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` NATReSA Republic of Mauritius Patterns & Trends of Alcohol and Other Drug Use ( PTAODU ) Series Treatment at Rehabilitation Centres following substance abuse Methadone Substitution Program Needle Exchange Program Control of dangerous drugs Drug use and HIV Selected national alcohol consumption indicators Alcoholic beverages trade Alcohol-related morbidity and mortality 2010 Island of Mauritius Volume 6 Port Louis, September 2011 National Agency for the Treatment and Rehabilitation of Substance Abusers (NATReSA), Max city, 16 Poudrière Street, Port Louis, Republic of Mauritius. http : //www.gov.mu/portal/site/natresa - email : [email protected] Patterns & Trends of Alcohol and Other Drug Use (PTAODU) , Volume 6. 2010 Preface The initiative to set up an information system , The Mauritius Epidemiological Network on Drug Use (MENDU), was implemented in collaboration with the UNODC in 2001 . This project was a collaborating effort involving the National Agency for the Treatment and Rehabilitation of Substance Abusers (NATReSA), Non-Governmental Organizations (NGOs) through their respective Rehabilitation Centres and other stakeholders in the area of control and prevention of substance abuse. MENDU was revised in 2007 and a new data collection system was put in place, titled “Patterns & Trends of Alcohol and other Drug Abuse”, more commonly known as PTAODU. The first PTAODU volume was published in 2007. This present documentation covers information for the period January to December 2010. It is the 6th volume of the PTAODU series. Care should be taken in the interpretation of information related to activities at rehabilitation centres for treatment following substance abuse. The information should be treated as “reported statistics” and not as the results of a representative sample study from which inference can be made about Alcohol or drug use for the whole population of the Island of Mauritius. Rigorous efforts have been made through the analysis exercise to minimize data collection errors , omissions , duplications and other data limitations . The quality of data submitted by rehabilitation centres still needed considerable improvement. Consequently, for information related to rehabilitation centres, limited cross-sectional, patterns and trends analyses have been worked out. This report is not legitimate as a source of information for legal decisions on matters pertaining to substance use or abuse rates in the Island of Mauritius or any matter pertaining to such use or abuse. Given the HIV concern in Mauritius , especially its link with intravenous drug users (IDUs), and also given the non-negligible presence of alcohol use and abuse , this report contains in addition, specific documentations which pay special attention to information on HIV, to the national methadone substitution therapy program , to the Needle Exchange program [NEP] , to national indicators on alcohol in Mauritius , to routine information on alcohol treatment in various health care institutions and to alcoholic beverages production and consumption. A chapter has been included regarding information on selected drug control activities. The inclusion of these secondary information suggests that, far from being a comprehensive study on the subject concerned, this routine report rather aims at being a retrospective and regular timely documentation on general aspects of substance abuse in Mauritius. Assistance given by Directors of NGOs gearing the rehabilitation centres, in providing information for this publication, is gratefully acknowledged. Gratitude is also put on record to all workers in the rehabilitation centres who, although very taken up with administrative and treatment activities, have kindly contributed one way or another to the success of the information system operations. The AIDS Unit, the Harm Reduction Unit and other different units of the Ministry of Health, the Police Department and the National Methadone Substitution Centre have also important inputs in this documentation. Patterns & Trends of Alcohol and Other Drug Use (PTAODU) , Volume 6. 2010 Acknowledgments The National Agency for the Treatment and Rehabilitation of Substance Abusers (NATReSA) is expressing its deep appreciation to all stakeholders mentioned below and is much thankful to them in providing all factual information for producing this report successfully. o Centre de Solidarité Pour une Nouvelle Vie, Rose Hill. o Help De Addiction Centre, Cassis. o Mahatma Gandhi Ayurveda Centre, Calebasses. o Sangram Sewa Sadan, St Paul. o Centre D’Accueil de Terre Rouge. o Dr Idriss Goomany Treatment Centre. o Etoile D’Esperance, Moka. o Lotus , Beau-Bassin Detention Centre o Police Department o Ministry of Health o AIDS Unit o Harm Reduction Unit : : Patterns & Trends of Alcohol and Other Drug Use (PTAODU) , Volume 6. 2010 Contents Page Alcohol & dangerous drugs (highlights) Rehabilitation Centres 1 Methadone substitution program 1 Drug use , HIV & viral hepatitis 2 Needle Exchange Program Control of dangerous drugs Alcohol 2 2-3 3 Introduction Methodology 4 5 Constraints and data limitations 5 Situation overview of alcohol use and abuse & dangerous drugs in Island of Mauritius The network of rehabilitative care Attendances at Rehabilitation Centres 6-7 8 Age & marital profile of patients 8 Referral sources 9 Treatment cases recorded at Rehabilitation Centres, by primary substances reported Primary substances used, reported at Rehabilitation Centres, by residential region of patients 9 9 - 10 Inpatient rehabilitative care, psychotherapy 10 - 11 and Methadone substitution Male rehabilitation in correction centre 12 Female alcohol abuse treatment in specialized rehabilitation centre 12 Control of 13 - 15 dangerous drugs Drug use, HIV & Needle Exchange Program 15 - 16 Alcohol trade, consumption and abuse Hospitalization and mortality following consumption of alcohol 17 - 18 18 - 19 Concluding remarks 19 - 21 Patterns & Trends of Alcohol and Other Drug Use (PTAODU) , Volume 6. 2010 Page PART I - Rehabilitation Centres 1 (a) 1 (b) 2 3 Figure 3 4-5 6-7 8 9 Availability and type of rehabilitation centres Availability and type of rehabilitation centres , by regional level Infrastructure and availability of rehabilitative services and detoxification Treatment cases at rehabilitation centres, by sex Treatment cases at rehabilitation centres, by primary substance used Treatment cases at rehabilitation centres, by age of patient Treatment cases at rehabilitation centres, by residence of patients Treatment cases at rehabilitation centres, by inpatients treatment Treatment cases at rehabilitation centres, by behavioral & pharmacologic treatment PART Figure 4-6 10–12 13-16 7 8 9 10 Figure 11 23 24 25 26 27 28 29 29 - Control of dangerous drugs Arrests of foreigners for drug offense. Arrests of foreigners for drugs offences, by substance & international region of origin Arrests and seizures for dealing & possession of drugs PART Figure Figure Figure Figure II 23 III - Intravenous drug users (IDUs) 31 32 33 - 35 and HIV Monthly incidence of HIV - January 2009 to December 2010 Annual incidence of HIV and HIV tests carried out - 1987 to 2010 Trend of female HIV incidence - 1998 to 2010 Evolution of IDU incidence - 2000 to 2010 37 Trend of HIV tests carried out among low & high risk groups - 39 PART 2003 to 2010 37 38 38 IV - Alcohol Figure 9 Figure 12 & 13 Trend of abusive alcohol consumption - 1987 to 2009 Alcoholic beverages trade (Local production , imports & exports) 41 17 Alcoholic beverages trade (Local production , imports & exports) 41 18 Trend of alcohol cases treated as inpatients in Government Hospitals- 2001 to 2010 43 19 Trend of alcohol cases treated as inpatients in Government Hospitals- 2001 to 2010, by cause 44 20 Trend of alcohol cases treated as inpatients in Private Clinics- 2004 to 2010 44 21 Deaths registered in whole Island of Mauritius due to alcohol-related diseases- 1996 to 2010 45 Figure 15 Causes of deaths due to alcohol-related diseases 45 2008 & 2010 41 Patterns & Trends of Alcohol and Other Drug Use (PTAODU) , Volume 6. Alcohol 2010 Island of Mauritius and dangerous drugs Highlights 2010 Rehabilitation Centres For the last three years 2008, 2009 and 2010, the number of treatment cases recorded at eight rehabilitation centres , was 1698, 1649 and 1760 cases respectively. In 2010, among patients known to have undergone treatment at six rehabilitation centres, 97% were male patients against 3 % females patients. For male patients known to have benefitted treatment at six rehabilitation centres in 2010 , those using primarily Subutex accounted for 62% , 21% for those using primarily Heroin , 14% for Alcohol and 3% for other substances. Among male patients known to have benefitted treatment at six rehabilitation centres in 2010 , 66% admitted they started using their respective primary substances when they were aged under 20 years. However, it was observed that only 3% of those who attended the rehabilitation centres in 2010 for treatment were aged under 20 years. In 2010, female patients attended rehabilitation centres mainly for alcohol problems while a nonnegligible proportion of Subutex cases were observed among them and few cases of Heroin as well . 