Voices of Change: Stakeholders’ Roles in the Fight Against Substance Abuse in Mogadishu, Somalia

Introduction

Harmful or risky consumption of psychoactive substances, including alcohol and illegal drugs, is referred to as substance abuse.¹ Substance abuse affects 15.3 million people worldwide and kills 3.3 million.² Due to their availability and affordability, psychoactive substances like alcohol, cigarettes, marijuana, cocaine, heroin, and glue are being used more.³ Drug abuse among youth is driven by exposure, affordability, and peer pressure, according to one systematic review.⁴ Additionally, 16.0% of substance users aged 15 and older globally engage in heavy episodic drinking for various reasons.⁵ Research has shown a strong link between unemployment and substance abuse, such as weeds and illicit drugs, among individuals aged 15 and above.⁶ Substance abuse, unemployment, poverty, low educational status, poor mental healthcare, driving while intoxicated, and adverse social concerns like failure to meet work, family, or school obligations, interpersonal conflicts, or violence while intoxicated were common in rural Americans (50 Substance abuse was 41.6% in sub-Saharan Africa, with Central Africa having the highest rate at 55.5%.⁷ Cannabis was the most prevalent illicit drug in Central and West Africa, with rates between 5.2% and 13.5%, 7% in urban and rural areas.⁸

Substance abuse is a growing concern in Somalia, with various factors contributing to the problem. Over 40% of street children use drugs, according to the Ministry of Women and Human Rights Development.⁹

Inhalant abuse, including the use of glue and other volatile substances, has been reported among street youth in Somalia. The inhalation of glue fumes is often used to achieve a psychoactive effect and is readily accessible to youth. This practice can have severe health consequences, including damage to the respiratory system and cognitive impairment.¹⁰

Opioid abuse has also become a growing problem in Somalia. The availability of prescription opioids, such as tramadol, has increased, leading to misuse and addiction issues. This is often linked to the region’s broader problem of counterfeit and unregulated pharmaceuticals.¹¹ Khat, glue, and weeds are the most common drugs abused on the streets, but the ministry found that nearly 10% use opioids and 17% use sleeping pills.⁹

Drug abuse among marginalised youth has increased crime, including violence against women and girls.¹² Injected drug use, particularly involving opioids and other substances, has also been reported among vulnerable populations in Somalia. The availability of illicit drugs, such as heroin and counterfeit pharmaceuticals, contributes to this problem. Injected drug use carries significant health risks, including the transmission of bloodborne diseases like HIV and hepatitis.¹⁰

Efforts have been made to address substance abuse in Somalia, including community-based initiatives, awareness campaigns, and international organisations providing support for addiction treatment and prevention programs. However, challenges persist due to the country’s ongoing conflict and political instability.

This study aims to examine the role of stakeholders in addressing substance abuse in Mogadishu, Somalia, using a narrative qualitative design.

Methods and Materials

A qualitative narrative design¹³ was adopted to determine stakeholders’ roles in addressing substance abuse during the awareness campaign conducted in Mogadishu. Purposive sampling was used to select all the available stakeholders who actively address substance abuse in the communities.

In-depth, semi-structured interviews were employed to gather data, enabling participants to freely and flexibly share their narratives and experiences. Thematic analysis of the collected qualitative data revealed patterns, commonalities, and disparities in the roles played by various stakeholders in combating substance abuse.

Population and Sampling

The study population consisted of 5 key stakeholders actively addressing Substance abuse awareness campaigns in the communities. These included a Somali police force (SPF), a National Medicines Regulatory Authority (NMRA) officer, two social workers, and a Ministry of Endowments & Religious Affairs representative.

