Illicit use of high-dosage buprenorphine in Tunisia

Abstract

In Tunisia, dependence to high-dosage buprenorphine (HDB) is expanding since the uprising of 2011, driving the epidemics of blood-borne infectons among people who inject drugs. Only one rehabilitaton center (Thyna center), run by the Tunisian Associaton for the Preventon of Drug Use is stll operatng in the country and acceptng to treat patents. The aim of this study is to provide evidence-based solutons for the mitgaton and preventon of HDB illicit use in Tunisia through the analysis and discussion of the results of a cross-sectonal survey conducted to describe the socio-economic, the medical characteristcs, the substance use paterns, and the treatment outcomes of patents seeking treatment at the Thyna  rehabilitaton center during the year 2013. The results of this survey showed that main demographic characteristcs of the patents using illegal HDB were single men, unemployed and from low-income urban areas. The intravenous use was privileged and incarceraton recurrences (p<0.05), alcoholism (p<0.01) and migraton (p<0.01) were associated with daily dosage of HDB. Most of the patents dropped out of treatment within the frst month at the center. The analysis reveals the unmet needs of the people who inject drugs in terms of preventon and treatment and identfes opioid maintenance therapy within a psychosocial rehabilitaton program framework as a good alternatve to the current available health services for people who use drugs in Tunisia. Future research areas will explore the social factors behind substance use and substance injecton in Tunisia among out-of reach groups of women and adolescents; as such data is needed to develop efcient policies.

Keywords: Injectng drug use, opioid, maintenance therapy, drug policy