56% of male alcohol patients were from urban residence , 81% of male heroin patients were from urban residence and 69% of male subutex patients were from urban residence. Among male patients, only 4% undergone inpatient rehabilitative treatment . Alcohol was the main reason for male inpatient rehabilitative treatment with 51% of male inpatient rehabilitative treatment followed by Subutex 36% of male inpatients. Methadone substitution program As at December 2010, 3600 clients were on methadone maintenance, representing 92% of total clients induced since 2006 through the government methadone program. As at December 2010, the total clients on methadone maintenance represented a coverage of 36% of the estimated total Intravenous drug users (IDU) population in the country. As at December 2010, clients on methadone maintenance were distributed across various government dispensing points as follows : 51 % were under the mobile caravans service in 7 localities, 20% were served by the 5 Regional General Hospitals , 12% at Brown Sequard Psychiatric Hospital, 7% at Dr Bouloux Area Health Centre and 10% at Mahebourg District Hospital. As at December 2010, considering the methadone mobile caravans service only, mobile points situated in Port Louis and Pailles combined, absorbed nearly 78% of the total mobile clients . The remaining 22% mobile clients attended mobile points in the district of Plaines Wilhems . Dispensing units located in the district of Port Louis accounted for 51% of total clients on methadone in the country. 1 Patterns & Trends of Alcohol and Other Drug Use (PTAODU) , Volume 6. 2010 Drug use, HIV and viral hepatitis. In the Island of Mauritius , for the last four years , the number of newly detected HIV+ cases was 546 cases in 2007, 538 in 2008 , 548 in 2009 and 568 in 2010. As at December 2010 , the total number of HIV+ cases registered since 1987 amounted to 4,787 with around 477 estimated to have passed away. Newly detected female HIV+ cases in 2010 represented 24% of all newly detected cases with a sex ratio of 3 new male cases for every new female case. In 1998 it was 1 male per female and was 8 males per female in 2004. In 2010, intravenous drug users (IDUs) constituted 76% of all newly detected HIV+ cases registered at the Ministry of Health through the routine HIV surveillance . It was 94% in 2005. Between 2004 and 2010, annual number of HIV tests carried out, ranged between 11,000 - 23,000 tests annually among high risk population and between 66,000- 72,000 tests annually among low risk population. (See Page 37 for definition) The positivity rate of HIV among antenatal cases, screened through routine tests performed in public laboratories , was 0.2% in 2007, 0.3% in 2008 , 0.2% in 2009 and 0.3 in 2010, made on 15,527 , 14,789 , 14,107 and 14348 annual tests respectively . Based on a national study of the Ministry of Health, the population of IDUs in 2009 was estimated to be around 10,000 in the Island of Mauritius, 90% were males against 10% females. Based on the same abovementioned national study, 47% of the IDU population were infected with HIV and 97% were infected with Hepatitis C. Almost all those who were HIV+ were also infected with Hepatitis C. Recent provisional indicators derived from a national study of the Ministry of Health carried out in 2010, indicated that 29% of the population of female sex worker (FSW) were infected with HIV and that 44% of them were infected with Hepatitis C. Needles Exchange Program (NEP) In 2010, among all NEP sites , Ministry of Health(MOH) NEP sites constituted 80% against 20% for NGOs. MOH catered for 89% of clients against 11% for NGOs. 67% of NEP sites (MOH & NGOs) were situated in the urban region. In 2010, the overall return rate of used needles (MOH & NGOs) was around 80% (90% for MOH and 74% for NGOs). The national NEP coverage ( MOH & NGO) was 53% of the total estimated IDU population of the country according to routine service data. Control of dangerous drugs Between January and December 2010, there were 377 arrests for dealing of drugs . Between July 2008 and June 2009, there were 267 arrests for dealing of drugs compared to 422 arrests for July 2007 to June 2008. Between January and December 2010, there were 1,415 arrests for possession of drugs . Between July 2008 and June 2009, there were 1,593 arrests for possession of drugs compared to 1,917 arrests for July 2007 to June 2008. 2 Patterns & Trends of Alcohol and Other Drug Use (PTAODU) , Volume 6. 2010 For the period January to December 2010, 55% of arrests for drug dealing were related to Canabis/Hashish, 11% for Heroin, 25% for Subutex and 9% for sedatives. During July 2008 and June 2009, 63% of arrests for drug dealing were related to Canabis, 25% for Heroin, 12% for Subutex and 1% for sedatives. In 2010, 20,247 units of Subutex were seized. There were seizures of 23,140 units of Subutex during July 2008 and June 2009 compared to 1,978 units of Subutex for period July 2007 to June 2008. Foreigners arrested for drug offences , between January and December 2010, were from 6 different nationalities compared to arrests of 14 different nationalities between July 2008 – June 2009. Between January and December 2010, French represented 50% of 20 foreigners arrested due to dangerous drug offence, Malagasies (30%), followed by other nationalities accounted each for 5% . Between July 2008 and June 2009, Malagasies represented 32% of 31 foreigners arrested due to dangerous drug offence, French (16%), followed by South Africans (10%) while other nationalities accounted each for either 7% or 3% . From January to December 2010, female foreign drug offenders arrested accounted for 20% of all foreigners arrested for drug offence compared to 32% for period July 2008 and June 2009. From January to December 2010, 50% of Malagasies arrested were females compared to 60% for period July 2008 and June 2009. 55% of foreigners arrested from January to December 2010, were found with Canabis/Hashish, 35% with Heroin 5% with Subutex and 5% with Sedatives . From July 2008 to June 2009, 55% of foreigners arrested were found with Heroin, 42% with Canabis/Hashish and 3% with Subutex . Alcohol In 2010 , local production of alcohol beverages figured up to 55,741, 000 litres with beer accounting for 67% of total local production against 65% in 2009. In 2009, 53,839,000 litres of alcohol beverages were produced locally. In 2010, imports of alcohol beverages amounted to 4,781,000 litres while 6,634,000 litres were exported. In 2009, imports of alcohol beverages amounted to 2,676,000 litres while 4,620,000 litres were exported. In 2010, out of 7106 cases treated as inpatients in government hospitals for alcohol, 69% were associated with alcohol dependence syndrome and alcoholic psychosis , 14% with alcoholic gastritis, 6% with liver problems and 11% with non-dependent abuse of alcohol or acute alcoholic cases. In 2010, 46% of inpatients cases treated ( 59% among males, 17% among females) at the specialized Brown Sequard Psychiatric Hospital were associated with alcohol abuse. Cases treated as inpatients at the Government Brown Sequard Psychiatric Hospital represented one third of all alcohol inpatient cases treated at all government hospitals. In 2010, while female alcohol inpatients were 11% of all alcoholic admissions in Government Brown Sequard Psychiatric Hospital , the corresponding proportion was 9% in Government General Hospitals. In 2010, 77% of national alcohol-related deaths registered were associated with liver diseases. In 2010, female deaths due to alcohol was 14% of the national alcohol-related deaths. In 2009, a national study of the Ministry of Health revealed that 16% of male adults , aged 20 years and over , consumed alcohol abusively. In 1998 it was 16% as well. Female adults abusive alcohol consumption prevalence was 0.6% in 2009 and was 0.5% in 1998 . In 2009, overall consumption of alcohol, whether light or abusive, was 49% ( 66% among male adults and 34% among female adults) 3 Patterns & Trends of Alcohol and Other Drug Use (PTAODU) , Volume 6. 2010 Introduction Several reports in the past have exposed the use of dangerous drugs and abuse of Alcohol in the Mauritian population and that all social groups are at risk even if the degree of risk may vary from one group to another. The most recent popular drugs are Heroin and Subutex (Buprenorphine) amongst others. Added to these, Canabis , often used as a “soft drug”, is also widespread. A Rapid Situation Assessment (RSA) on Substance Abuse was conducted in Mauritius in January 2004 by the Ministry of Social Security, National Solidarity, Senior Citizen Welfare and Reforms Institution with the technical support of the United Nations Office on Drugs and Crime (UNODC). The RSA revealed that the main drugs used by the interviewers were tobacco (97%) followed by heroin (96%) and Cannabis (95%) Drugs which were regularly used by that group remained Brown Sugar (97.0%), followed by psychoactive substances, Codeine (55%), Buprenorphine (44%), Tramadol (9%), Rivotril (14%) and Rohyphol (22%). Age of initiation among them was below 18. It also indicated that 60% of them shared needles. A rapid situation assessment carried out in 2004 among Intravenous Drug Users (IDUs), by the Ministry of Health & Quality of Life, showed that 95% of Heroin users were using injecting method. In addition, 80% of the IDUs had ever shared injecting equipments. In 2009, the population of IDUs was estimated to be around 