opinion

10-20

21-40

41-61

Number

Proportion (%)

It is easy to stop consuming drugs
34 101 7 142 44
It is not easy to stop consuming drugs
18 98 22 138 42
Unsure whether it is easy to stop consuming drugs
2 35 8 45 14
Total
54 234 37 325 100

Drugs came from both local and foreign sources. Local growers, pharmacies, friends, street vendors and traditional healers provided drugs for the domestic market. In addition, drugs came from neighbouring countries and India.

Traditional use of drugs

Drugs were used in celebrations and cultural rituals. Cannabis was often mixed with palm wine to enhance the fermentation process as well as the effect of the alcohol. Other substances with stimulating effects, such as certain herbs and fruits and a certain kind of tree bark, were also used by some communities in traditional rituals. For example, people in a secret society of the Bayangi ethnic group used a mixture of herbs and fruits to concoct ewimbwe, which enabled them to recognize 150 signs. The drug helped to prepare them for meditation. Another traditional drug called mawum,which came from the bark of a certain kind of tree, was commonly used by members of the Bafaw ethnic group. It was made by mixing the bark with palm wine and local gin. It was generally believed that elders always used traditional drugs during death celebrations to keep themselves awake.

The second most common traditional use of drugs was for treating human diseases. Traditional doctors reserved an important place for cannabis in their Pharmacopoeia. They used it to treat filariasis and other illnesses and to evoke spirits. Patients were washed with mixtures containing cannabis to drive away evil spirits. Cannabis was added to body lotions for patients and was used to embalm corpses.

Women used cannabis as a pessary in order to keep their vaginas dry during sexual intercourse so as to increase their partners' pleasure. Women also mixed cannabis with oil to stimulate hair growth.

Cannabis was used in farms as a fertilizer and as a treatment for cacao pod diseases. Some farmers in Mbalmayo reported that it was also useful in hunting. Animals that fed on cannabis were easy prey.

Discussion

The study population represented most of the ethnic groups in Cameroon. The respondents came from a wide range of occupations. The presence of fewer women in the sample might have been partly due to the selection method used. In Cameroon, females are generally not as free as males to adopt certain behaviour such as drinking alcohol or smoking. Hence, it was possible that women were less exposed than men to illicit drugs.

Cannabis was grown locally in small towns, making it easily accessible to young children. In addition, repressive measures against drug abuse were almost non-existent in small towns, a fact that further encouraged the open use of drugs and increased the exposure of young children to drug use.

In big cities, however, the situation was different. Since possession and use of cannabis were illegal its availability was restricted in big cities, where law enforcement officers could easily detect it by its odour.

Young people tended to believe they could easily stop abusing drugs, possibly because they had just started taking drugs and had not yet become dependent on them. However, that could also have been the result of a false sense of assurance attributable to their youth. It is important to consider this factor in designing preventive programmes for youth.

Lysergic acid diethylamide (LSD) was reported to be consumed at Douala and Maroua but no LSD abusers were encountered in the study. However, cannabis, amphetamines, cocaine, solvents and benzodiazepine accounted for 91 per cent of the drugs abused among the drug abusers interviewed. It is possible that the study did not reveal any LSD abuse because abusers of that substance tend to come from a higher social class. In addition, LSD could have been rnisclassified in the study.

Although most informants identified benzodiazepine as the most abused pharmaceutical drug, the majority of drug abusers reported that amphetamine-type drugs were consumed most. The discrepancy could partly be explained by the fact that amphetamines were more available on the street market and benzodiazepines were more available in pharmacies. The street market competed with the pharmacies, a fact that might have also contributed to some pharmacists being less strict regarding the selling of psychotropic substances. Alcohol and drugs were called "brother and sister" by key informants.

In the past society had been able to control the use of psychotropic substances used in traditional dances and rituals. Such ritual use of drugs had been considered the privilege of the older generation and had been reserved for those initiated into certain secret societies. However, that had changed drastically, as young adults and even children were using cannabis "to feel high" or to muster courage.

Increased idleness, a diminishing respect for elders, liberalization in alcohol sales, the influence of the mass media and poor legislation had all contributed to the increasing availability of alcohol and drugs among youth. In addition, drinking alcoholic beverages and smoking were regarded as signs of emancipation and of being fashionable.