Results

Thematic analysis of the semi-structured interviews revealed six overarching themes that capture the diverse perspectives and experiences of stakeholders in addressing substance abuse in Mogadishu, Somalia. These themes are:

Theme 1: Role of Police and NMRA and, Religious Leaders, Social Workers in the Prevention and Management of Substance Abuse Within the Mogadishu Community

The prevention and management of substance abuse within the Mogadishu community require a multi-faceted approach involving various stakeholders, including the police force, the National Medicines Regulatory Authority (NMRA), religious leaders, and social workers. Each of these entities plays a unique role in addressing this complex issue:

Police

• Law Enforcement: The police play a crucial role in enforcing drug-related laws, arresting drug dealers, and dismantling drug trafficking networks. Their presence helps deter drug-related crimes.
• Community Policing: Engaging in community policing efforts, the police can build trust within the community, gather information about drug-related activities, and work with residents to identify and address substance abuse issues.
• Diversion Programs: Some police departments may have diversion programs that aim to refer individuals with substance abuse issues to treatment and support services rather than pursuing criminal charges. This approach can help address the root causes of addiction.

NMRA (National Medicines Regulatory Authority)

• Regulation and Oversight: The NMRA regulates the pharmaceutical industry, ensuring that prescription medications with potential for abuse are properly controlled, prescribed, and dispensed.
• Monitoring and Surveillance: The NMRA monitors the pharmaceutical market to detect illegal or unapproved drugs, counterfeit medications, and improper distribution, preventing dangerous substances from entering the community.
• Public Education: The NMRA can contribute to public awareness campaigns about the dangers of misusing prescription drugs and the importance of responsible medication management.

Religious Leaders

• Moral and Religious Guidance: Religious leaders provide moral and religious guidance, emphasising the harmful effects of substance abuse and promoting virtuous, drug-free lives in line with religious teachings.
• Education: Religious leaders can raise awareness about substance abuse through religious events, sermons, educational programs, and encouraging prevention measures.
• Support for Recovery: Many religious communities establish support groups and recovery programs, providing individuals seeking recovery with a sense of belonging and purpose.

Social Workers

• Assessment and Counselling: Social workers can assess individuals struggling with substance abuse, provide counselling, and develop treatment plans.
• Case Management: They help coordinate various aspects of an individual’s treatment and recovery, including access to healthcare, housing, and social services.
• Advocacy: Social workers can advocate for clients within the healthcare and legal systems to ensure they receive appropriate treatment and support.
• Community Outreach: They may engage in outreach programs to educate the community about substance abuse, prevention, and available resources.

Theme 2: What is the Prevalence of Substance Abuse in Mogadishu Community?

There is a significant prevalence of psychoactive substances, including cannabis, pethidine, tramadol, marijuana, cocaine, heroin, glue, and, more recently, high doses of pregabalin. The drug landscape is in a constant state of flux, with new substances and usage trends emerging regularly. In light of these findings, it becomes imperative for authorities to remain vigilant and well-informed about the latest drugs and methods of drug distribution to address these evolving issues effectively, one striking example of this evolving drug landscape is the substantial misuse of pregabalin for non-medical purposes, often driven by the desire to experience euphoric or sedative effects. This misuse frequently involves the consumption of higher-than-prescribed doses of 450mg and the use of pregabalin without a valid prescription.

Theme 3: How is the Relationship with Other Stakeholders in Collaboration to Reduce Substance Abuse?

Collaboration among these stakeholders is crucial for a holistic approach to substance abuse prevention and management within the Mogadishu community. Effective communication and coordination among law enforcement, regulatory bodies, religious leaders, and social workers can help ensure that individuals with substance abuse issues receive the necessary support, treatment, and guidance, ultimately reducing the impact of substance abuse on the community’s well-being.

Theme 4: What Do You Think Can Be Further Be Done to Overcome the Current State of Substance Abuse Within Mogadishu Community?

To further address substance abuse in the Mogadishu community, several actions can be taken:

• Increase Public Awareness: Launch comprehensive public awareness campaigns to educate residents about the dangers of substance abuse and its impact on individuals and the community.
• Enhance Prevention Programs: Develop and expand prevention programs in schools and communities to target at-risk youth. These programs can include life skills training, peer support groups, and mentoring.
• Improve Access to Treatment: Increase the availability of addiction treatment centres and services, ensuring that individuals with substance use disorders have access to proper care, including detoxification, counselling, and rehabilitation.
• Community Policing: Collaborate with local law enforcement agencies to crack down on drug trafficking and illicit drug markets. Community policing can build trust between law enforcement and residents, making it easier to gather information and address substance abuse issues.
• Support Families: Establish family support services to help families cope with the challenges of having a loved one struggling with addiction. This can include counselling, support groups, and resources for families dealing with substance abuse.
• Engage Religious and Cultural Leaders: Encourage religious and cultural leaders to take an active role in addressing substance abuse issues within their communities. Their influence can be instrumental in shaping community norms.
• Mental Health Services: Recognize and address the mental health aspects of substance abuse. Provide mental health services to individuals with co-occurring mental health and substance use disorders.
• Job Training and Employment Opportunities: Create vocational training programs and job placement services for individuals in recovery, helping them reintegrate into society and gain stable employment.
• Data Collection and Research: Invest in data collection and research to better understand the local dynamics of substance abuse, which can inform the development of targeted interventions.
• Strengthening Rehabilitation Facilities: Improve the quality and capacity of rehabilitation centres to accommodate more individuals seeking treatment and to provide evidence-based therapies.
• Community Partnerships: Foster collaborations between government agencies, NGOs, healthcare providers, and community-based organizations to create a comprehensive and coordinated approach to combat substance abuse.
• Legislative Reforms: Review and update existing drug-related legislation to ensure that it aligns with current challenges and allows for more effective responses to substance abuse issues.
• Peer Support Networks: Establish peer support networks for individuals in recovery to provide ongoing encouragement and assistance.

Theme 5: What are the Challenges You Experience While Implementing the Activities to Prevent Substance Abuse?

Here are some common challenges that stakeholders encountered:

1. Limited Resources: there are limited resources, including personnel, funding, and equipment, to combat substance abuse effectively. This can hinder their ability to conduct thorough investigations, carry out prevention programs, or respond to drug-related emergencies.
2. Changing Drug Trends: The drug landscape is constantly evolving, with new substances and trends emerging regularly. Authorities must stay updated on the latest drugs and drug distribution methods to combat these issues effectively. For example, there is a massive report that pregabalin is used for non-medical reasons, such as to achieve a euphoric or sedative effect. This misuse can involve taking higher doses using it without a valid prescription.
3. Complexity of Addiction: Addressing substance abuse requires a nuanced understanding of addiction as a health issue. Some of the officers may not have the necessary training to differentiate between users and traffickers or to handle individuals with substance use disorders appropriately.

Theme 6: How Can You Relate the Crime Incidences with Substance Abuse?

Drug abuse can have a significant impact on an individual’s likelihood of committing crimes. While not everyone who abuses drugs engages in criminal activity, there is a well-established connection between substance abuse and various types of crimes. Here are some of the key ways in which drug abuse can lead to criminal behaviour:

1. Financial Motivation: Drug addiction can be expensive, leading individuals to commit property crimes such as theft, burglary, or robbery to obtain money or valuables to support their drug habit.
2. Violent Crimes: Some drugs can lead to aggressive and impulsive behaviour, increasing the risk of violent crimes such as assault and domestic violence.
3. Drug Trafficking: Individuals involved in drug abuse may become drug traffickers or dealers, engaging in the illegal distribution of drugs, which is a criminal offence.
4. Property Crimes: Drug users may steal or damage property to obtain drugs or as a result of drug-induced impaired judgment.
5. Driving Under the Influence (DUI): Operating a vehicle under the influence of drugs or alcohol is a crime that can lead to accidents, injuries, and fatalities.

Stakeholders across various sectors unanimously agree on the severity of this issue and its detrimental impact on individuals, families, and the broader community.