10,000. Furthermore, infectious diseases were highly present among IDUs. The 2009 national IDU study revealed that HIV prevalence was 47% among IDUs, Hepatitis C was 97% among IDUs, while 9% of IDUs were positive with Hepatitis B. In 2010, routine surveillance statistics of the Ministry of Health and Quality of Life showed that 76% of new HIV+ cases detected were IDUs. On the other hand, according to national Non-Communicable Diseases (NCD) surveys of the Ministry of Health, alcohol is consumed by a large number of male Mauritians (66% in 2009) and seems to be an integral part of the Mauritian social life. A significant proportion of male drinkers consume alcohol abusively (16% in 2009) and the consequences have been evoked in different other reports , namely , serious morbidity conditions, domestic violence, crimes including sexual offences and road traffic accidents amongst others. In its strategy to reduce risk factors of cardiovascular diseases and also to reduce other health and social problems resulting from abuse of alcohol, Government has passed on regulations under the Public Health Act Regulations 2008 for prohibition on advertisement, sponsorship , restriction on sale and consumption in public places of alcoholic drinks. These regulations came into operation in March 2009 and a severe fine has been prescribed for those who would commit offence by contravening such regulations. Similar regulations are also operative for tobacco sale and consumption as from 2008. 4 Patterns & Trends of Alcohol and Other Drug Use (PTAODU) , Volume 6. 2010 Methodology This documentation is the 6th volume on Patterns and Trends of Alcohol and Other Drug Use in Mauritius. The documentation has been organized in four parts. Information in Part 1 is based on data submitted by the rehabilitation centres listed below : I. II. III. IV. V. VI. VII. VIII. Sangram Sewa Sadan, Saint Paul, Centre d‟Accueil de Terre Rouge, HELP De Addiction Centre, Cassis, Dr Idriss Goomany Treatment Centre, Plaine Verte, Centre de Solidarité Pour une Nouvelle vie, Rose Hill, Etoile d‟Espérance, Moka, Mahatma Gandhi Ayurveda Centre, Human Service Trust, Calebasses, and Lotus, at Beau Bassin Prison. All the above centres are Non-Governmental Organisations helping in treatment and rehabilitation of substance abusers that are working in collaboration with NATReSA, and which offer help advice and information about a wide range of issues including Alcohol/drugs problems and related aspects. Part 1 of this report has been developed upon the use of a standard questionnaire completed at the level of each rehabilitation centre. All the indicators for Part I of this report are based on information related to characteristics of cases reported at rehabilitation centres for treatment following substance abuse. Thus the information is essentially of “reported” nature and not the results of a representative sample study from which inference can be made about Alcohol or drug use for the whole population of the Island of Mauritius. Part II to Part IV related issues. of the documentation are considered as secondary information on alcohol and drug Part II is about information on selected activities of the Police Department in the area of drug control. Part III develops a general overview of the trend of HIV AIDS in the country with emphasis on intravenous drug users (IDU) using routine service statistics and a few national survey figures. Part IV is an outline of alcohol issues in Mauritius, namely ; production, consumption, and its impact on health status of individuals and on the health care system . This is presented through official routine statistics and also through national survey-based indicators. Constraints and limitations of data submitted by rehabilitation centres Rigorous statistical data cleaning has been performed to minimize problems associated with database management. While remarkable efforts have been deployed by rehabilitation centres to provide the data, the quality of data submitted still needed considerable improvement . The various data difficulties encountered were ; large duplication of records, missing data , absence of completeness, inconsistent data and bias answers amongst others. The proportion of questionnaires with no National Identity Cards ( NIDs ), incomplete NIDs and errors in NIDs was substantial , such that the use of NIDs as unique identifier was not possible . This situation has complicated database management exercises as a whole. Consequently, in Part 1, some analyses with cross-sectional dimensions showing association and other patterns and also trends analyses have been avoided. Data have been analyzed only for patients whose National Identity cards were available and thus all analytical information in Part I relate to “patients known to have undergone treatment ” within six abovementioned rehabilitation centres participating to this annual exercise. Data are given separately for two other centres ; one treating male inmates of a correctional institution and the second one specialized in the rehabilitation of female alcoholic patients. 5 Patterns & Trends of Alcohol and Other Drug Use (PTAODU) , Volume 6. 2010 Island of Mauritius Alcohol and dangerous drug in 2010 Situation overview This documentation attempts to describe the pattern of alcohol abuse and use of dangerous drugs in the Island of Mauritius for the annual period January to December 2010. The documentation has been structured in four Parts. Part I is based on information related to cases reported at rehabilitation centres affiliated to the National Agency for the Treatment and Rehabilitation of Substance Abusers ( NATReSA ) . Part II to Part IV of the documentation are considered as secondary information on alcohol and drug. Part II is about information on the Police Department selected activities in the area of drug control. Part III develops a general overview of the trend of HIV AIDS in the country with emphasis on intravenous drug users (IDU) using mainly routine service statistics and a few national survey figures from the Ministry of Health & Quality of Life. Part IV is an outline of alcohol issues in Mauritius, namely ; trade, consumption, and its impact on health status of individuals and on the health care system . This is presented through national survey-based indicators and also through official routine statistics. For Part I of this present review , out of 13 rehabilitation centres collaborating with NATReSA, in the Island of Mauritius, only 8 centres participated to this annual data collection and analysis exercise and analyses are carried out only for six centres and for two other centres some basic tables are presented due to the nature of their respective data collection constraints. Regarding Part 1 of this documentation, while committed efforts and remarkable generosity have been deployed by rehabilitation centres to provide the information, the quality of data submitted still needed considerable improvement. As a result, due to data limitations and constraints as already explained in the methodology section, most indicators in this present documentation are indicative and give a reflection of the general tendency. The different forms and sources of information integrated in this review make this present paper a documentation on aspects of drug use and alcohol abuse prevailing in the country. The inclusion of these information suggests that, far from being a comprehensive study on the subject concerned, this routine report rather aims at being a retrospective and regular timely documentation on aspects of substance abuse. These information are expected to be useful for planning and the strategies to be adopted, as well as for program orientation. Social workers, as well as the public in general, will also find in these information, stones they would wish to add to the edifice of substance abuse prevention. The network of rehabilitative care and availability of services In Mauritius, the rehabilitation system comprises of 3 phases, namely, the first contact as the 1 st phase, secondly the treatment process which consists of medical treatment, counseling, occupational and recreational activities and thirdly the follow-up and aftercare which includes the psycho-social support. 6 Patterns & Trends of Alcohol and Other Drug Use (PTAODU) , Volume 6. 