Changes in the way social events were conducted in Cameroon had increased people's exposure to drugs. At most traditional events, alcohol was offered, as well as tree bark, roots or other stimulants such as cola nuts. Population growth and the increased number of festive occasions had resulted in there being more opportunities to consume psychotropic substances. Due to the economic crisis, it had become harder to provide as much alcohol at such occasions as before; thus, more substances were mixed with drinks to make guests feel "high" after having drunk only a small amount.

Unfortunately, drug users were not always aware at the outset of the problems caused by drugs. Even when problems did occur, the users did not know exactly where to seek advice. Many were more concerned about being reprimanded and imprisoned than about being treated.

In some rural communities such as Kumba, there was a growing conflict between youth and the older generation over the production of cannabis. The youth had abandoned the cultivation of traditional cash crops for cannabis cultivation, which was less demanding in terms of the physical effort required and which generated more revenue. The older generation was against the new trend because of the social problems and disorders attributed to the sale and consumption of cannabis.

The policy of expelling drug abusers from school regardless of whether they were first-time experimenters or hard-core abusers had resulted in a worsening of the drug abuse situation.

Drug abuse and sexuality

Key informants reported that in most rape cases the rapist had a history of drug abuse. Males believed that taking cannabis made them irresistible to females. Women, mostly sex workers, believed that cannabis increased their chances of attracting more clients and improved their sexual performance. Polygamous men took stimulants to maintain a high level of sexual performance. The consequence was increased demand for tranquilizers to reduce the effects of the stimulants. It was also reported that tree bark and roots with stimulant properties were reserved in certain communities for consumption by men only and that men chewed such substances constantly to maintain their level of sexual performance.

Data sources

Data on substance abuse were available from law enforcement agencies and from the departments responsible for women and social affairs, penitentiaries, public health, youth and sports, agriculture, communication and education. However, data collection systems were generally not maintained well.

Study limitations

Data collection for the study took place in June, when most of the schools were on holiday, thus reducing the recruitment of secondary school students. The study team was not able to recruit respondents from the higher social classes. Cases involving drug overdose had been reported among teenagers from upper-class families. Thus, the reported extent of cocaine use and the extent of its use by injection may well have been underestimated in the study.

Two other factors that could have affected the reliability of the data collected were the short training time for the interviewers and the fact that drug abusers were keenly aware that it was illegal to abuse and/or possess drugs. Those issues were taken into account in drafting the questionnaire. The questionnaire was designed to elicit short, simple answers in order to reduce errors and biases. The consistencies found among the data obtained from key informants and drug abusers and among other existing data showed that the results were valid.

Recommendations

On the basis of the study, it is recommended that a national integrated drug control programme should be designed to harmonize strategies to reduce the demand for and to control the supply of illicit drugs. The programme should consider the following:

  1. Conducting studies on traditional treatment of certain diseases, on rituals or on religious practices in Cameroonian society and culture in order to improve the understanding of drug use in those settings;

  2. Developing information, education and communication targeting people exposed to and at risk of drug abuse;

  3. Providing financial assistance for the organization of local or national campaigns to inform the population of the effects of drug abuse on individuals, families and communities;

  4. Reducing the risk of exposure to drug abuse among children and adolescents by providing recreation and promoting physical training for youth in communities;

  5. Controlling alcohol and tobacco advertising and strengthening the enforcement of laws governing pharmacies;

  6. Providing social reintegration services through a multidisciplinary team;

  7. Identifying stress factors leading to social disability and drug addiction.

Conclusion

This study was the first of its kind on drug abuse in Cameroon. It was found that illicit drug consumption in the country was widespread and increasing. Cocaine and heroin, previously thought to be drugs only passing through Cameroon, were actually being consumed locally, in addition to cannabis. Contrary to earlier views that there were no injecting drug abusers in Cameroon, the study found that injecting was one of the routes used to administer cocaine. Illicit drug consumption occurred among members of all ethnic groups and among members of both sexes. Youth began to abuse substances at a much earlier age in smaller towns than in big cities.

Alcohol consumption was common among the drug abusers studied. The majority of the drug abusers interviewed rejected the idea of quitting the drug habit, although a few indicated their willingness to seek professional help, provided that they would not be arrested or reprimanded. Unfortunately, the country lacks the infrastructure to support the treatment and counselling of drug abusers.

The study revealed that there was a need to address certain issues such as the nature and effects of traditionally used psychotropic substances; the effects of cannabis when used as a pessary by women and the effects of other substances readily available on the street market.

Rapid assessment was appropriate for this study because it was flexible enough to take into consideration differences between study areas and between various groups of key informants.