Of drug use?
tion the Mayo Clinic explains. This means tramadol acts similarly to some antidepressants as well as giving users an energy boost.
Amgad says he has tried kicking his spiralling drug habit more times than he can remember. “I got married and thought it would motivate me, but the drugs were stronger. My wife would push me away, and I felt even more like a failure.”
Every time the effect of the pills wore off, Amgad would be wracked with self-loathing, anger and unbearable cravings. People who are dependent on tramadol can experience withdrawal symptoms such as anxiety, sweating and insomnia when they stop using the drug, a 2014 WHO report explains.
In Egypt, the ministry of social solidarity’s Fund for Drug Control and Treatment of Addiction (FDCTA) runs government’s battle against drug dependence, says Tamer Hosni, a psychologist who has been with the drug body for years.
FDCTA has gathered data that show one in 10 people have used an illicit drug at least once in 2016 — a prevalence almost double the global average of 5%, UNODC’s 2015 World Drug Report reveals.
“We give lectures about dangers of addiction, including smoking and drugs, in universities, schools and community centres,” Hosni says.
If that seems rather inadequate, given the enormity of the problem, Hosni points to the celebrity power the FDCTA has harnessed in a massive awareness campaign launched in 2015.
Celebrities such as the footballer Mohamed Salah, singer Hisham Abbas and actor Mohamed Ramadan are the faces of the star-studded campaign.
Documentaries, including 10-minute mini features shown in schools, are part of the project. Separately, a fictionalised television series called Taht El-Saytara (Under Control) was screened, unveiling the world of drug addiction in 30 episodes. This was the first large-scale creative work aimed at shaking off the strong social and cultural stigma of drug addiction in Egypt.
“The series has been incredibly helpful in family education,” says Omar.
Meanwhile, the FDCTA’s 24-hour hotline now fields more than 500 calls a day. “The high demand on the FDCTA’s free support has naturally created a waiting list,” he says. “In 2016 the fund supported over 82 000 people. Our Facebook page has over 1.5-million likes and over 22-million active viewers.”
But Omar is concerned that the country’s ban on opioid substitution therapy (OST) is hindering its drug response.
As part of OST, doctors prescribe legal replacement options such as the drugs methadone or buprenorphine for people who use opiods, which are often taken as pills or liquids under the direct supervision of health workers.
Although these therapies do not give people a “high”, they allow opioid users to avoid debilitating withdrawal symptoms.
OST programmes have been shown to reduce illegal drug use, criminal activity linked to drugs as well as overdose deaths and even new HIV infections among people who use drugs, according to a 2011 study published in the Bulletin of the World Health Organization.
In 2015, UNODC found that not only could OST be critical to managing opioid dependence in Egypt but it could also help to prevent rising HIV and hepatitis C infections, including those among injecting drug users who share needles.
Egypt has the world’s highest rates of hepatitis C, a bloodborne infection, a 2007 study published in The Journal of the Egyptian Public Health Association revealed.
Omar supports the UN’s recommendations but methadone remains illegal in Egypt and OST is still highly contentious in the country, because many health professionals are convinced that the drugs would be diverted to illicit markets.
In its absence, most government and university hospitals rely on cognitive behavioural therapy (CBT), according to a 2015 UNODC report.
As part of this kind of approach, patients work with psychologists to change the way they think about challenging situations such as substance abuse.
Meanwhile, the 12-step Narcotics Anonymous (NA) programme, a peer support group similar to Alcoholics Anonymous, is active in the country.
But research into the effectiveness of these programmes has historically been mixed and contentious.
A 2009 review by the international Cochrane Collaboration found that, although available studies indicated people in 12-step programmes seemed to benefit from them, participants should be cautioned that there was still a lack of evidence on their overall effectiveness.
Amgad’s brother and close friends have supported him through his battle against drugs, paying for him to go to NA.
“I have been clean for seven months,” he says. “It’s been a long and slow process.”
But Omar stresses the real need: to improve outreach services for people who use drugs.
“The way you reach them is through syringe exchange programmes, health promotion, civil society work on the ground,” he says.
“Even if this [methadone misuse] happens, it will be less harmful than, for example, heroin.
“We need civil society to keep pressuring the government to legalise those drugs.”
Amgad does not know when — or if — he will find a job again.
He is still on the NA programme, praying the guilt will go away.
“I harmed a lot of people around me, especially my family,” he says. “It is only now that I can start making up for the pain I caused.” —