2010 Alcohol detoxification is essentially provided by the Government General Hospitals and the Government Brown Sequard Psychiatric Hospital. Psychosocial support and follow-up of many of these patients is ensured by treatment and rehabilitation centres funded by NATReSA. A comparatively small proportion is done in the private sector. Substitution therapy of narcotic drugs clients is maintained under a network of Methadone dispensing units, headed by a National Methadone Substitution Centre. Still many other substances abusers who opt for drugfree treatment call at those treatment and rehabilitation centres which provide a panoply of services to them. Availability of rehabilitative care In 2010, the network of rehabilitative treatment around the Island of Mauritius, continued to offer a range of infrastructural services , namely ; day care services, residential stages, exclusive female alcoholic rehabilitative treatment and rehabilitative care within a detention centre amongst others. For a total of nine rehabilitation centres, out of the 9 districts of the Island of Mauritius, there were only 5 (56%) districts with at least one rehabilitation centre. The four districts without any rehabilitation centre were; Rivière du Rempart, Flacq, Grand Port and Savanne, all four being rural districts. Apart from the abovementioned nine centres, in 2010, there was one more centre in the district of Port Louis, treating both males and females for alcohol and drug use . In Mahebourg, in the district of Grand Port, a group of volunteers a few years back started an initiative to welcome patients in view of rehabilitation but this group was not yet delivering full-scale rehabilitative treatment and was contributing to direct patients towards specialized centres , specially for Methadone therapy. Drug abuse substitution Centres ( Methadone) As at December 2010, government infrastructure for the national Methadone substitution program , consisted of a national substitution centre in the district of Plaines Wilhems , one day care centre in the district of Grand Port, 5 Methadone dispensing points at the level of Regional General Hospitals situated in five districts, namely, Port Louis, Pamplemousses, Plaines Wilhems, Grand Port and Flacq. Methadone dispensing services were also available at the Government Brown Sequard Psychiatric Hospital in the district of Plaines Wilhems, the Bouloux Area Health Centre in the district of Port Louis and finally through mobile caravans substitution services in selected targeted localities situated in the district of Plaines Wilhems and Port Louis. See Table 2 on Page 24 and map on page 25. Within a period of two weeks , the National Substitution Centre on average registered 45 patients‟ discharges following Methadone substitution residential care . Patients obtained discharges on stable Methadone dose and were recommended to be on a minimum of 6 months maintenance, taking their daily doses in the morning at the nearest convenient dispensing point. An account of the Methadone substitution system and its performance in Mauritius as at December 2010 , is given in a further section on page 11. Detoxification Centres (Alcohol ) Medical treatment for alcohol abuse and alcohol detoxification were performed essentially at the Government Hospitals . In 2010, inpatients alcohol medical treatment or detoxification at the private clinics accounted for only 4% of both government and private sector cases combined. 7 Patterns & Trends of Alcohol and Other Drug Use (PTAODU) , Volume 6. 2010 Attendances at rehabilitation centres In contrast to the previous years, the 2010 analyses were patient-based oriented instead of focusing on treatment cases which normally include re-entries and follow-up cases and usually do not allow appropriate examination of the characteristics of patients. In 2010, based on patients for whom the national identity card numbers were available, data were available for only six rehabilitation centres and a total of 1301 patients were known to have undergone rehabilitation treatment within these six centres . However regarding treatment cases including possible re-entries or follow-up cases, data submitted by eight rehabilitation , in 2010, suggested that the trend for the period 2007 to 2010, ranged roughly between 1600 and 2000 cases annually. 97% of patients know to have received rehabilitative treatment were males against 3 % female patients. Age and marital profile of patients at rehabilitation centres Among 1,258 male patients known to have undergone rehabilitation treatment , 86% were in the age group 20 - 49 years, while 9% were aged 50 – 59 years. Males aged under 20 years represented 3% and those aged 60 years and over accounted for 2%. Out of 175 males reported for treatment linked to primary abuse of Alcohol, 35% were in the age group 40 – 49 years, followed by those aged 30 – 39 years (30%), 50 – 59 years (21%), 20 29 years ( 8%) , 60 years and above represented 3% and less than 1% for no stated age. Within a reported total of 266 males using primarily Heroin , 42% were in the age group 30 – 39 years, followed by those aged 20 – 29 years (29%), 40 – 49 years (15%) , 50 – 59 years (3%) and less than 1% for no stated age. Among 782 males reported for using primarily Subutex , 36% were in the age group 30 – 39 years, followed by those aged 20 – 29 years (32%), 40 – 49 years (21%), and 50 -59 years ( 9%) . 29% of male patients asserted that they started using the primary substances reported when they were aged under 15 years. 37% started between 15 and19 years, 23% started between 20 and 29 years, 7% started between 30 and 59 years and 4% no stated age. Among male Subutex patients , 70% started using Subutex for the first time when they were still under 20 years. 14% of male alcohol patients reported they started consuming alcohol under the age of 15 years and 45% for those who started under 20 years . 30% of male Heroin patients started with Heroin when they were aged under 15 years while it was 68% for those having started under 20 years . Overall, 66% of male patients asserted they started with their respective primary substances reported when they were under 20 years. 8 Patterns & Trends of Alcohol and Other Drug Use (PTAODU) , Volume 6. 2010 Treatment recorded at rehabilitation centres, by primary substances reported With the same pattern as for previous years , in the year 2010, male treatment cases recorded at rehabilitation centres revealed that Subutex , Alcohol and Heroin remained the three major primary substances used. These three primarily used substances represented roughly 97% of all primary substances reported for treatment cases recorded. In 2007 and 2008, there was an indication that Heroin was the leading primary substance reported at rehabilitation centres followed by Subutex and Alcohol , both at rather the same level. In 2009, Subutex was the most popular primary substance reported at rehabilitation centres with around 45% of treatment cases recorded, then came Alcohol with 27% cases and in third place Heroin accounting for 24%. In 2010, based on male patients known to have undergone rehabilitation treatment, Subutex was once again the most prevalent primary substance reported at rehabilitation centres with around 62% of patients, followed by Heroin 21% and Alcohol with 14%. Primary substances used , reported at rehabilitation centres, by residential region of patients As for the previous years, in 2010 patients seeking rehabilitative treatment converged to rehabilitation centres from all geographical parts of the Island. Based on treatment cases recorded at rehabilitation centres, the use of drugs and abuse of alcohol , as in the past, were yet again most popular for urban clients , characterized by the two urban districts, namely , Port Louis and Plaines Wilhems. It is also worth noting that the district of Pamplemouses was the most concerned rural district. This can be explained partly by accessibility , availability to treatment centres and by the fact that this district lies at the periphery of the district of Port Louis which itself was the second most important area in terms of high attendances at rehabilitation centres. In fact , in 2010 , based on patients known to have undergone rehabilitation , patients residing in Port Louis and Pamplemousses combined , represented around 37% of treatment cases recorded , that is, just above one third of all cases recorded at all centres. Among the nine districts of the Island of Mauritius, Plaines Wilhems was the district of residence most popularly reported , accounting for 40% of all male patients who visited rehabilitation centres. In second position , was male patients residing in Port Louis district , accounting for 29% , followed by Pamplemousses district with 9% and the remaining six districts accounted each for 3% to 5% of patients . On the other hand, 69% of male patients were from urban region against 31% from rural region . As regards pattern of primary substances reported by district of residence of patient, for the period January to December 2010, 38% among male patients with primarily Alcohol problems reported that their district of residence was Plaines Wilhems, followed by Port Louis with 18% , Flacq with 9%, Pamplemousses, Rivière du Rempart , Moka and Black River each with around 5% to 7% and finally Grand Port district with 2%. Most of the male patients with primarily Heroin problems reported Plaines Wilhems (61%) as their district of residence, followed by Port Louis (20%), Grand Port (8%), Port Louis (6%) and the remaining five other districts of residence accounted each for 1% - 2 % of total Heroin patients. 9 Patterns & Trends of Alcohol and Other Drug Use (PTAODU) , Volume 6. 