Discussion

The primary objective of this study was to investigate and gain insights into the roles played by different stakeholders in addressing substance abuse problems. This study employed a narrative qualitative methodology to understand better the experiences, perspectives, and actions of various stakeholders involved in addressing substance abuse. The research conducted in this study aimed to identify the various obstacles, difficulties, and successful approaches utilised by stakeholders involved in substance abuse prevention, treatment, and harm reduction initiatives. The research results have emphasised the importance of diversion programs, which prioritise the redirection of individuals who are struggling with substance abuse problems towards treatment and support services rather than pursuing legal charges. This alternative methodology exhibits the potential to tackle the underlying factors contributing to addiction effectively. The study’s findings provide insight into the active engagement of stakeholders in public awareness campaigns pertaining to the misuse of prescription drugs, highlighting the significance of collaborative endeavours in tackling this crucial healthcare concern. The findings of this study have wide-ranging implications for public health, responsible medication management, and policy considerations. These implications underscore the importance of continued research and collaboration among various stakeholders to maximise their effects further. The present study’s results provide insight into the notable occurrence of psychoactive substances, such as cannabis, pethidine, tramadol, marijuana, cocaine, heroin, glue, and, more recently, elevated doses of pregabalin. The dynamic nature of the drug landscape is apparent as new substances and patterns of usage continue to arise regularly. Given these findings, authorities must maintain a state of vigilance and stay updated on the most recent drugs and modes of drug dissemination to tackle these dynamic challenges effectively. A notable illustration of this ever-changing drug environment is the significant misuse of pregabalin for non-medical purposes, often motivated by the pursuit of euphoric or sedative effects. The aforementioned misuse often entails the ingestion of doses exceeding the prescribed amount and the utilisation of pregabalin without a legitimate prescription. The research emphasises the growing prevalence and extensive utilisation of these substances in Mogadishu, attributing their accessibility and affordability as significant drivers of this phenomenon.

The research findings also highlight a significant concern regarding the scarcity of resources, including personnel, funding, and equipment, which poses a hindrance to the ability to address substance abuse effectively. The presence of these constraints poses obstacles to conducting thorough investigations, obstructs the implementation of prevention programs, and prolongs the time it takes to respond to emergencies related to drug use. It is imperative to acknowledge and prioritise the resolution of these resource constraints to optimize the efficacy of interventions and establish a comprehensive and proactive strategy in the fight against substance abuse. This study highlights the imperative for regulatory agencies to proactively monitor the pharmaceutical industry to identify and address the presence of illicit or unauthorised drugs, counterfeit medications, and inappropriate distribution practices. Maintaining a state of vigilance is of utmost importance to effectively prevent the infiltration of potentially harmful substances into the local community. Furthermore, it is imperative to engage in collaborative endeavours with international organisations and neighbouring nations to tackle the intricate challenges associated with cross-border drug trafficking effectively. The study’s findings provide additional evidence supporting the correlation between drug abuse and criminal behaviours. Although not all individuals who abuse drugs engage in illegal behaviours, there exist evident correlations between drug abuse and criminal activity. Drug addiction can result in severe financial distress, thereby precipitating engagement in property crimes. The administration of specific pharmaceutical substances has the potential to induce aggressive and impulsive behaviours, thereby increasing the likelihood of engaging in violent acts. Moreover, it is worth noting that specific individuals who are entangled in substance abuse may also engage in drug trafficking, which is an unlawful and illicit endeavour. The recognition of these connections is crucial for the development and implementation of comprehensive intervention strategies. This discourse highlights the imperative for authorities to adjust and address the ever-changing nature of the drug issue. To effectively address the issue of substance misuse, law enforcement agencies, healthcare providers, and policymakers must devise comprehensive strategies that encompass not only the regulation and dissemination of these substances but also prioritise prevention, education, and rehabilitation endeavours.

Conclusion

This research has provided valuable insights into the prevalence and complexities of substance abuse in Mogadishu, Somalia. It highlights the critical roles played by various stakeholders, including the police, the National Medicines and Regulatory Authority (NMRA), religious leaders, and social workers, in addressing this multifaceted issue. The study reveals a concerning presence of psychoactive substances in the city, underscoring the need for adaptable and responsive strategies from authorities. Effective collaboration among stakeholders is paramount to ensure comprehensive support for individuals struggling with substance abuse. However, the study also acknowledges the challenges posed by limited resources, the evolving trends in drug use, and the intricate nature of addiction, emphasising the need for ongoing efforts and continuous adaptation. Additionally, the research sheds light on the link between substance abuse and criminal behaviour, further emphasising the importance of tackling this issue. To effectively address substance abuse in Mogadishu, a united front must be established among stakeholders, policymakers, and communities. This collective effort should encompass the implementation of comprehensive prevention programs, the expansion of accessible treatment options, and the adaptation of strategies to the evolving drug landscape. Furthermore, providing support systems for those affected by substance abuse should remain a central focus of all interventions.