2010 35% of male patients who used Subutex primarily, reported Port Louis as their district of residence, followed by those who reported Plaines Wilhems (34%), Pamplemousses (11%), Black River (5%) and the remaining five other districts of residence accounted each for 2% - 4 % . Mauritius being a small Island of 2000 km2 with a high population density of 667 inhabitants per square kilometer , thus , most social phenomenon can be expected to stretch , proliferate and vary sporadically throughout the different geographical areas. Drug use , as well, is not an exception to the rule. In 2010, drug use and alcohol abuse were present in almost all regions of the Island. The severity at which different localities were affected varied obviously , as commonly known, for various economic and social reasons. Alcohol abuse was both an urban and rural scourge. Heroin was definitely an “urban” drug although its use in the rural region was not negligible. Subutex also was predominant in the urban region while being significantly present in the rural region. Type of treatment and services delivered (Inpatient, psychotherapy & Methadone) Inpatient rehabilitative care managed by rehabilitation centres As in the previous years, a proportion of rehabilitation centres offered both outpatient and inpatient treatment , but inpatient rehabilitative treatment as a whole, was still a marginal service and its availability or utilization remained quite rare, at least for male cases. In 2010, for instance, out of 1258 male patients only 49 (4%) went through inpatient care within rehabilitation centres . Among the abovementioned 49 inpatients rehabilitative cases, Alcohol inpatient cases accounted for 51%, Subutex inpatient treatment represented 36% and Heroin inpatient cases was 10%. Pharmacological and behavioral treatment The main therapies employed were ; counseling by staff, psychosocial support by psychologists, substitution therapy, detoxification and traditional medicine. Within rehabilitation centres , based on patients known to have undergone rehabilitation treatment, around 81% were referred for detoxification. There was on the other hand, an indication that most centres managed to maintain a counseling performance through either group or individual psychotherapies, with 88% patients reported to have undergone counseling. Most centres admitted the determinant role of individual counseling in the rehabilitation process , but they complementarily performed counseling in group and had even privileged involvement of friends, acquaintance and family in the rehabilitative process. Some centres are in favor of a qualitative assessment of behavioral treatment instead of quantitative evaluation , arguing that generally complex multifaceted underneath works are often tactfully carried out to reach acceptable results. Among the reasons evoked for clients not attending psychological support were ; taken by work, transport difficulties, fear following use of illicit drugs, relapses and those who were naturally or perhaps psychologically or socially , not motivated and not interested in psychological support. 10 Patterns & Trends of Alcohol and Other Drug Use (PTAODU) , Volume 6. 2010 Methadone substitution program In the need to reduce harm of drug use , Methadone as a maintenance treatment is now clearly recognized worldwide , namely in preventing opioid withdrawal , in reducing or eliminating drug cravings. The use of Methadone has become determinant in protecting health of people who use opioid drugs regularly and who are infected with HIV or hepatitis C while reducing the risk of spreading infection through needle sharing. In Mauritius , following the HIV epidemic shift from heterosexual to injecting drug use in 2002, an action plan was worked out by governmental and non-governmental stakeholders to prevent the spread of the disease. The action was constructed on three strategic pillars namely; supply reduction, demand reduction and harm reduction. The components of the demand reduction strategies have been set out as ; primary prevention, medical detoxification and social reintegration. In this context, Methadone in the rehabilitative care , as a maintenance treatment , was expected to play a fundamental role in both demand and harm reduction strategies to help the patients avoiding dangerous drugs and to reduce the use and sharing of contaminated injecting equipment. Backed by the National Aids Committee in April 2006, the Methadone substitution therapy started in November 2006. The initial objective was to reach 3000 Methadone clients , starting gradually in 2007 with 500 then moving to 1500 and then to 3000 by 2009-2011. Based on information available at the level of substitution centres, as at December 2010, there was an indication that the abovementioned target of 3000 clients on Methadone maintenance has been attained. In fact, as at December 2010, 3600 induced methadone patients were registered while an estimated 92% of the induced patients were on maintenance. In 2010, the distribution of clients on Methadone maintenance by government dispensing points , was as follows; 51% for the mobile caravans, 20% for the five Regional General Hospitals , 12% for Brown Sequard Psychiatric Hospital, 7% for Bouloux Area health Centre and 10% for Mahebourg District Hospital . Within the mobile caravan methadone service points , clients on Methadone maintenance were distributed as follows; Plaine Verte accounted for 24%, Saint Croix 31% , Vallée Pitot 12%, Vacoas 11% , Rose Hill 10%, Pailles 5% and Plaine Lauzun 6%. It is to be noted that , as at December 2010, the number of clients on Methadone maintenance sustained by mobile caravans at Plaine Verte and Sainte Croix , both combined, represented 28 % of total clients at all dispensing points in the Island of Mauritius. Figure 1 Island of Mauritius Distribution of Clients on methadone maintenance at dispensing units as at December 2010 Government Regional General Hospitals 20% Mobile caravans 51% District Hospital 10% Bouloux Area Health Centre 7% 11 Government B. Sequard Psychiatric Hospital 12% Patterns & Trends of Alcohol and Other Drug Use (PTAODU) , Volume 6. 2010 Male rehabilitative services in correctional institution In 2010, 79 male rehabilitative treatment cases were reported in a correctional institution, through its drug rehabilitation unit. 1% of these treatment cases were related to patients aged less than 20 years, 46% for age group 20 – 29 years and 53% for those in the age group 30 years and above. Regarding marital status, 44% were associated with single patients, 20% married, 29% in a union and 6% divorced or separated . The age at first use of drugs was reported to be under 20 years for 77% of cases . Subutex was the most popular drug reported as primary substance used, with 73% of cases followed by Canabis , 19% and Heroin with 8% of cases. In 2010, 94% of the treatment cases in the correctional institution have ever had HIV tests with an overall positivity rate of 52%. Female specialized alcohol abuse rehabilitative care In 2010, 161 female treatment cases were reported in a specialized female alcohol abuse rehabilitation centre. 6% of the reported cases were associated with women aged less than 30 years, 32% in the age group 30 – 39 years , 31% in the age group 40-49 years, 27% in the age group 50-59 years and 4% for 60 years and above. There was indication that most of the abovementioned women seeking rehabilitative treatment following alcohol abuse were married (55% of cases). Other marital status were distributed as follows ; 15% for widowed, 13% for divorced / separated, 9% for single and 7% for those in a union. In short , 91% of these women somehow have ever had a living partner. Nearly 60% of the abovementioned cases treated came from the urban region against 40% rural areas and most were primarily referred for rehabilitative treatment following hospital or clinical care (43%) . The secondary referral source was by family support , thirdly by social and religious organizations . Around 5% only were cases referred by friends. Regarding the period they started consumption of alcohol , 75% of cases were related to first use of alcohol under 20 years of age. 12 Patterns & Trends of Alcohol and Other Drug Use (PTAODU) , Volume 6. 2010 Control of dangerous drugs In its ongoing fights against dangerous drug trafficking , government passed on a new law related to drug problem in the year 2000 , the “Dangerous Drug Act 2000” . The objective was to further discourage individuals to get involved in drug trafficking . This law was amended in 2003 to enhance control on sale, manufacture and store of dangerous drugs. Furthermore the amended law aimed at strengthening collaboration between local and international authorities. International passenger traffic Arrivals of passengers from abroad (excluding inter islands traffic) amounted to 1,226,428, 1,156,579 and 1,252,038 for the years 2008, 2009 and 2010 respectively. In 2010, out of the 1,252,038 arrivals, there were 934,827 tourist arrivals representing 74% of all arrivals. The distribution of category of tourist arrivals was as follows ; 92% for visitors on holidays, 3% for visitors on business , 0.6% were in transit , 0.4% for visitors on conference, 0.2% for sports, and 3% not stated type of tourist arrivals. In Mauritius, in 2010, arrivals by air accounted for 96% (1,202,351) against 5% (49,687) by sea. Mauritian residents arrivals by sea constituted only 2% of all sea arrivals ( excluding crews). For the same period January to December 2010, among tourist arrivals , based on country of residence, European tourists represented 65% , with mainly French, British , Italian, German and secondarily Austrian, Belgian , Dutch, Spanish, Swedish , and Swiss amongst others . African tourist arrivals accounted for 24% , with mainly South Africans and residents from Reunion Island and secondarily with Malagasies and residents from Seychelles . Asian represented 8% of tourist arrivals with mainly Indians and Chinese and secondarily with residents from United Arab Emirates , Singapore, Malaysia , Japan and Hong Kong amongst others. America and Oceania tourist arrivals combined, contributed to 3% of tourist arrivals . Arrest of foreigners During the period January to December 2010, there has been regular monthly arrests of foreigners for dangerous drugs offences, except in May and September. For the same period, monthly arrests of foreigners ranged from 1 to 4 arrests per month . Female offenders were 20% of all foreigners arrested. Regarding nationality of foreigners arrested, offenders were from 6 different nationalities . French accounted for 50% of foreigners arrested , followed by Malagasies (30%) and the remaining 20% were German, Italian , Swiss and Indian. Malagasies were mostly females and were involved in mainly Heroin while French , being essentially males , were involved in Canabis / Hashish. 55% of foreigners arrested for dangerous drugs offences were involved in Canabis / Hashish while 35 % were involved in Heroin, 5% for Subutex and 5% for sedatives. 13 Patterns & Trends of Alcohol and Other Drug Use (PTAODU) , Volume 6. 2010 Arrests for drug dealing For the period January to December 2010, 377 arrests were registered for dealing of drugs compared to 267 arrests for the period July 2008 to June 2009 and 422 arrests for the period July2007-June2008. During the period January to December 2010, 203 arrests (53%) for dealing of drugs were related to Canabis , 96 arrests for Subutex (25%), 42 arrests ( 11%) for Heroin, 33 arrests (8%) for sedatives and 3 arrests for Hashish. During the period July 2008 to June 2009, 168 arrests (63%) for dealing of drugs were related to Canabis , 67 arrests (25%) for Heroin , 31 arrests (12%) for Subutex and 1 arrest for sedatives. The corresponding arrests for dealing of drugs in the previous period July2007-June2008 amounted to 266 arrests for Canabis(63%), 137 arrests for Heroin(32%) and 19 arrests for Hashish(5%). Dealing of drugs and Seizures For the period January to December 2010, in connection with dealing of drugs , 11.1kg of Cannabis , 3.7kg of Heroin , 20247 units of Subutex , 19317 units of sedatives and 0.1 kg of Hashish were seized. For to the period July 2008 to June 2009, in connection with dealing of drugs , 7.0 kg of Cannabis , 7.9kg of Heroin 418 units of Subutex and 12 units of sedatives were seized compared to the period July2007-June 2008 with seizures of 25.1 kg of Cannabis, 10.7 kg of Heroin and 24.2 kg of Hashish. Arrests for drug possession For the period January to December 2010, there were 1415 arrests registered for possession of drugs compared to the period July 2008 to June 2009 with 1593 arrests and 1917 arrests for period July 2007 to June 2008. During the period January to December 2010 , 577 arrests (40%) for possession of drugs were related to Canabis , 564 arrests (39%) for Subutex , 165 arrests (11%) for Heroin , 99 arrests (6%) for sedatives , 8 arrests for methadone and 2 arrests for Hashish. During the period July 2008 to June 2009, 546 arrests (34%) for possession of drugs were related to Canabis , 831 arrests (52%) for Subutex , 137 arrests (9%) for Heroin 70 arrests (4%) for sedatives and 9 arrests for Hashish. The corresponding arrests for possession of drugs in the previous period July2007-June2008 was 619 arrests for Canabis(32%), 507 arrests for Heroin(26%) , 418 arrests for Subutex (22%), 281 arrests for Opiods (15%) , 70 arrests for sedatives(4%) , 21 arrests for Hashish ( 1%) and 1 arrest for Ectasy. The corresponding arrests for possession of drugs in the previous period July2007-June2008 was 619 arrests for Canabis(32%), 507 arrests for Heroin(26%) , 418 arrests for Subutex (22%), 281 arrests for Opiods (15%) , 70 arrests for sedatives(4%) , 21 arrests for Hashish ( 1%) and 1 arrest for Ectasy. 14 Patterns & Trends of Alcohol and Other Drug Use (PTAODU) , Volume 6. 2010 Drug offences reported According to Economic and Social Indicators of the Central Statistics Office, for the years 2008, 2009 and 2010 , there were respectively 4156, 4081 and 3839 drug offences registered by the Police Department, giving offence rates of 4.4 per 1000 adult population aged 15 years and above in 2008, 4.2 per 1000 in 2009 and 3.9 per 1000 in 2010. On the other hand, in 2010, out of 3687 prison convicts , drug offenders represented 17%. Drug use and HIV Intravenous Drug Users (IDUs) The changing configuration of drug use from smoking to injecting of drugs has given rise to heavy outbreaks of HIV infection among intravenous drug users, their sexual partners and children. In 2009, a national study of the Ministry of Health and Quality of Life , revealed that the population of Intravenous Drug Users (IDUs) was estimated around 10,000 with 90% males against 10% females. The prevalence of HIV among this population was 47% while prevalence of Hepatitis C was 97%. The study also showed that prevalence of HIV+ among the male homosexual population was 8% and was 29% among the population of female sex workers . From routine reported statistics of the Ministry of Health , the percentage of newly detected HIV infected intravenous drug users (IDU) on total newly detected HIV cases reported in Mauritius, was 20% in the year 2000, then increased to 86% in 2003 and continued to increase to reach a peak of 94% in 2005. From 2005 there has been a constant decrease to 76% in 2010. Routine HIV tests From the year 2004 to 2010, the number of HIV tests carried out annually has been around 11, 000 – 23,000 tests among the high risk group, which comprised prison inmates, sex workers, drug users and tuberculosis patients amongst others. For the same period, the annual HIV tests carried out ranged between 66,000 – 72,000 tests yearly among low risk group , i.e, blood donors, pregnant women, dialysis patients, cardiac surgery patients, outgoing citizens requesting visa amongst others. The positivity rate of HIV observed through routine tests performed in public laboratories , was 0.66% in 2008 , 0.67% in 2009 and 0.69% in 2010, made on 84,435 , 83,350 , and 84,432 tests respectively. 15 Patterns & Trends of Alcohol and Other Drug Use (PTAODU) , Volume 6. Routine HIV 2010 surveillance The monthly average number of newly detected HIV cases reported per month was 45 cases for the year 2008 , 46 monthly cases for 2009 and 47 monthly cases for 2010. The annual number of newly detected HIV+ cases registered, was on average 542 new annual cases for the three years 2006, 2007 and 2008. In 2010, 568 newly detected cases were registered against 548 cases in 2009. A sharp rise was observed for reported HIV/AIDS cases in Mauritius as from 2003 and was most likely depicted due to the increased HIV testing carried out, particularly among IDUs in various institutions (prison, rehabilitation centres, outreach services) Since October 1987, when the first case of AIDS was registered, the total number of HIV/AIDS cases detected, up to the end of December 2010 in Mauritius, amounted to 4,787 ( 3,862 males and 925 females ). 477 Mauritians registered as HIV/AIDS cases were known to have passed away since 1987. Female HIV cases The percentage of annual newly detected female HIV cases decreased from 44% in 1998 to 12% in 2004. However, annual increase in the percentage of new HIV female cases detected was observed as from 2005 to reach a figure of 24% in 2010 . The sex ratio (males per female) of registered newly detected HIV+ cases was 1 male per female in 1998 then increased to 8 males per female in 2004 followed by a constant decrease up to 3 males per female in 2010. The positivity rate of HIV among antenatal cases screened through routine tests performed in public laboratories , was 0.2% in 2007, 0.3% in 2008 , 0.2% in 2009 and 0.3 in 2010. Tests were made on 15,527 , 14,789 , 14,107 and 13,512 subjects in 2007, 2008 , 2009 and 2010 respectively . Needle Exchange Program [ NEP ] Needle exchange schemes provide access to sterile syringes and other injecting equipment to reduce the risk of intravenous drug users (IDUs) coming into contact with other users' blood. There is clear evidence that needle exchange programs (NEP) have reduced HIV transmission rates among injecting drug users in areas where they have been established. The World Health Organization (WHO) released a report in 2004 that reviewed the effectiveness of needle exchange programs in many countries, and examined whether they promoted or prolonged illicit drug use. The results produced convincing evidence that needle exchange programs significantly reduce HIV infection, and no evidence that they encourage drug use. In Mauritius, the HIV epidemic which started in 1987 with intensification around 2002 is actually classified as concentrated with the IDU population as a significant contributing factor in HIV transmission. This situation led the country policy decision makers to adopt the HIV and Aids Act in 2006 to enable implementation of a Needle Exchange Program (NEP) as part of a harm reduction strategy together with the previously described Methadone Substitution Program . In Mauritius, the NEP is sustained both by NGOs and by the Ministry of Health (MOH) through its Aids Unit and the Harm Reduction Unit . By June 2010, MOH services accounted for nearly 80% against 20 % for NGOs in terms of the number of NEP sites operated. 16 Patterns & Trends of Alcohol and Other Drug Use (PTAODU) , Volume 6. 2010 The MOH‟s NEP functions with mobile caravans geared by nursing officers and assisted by health care assistants . The essential services are ; provision of clean injecting equipment for a whole week, return of used ones, counseling, HIV testing , referral , condoms distribution, preventive education. Daily activities are run from Monday to Friday with morning and afternoon sessions. In 2010, out of 35 NEP sites of MOH , 37 % was in Port Louis, 29% in Plaines Wilhems, 14% in the northern region, 11% in the south east region and the remaining 9% in the eastern and western region. 20% of these 35 sites were serviced with additional support of peer leaders. Regarding functioning of NEPs by NGOs, in 2010, 8 sites were in operation on a daily basis. These NGOs‟ programs were operating under the aegis of the Ministry of Health in term of provision and control of materials by its NEP section. In 2010, the total number of clients reached was around 5300 (53% of the estimated national IDU population) with 89% for the Ministry of Health against 11% NGOs „ clients . The monthly number of syringes supplied, both by MOH and NGOs , turned around 35,000 – 40,000. Based on 2009 data, the overall return rate of needles was 80% ( 90% for NGOs and 74% for MOH) HIV tests carried out among clients within the Ministry of Health NEP in 2009 , among selected 574 subjects , revealed a positivity rate of 15%. The national IDU survey of 2009 showed an HIV prevalence of 47% among the IDU population. Alcohol Alcohol beverages trade In 2010 , imports of alcohol beverages amounted to 4, 781,000 litres while 6,634,000 litres were exported. The local production of alcohol beverages figured up to 55,741, 000 litres with beer accounting for 67% of total local production against 65% in 2009. Imports of alcoholic beverages added to local production after exports, amounted to 53,888, 000 litres in 2010 against 51,915,000 litres in 2009 which gave a per capita of 113 litres of alcohol beverage per male aged 15 years and above in 2010 or a per capita of 55 litres per population aged 15 years and above . Alcohol in the monthly family consumption expenditure According to the official Household Budget Report 2007, out of the total local sales of alcoholic beverages and tobacco, 80% were consumed by households. The report showed that household monthly expenditure on alcoholic beverages and tobacco as a percentage of monthly total household consumption expenditure , was 9% in 2002 and 10% in 2007. It was also demonstrated that, regarding average monthly consumption expenditure , alcoholic beverages and tobacco ,as an item , was ranked in 4 th position of importance of monthly expenditure just after food, secondly transport and thirdly household utilities like water, electricity, housing , gas and fuel. 17 Patterns & Trends of Alcohol and Other Drug Use (PTAODU) , Volume 6. 2010 Alcohol use and abuse According to the 2009 national Non-Communicable Diseases(NCD) Survey of the Ministry of Health and Quality of life , among adults aged 20 years and above , 49% consumed any alcohol (66 % among male adults and 34% among female adults). Those classified as ex-drinker , i.e , who had stopped for more than 6 months , accounted for only 2% ( 2% among male adults and 2% as well among female adults ). Abusive consumption of alcohol The abovementioned study showed that crude prevalence of abusive alcohol consumption among male adults was 16% . The trend for different similar national surveys was 18% in 1987, 14% in 1992, 16% in 1998 and 19% in 2004 . Among female adults , prevalence of abusive alcohol consumption was 2% in 1987, 2% in 1992, 0.5% in 1998, 2% in 2004 and 0.6% in 2009. The 2009 national study also revealed that the prevalence of abusive alcohol consumption by age group among males , was 12% among those aged 20-29 years , 16% among males aged 30-39 years, 19% among males aged 40-49 years, 16% among males aged 50-59 years, 13% among males aged 60-69 years and 9% for 70-79 years. For females it was 1% among females aged 20-29 years, 0.9% for 30-39 years, 0.4 % for 40-49 years, 0.4% for 50-59 years, 0.6% for 60-69 years and 0.6 for 70-74 years. Alcohol-related health problems Alcohol abuse and hospitalization The average annual number of cases (admissions and re-admissions) treated as inpatients in Government Hospitals, due to Alcohol, was 6623 per year for the period 2004 to 2006 and was on average 6784 annual cases for the period 2007 to 2010. In 2010, the annual number of cases was 7106. 91% of the 7106 cases in 2010, were male cases against 9% female cases. Considering the last three years, 2008, 2009 & 2010 , alcohol inpatient cases (admissions + readmissions) at the public specialized Brown Sequard Psychiatric Hospital , represented 29% of all Alcohol cases treated as inpatients in all Government Hospitals. It should be understood, that there might have been patients moving from Government General Hospitals to the specialized Brown Sequard Psychiatric Hospital and inversely within the same period of time. Thus, this information should be regarded as a proxy indicator of the burden of alcoholic patient treatment and its impact on the country‟s whole health care system and resources. 18 Patterns & Trends of Alcohol and Other Drug Use (PTAODU) , Volume 6. 2010 Alcohol and morbidity Out of the previously mentioned 7106 cases of alcohol-related diseases treated as inpatients in all Government Hospitals for year 2010, 69% were cases of dependent abuse of alcohol, persistent use of alcohol and alcoholic psychosis, 14% were alcoholic gastritis, 6% cirrhosis and liver diseases linked with alcohol and 11% were cases of non-dependent abuse of alcohol. Alcohol and mortality The number of deaths registered due to alcohol was 252 in 2010 representing an average of 265 annual deaths due to alcohol registered between 2006 and 2010. For the last five years, there has been 250 – 300 annual deaths registered due to Alcohol . Considering data for 2009 and 2010, 77% of deaths registered due to alcohol-related diseases were attributable to alcoholic liver diseases including cirrhosis , while alcohol dependent syndrome represented 23%. Deaths registered in whole Island of Mauritius due to Alcohol, occurred mainly in the age group 40 years and above . Female deaths registered in whole Island of Mauritius , due to Alcohol, represented 14 % of all deaths registered due to Alcohol. Concluding remarks a. Between July 2008-June 2009, most arrests for dealing of drugs were related to Canabis and most arrests for possession of drugs were associated with Subutex. For the whole year 2010, arrests for dealing of drugs was again most popular for cannabis cases but regarding possession of drugs , Canabis and Subutex were almost at the same level of mostly arrested cases. b. The constant figure of 6000 – 7000 cases treated as inpatients in Government Hospitals annually from 2001 to 2010 suggested that Alcohol abuse was still persistent in Mauritius. Even if Government General Hospitals treated a substantial proportion of these cases , (28%) needed specialized treatment at the government Brown Sequard Psychiatric Hospital. c. d. In 2010, within the specialized Brown Sequard Psychiatric Hospital itself, Alcohol inpatient treatment accounted for 59% among all male inpatient cases and 17% among all female inpatient cases. Most alcohol cases were either dependent abuse or persistent use of Alcohol according to the International Classification of Diseases (ICD 10). This is the 6th edition of the PTAODU series which started with a first volume published for the first semester of 2007. Insignificant interest in the information system is still perceptible and has not yet received full advocacy. Interest in information support for evaluation and monitoring of services and activities need to be promoted and scaled up at all levels of the rehabilitation system. It is understood that there are priorities at rehabilitation centres and that data collection can be accepted to be secondary but this should not be optional and consequently be neglected . The information system is actually very user-friendly and does not require high level training . 19 Patterns & Trends of Alcohol and Other Drug Use (PTAODU) , Volume 6. 2010 e. In 2010, Alcohol, Heroin and Subutex were again the three major problems for which male patients attended rehabilitation. Subutex was again the most popular drug for which patients looked for treatment in 2010. f. Overall, 66% of male patients asserted they started with the primary substance reported when they were under 20 years. g. The drug harm reduction strategy , adopted in 2006 by the Ministry of Health, is making its way optimistically. The 2006 preset target of 3000 clients on methadone maintenance by 2009-2011 , has been fullfilled. The use of Methadone as a substitution therapy coupled with the “Needle Exchange Program” , is contributing in the containment and reduction of problems associated with drug use like the spread of infectious diseases as well as all the complications linked to dangerous drug cravings. For instance , the percentage of IDUs registered among new HIV+ cases has decreased from 95% in 2005 to 76% in 2010. h. Although the benefits of Methadone in terms of economic, health and social promotion are unanimously recognized, some actors in the rehabilitation system still expressed a feeling of unfinished work regarding the Methadone long-term or permanent treatment . This school of thought emphasized that the positive role of Methadone long-term treatment should not refrain rehabilitative care providers to work towards a holistic accomplishment , that is, to work towards a total drug-free state of the individual. i. Despite its remarkable development and progress since it was launched in 2006, the Methadone Substitution Program still confronted a sizeable challenge in 2010 . The 3,600 methadone clients on maintenance, by December 2010 , yet represented only one third of the estimated population size of IDUs in the country . In 2009, the Mauritius national Integrated Biological Behavioral Sampling Survey (IBBS) estimated this population to be around 10,000. However, the encouraging note was that , according to routine data, 53% of the estimated IDU population were complying to the exigencies of the national needle exchange program. j. Set up in 2006, the Needle Exchange Program ( NEP) started with a few NGOs . In 2010, this program was being sustained by both the Ministry of Health and NGOs, with 80% of services being fulfilled by MOH against 20% for NGOs. According to the World Health Organization (WHO) recommendation, the desirable minimal performance should be a coverage of at least 60% of the IDU population. In 2009 , the Integrated Biological Behavioral Sampling Survey (IBBS) revealed that 60% of IDUs have ever visited the NEP services. k. In Mauritius, the rehabilitative system is a complementary work between government and NGOs. The public health care largely tackles the medical and detoxification part while the psychosocial support is sustained by the NGOs. As for previous years, rehabilitation centres reported that they had maintained a psychosocial support program and a variety of approaches was evoked, ranging from professional to untrained counseling . 20 Patterns & Trends of Alcohol and Other Drug Use (PTAODU) , Volume 6. 2010 2010 data suggested that nearly less than 10% of patients known to have undergone rehabilitative treatment did not go through any counseling session. No formal assessment were carried out to determine whether for those who received psychological supports , the minimum requirements were met in terms of level of psychological treatment, since there were no basic standard programs or common activity framework to guide the different centres . Nevertheless, the main argument was that , since all centres were working towards a common result , the diversity of behavioral therapies delivered by the different centres had the advantage that it allowed and respected creativity , flexibility and adaptability while taking into account the different specificities , nature and vision-mission statements of the NGOs. l. Rehabilitative treatment following alcohol abuse remained the leading cause for female attendances at rehabilitation centres. However female cases of Subutex were nonnegligible and fewer cases of Heroin were also registered. m. Even though the country has , during recent years , developed several strategies to combat HIV and that encouraging results have been observed , in 2010 the situation still called for vigilance by considering the prevalence of HIV among specific risk populations , specially the intravenous drug users and female sex workers, as was found out in a national study carried out in 2009 by the Ministry of Health. A quasi hundred percent of IDUs was infected with Hepatitis C and 47% of this population was infected with HIV. The situation among female sex workers also was a concern with 29% HIV positive and 44% infected with Hepatitis C. . In the national study, it was important to note that nearly 40% of female sex workers reported they had ever injected drugs. Among them 31% had done so in the previous three months and more than 50% of those who had injected drugs were infected with HIV while 90% female IDUS were infected with Hepatitis C. n. Regarding control of drug trafficking , there was indication that the origin of dangerous drug entering the Island of Mauritius from abroad, was quite opened . Foreign drug trafficking were expected to come from a wide variety of countries. This was illustrated by the 14 different nationalities involved in Police arrests between July 2008 and June 2009 showing the different continents of origin concerned , namely , Europe, Africa and Asia. In year 2010, 6 different nationalities were involved in Police arrests , namely Malagasy, French, Indian, Swiss , Italian and German . Among these 6 nationalities 5 were already involved in 2009. o. The two main weaknesses are , firstly, data submission which is considerably delayed and secondly the quality of data itself needs to be improved. In 2010, the main problems persisted with omission of information on very basic but important variables like the national identity card number, age, sex , residence, services, primary and secondary substances used, HIV tests, needle sharing amongst others. There is need to reiterate emphasis on accurate filling and completing of the questionnaire as well as at the level of data entry on computer to improve the quality of data in order to enable proper and enhanced analysis of the situation, specially crosssectional study. 21 Patterns & Trends of Alcohol and Other Drug Use (PTAODU) , Volume 6. 2010 Part 1 Attendances at rehabilitation centres following substance abuse Period January to December 2010 22 Patterns & Trends of Alcohol and Other Drug Use (PTAODU) , Volume 6. 1.0 2010 Attendances at rehabilitation centres 1.1 (a) Infrastructure for treatment and rehabilitation of substance abusers. For the year 2010, in the Island of Mauritius, among nine main centres attached to NATReSA, 4 centres (44%) delivered day care services only, while 5 centres (56%) offered day and/or residential services. There were 2 female residential centres , 2 male residential centres and 5 centres for treatment of both sexes (4 exclusive day care + 1 day/residential) . Rehabilitation and treatment were delivered for both Alcohol and drug abuse problems by 8 (89%) centres. Only one female centre provided treatment and rehabilitation exclusively for Alcohol problems . All centres with day care services only , treated both male and female patients. Table 1(a) - Nine centres by type and availability of services , 2010 CENTRE CENTRE FOR FEMALE ONLY CENTRE FOR MALE ONLY CENTRE FOR BOTH SEXES TOTAL DAY CARE SERVICES ONLY ALCOHOL and DRUG na na 4 4 AVAILABILITY OF SERVICES DAY & OR RESIDENTIAL SERVICES ALCOHOL ALCOHOL ONLY and DRUG 1 1 na 2 na 1 1 4 TOTAL NUMBER OF CENTRES ALL CENTRES ALCOHOL ONLY 1 na na 1 ALCOHOL and DRUG 1 2 5 8 1.1 (b) Infrastructure at regional level 2 2 5 9 na : no service Considering a total of nine centres, out of the 9 districts of the Island of Mauritius, there were only 5 (56%) districts with at least one rehabilitation centre. The four districts without any centre were ; Rivière du Rempart, Flacq, Grand Port and Savanne. Only four districts had residential centres (2 for males and 2 for females). Table 1 (b) - Nine rehabilitation centres by district - 2009 DAY CARE SERVICES ONLY DAY & OR RESIDENTIAL SERVICES CENTRE DISTRICT MALE FEMALE CENTRE CENTRE CENTRE FOR MALE FEMALE BOTH CENTRE CENTRE SEXES PORT LOUIS 2 PAMPLEMOUSSES 1 ALL CENTRES FOR MALE FEMALE BOTH CENTRE CENTRE SEXES Total CENTRE BOTH SEXES number of centres - - 2 1 - 1 2 RIVIERE DU REMPART - - - - 1 2 FLACQ - - - - GRAND PORT - - - - SAVANNE - - - - 1 - 2 3 - 1 - 1 - 1 - 1 2 2 5 9 PLAINES WILHEMS 1 1 MOKA BLACK RIVER ISLAND OF MAURITIUS 1 1 1 4 2 2 1 It is to be noted that annual data are submitted and received at central level by only part of the above centres. 23 Patterns & Trends of Alcohol and Other Drug Use (PTAODU) , Volume 6. 2010 1.2 Infrastructure for detoxification (Alcohol medical treatment and drug Methadone substitution) Table 2 Infrastructure and availability of services for general treatment, substitution or detoxification - 2010 Regional General Hospitals 5 √ √ District General Hospital 1 √ √ Specialized Psychiatric Hospital 1 √ √ Area Health Centre (Dr Bouloux) 1 √ National Methadone Substitution Centre 1 √ Vacoas (nr Police Station) 1 √ √ √ Rose Hill (nr Police Station) 1 √ √ √ Plaine Lauzun (12.01.2009) 1 √ √ √ Plaine Verte ( 06.04.2009) 1 √ √ √ Pailles ( 11.05.2009) 1 √ √ √ Vallée Pitot ( 18.05.2009) 1 √ √ √ Sainte Croix ( 20.07.2009) 1 √ √ √ √ √ √ √ √ √ √ 24 √ Black River Moka √ Plaines Wilhems √ Savanne Grand Port Pamplemousses Flacq Port Louis √ Mobile Caravans Day Care + residential Day Care √ Rivière du Rempart District location Methadone substitution service Dispensing unit Alcohol and drug hospitalization treatment Health point Number Services Patterns & Trends of Alcohol and Other Drug Use (PTAODU) , Volume 6. Figure 2 2010 Map showing infrastructure of rehabilitative , medical and detoxification care 1.3 Treatment at rehabilitation centres following substance abuse 1.3.1 Patients known to have benefitted treatment at rehabilitation centres In 2010, a total of 1,301 patients were known to have received rehabilitation treatment at six rehabilitation centres. Out of these 1,301 patients , 1258 were males , representing 97% of patients against 43 (3%) female patients. (Data for a significant number of female alcohol cases treated at a specialized female alcohol rehabilitation centre and a few male patients treated in a correctional institution , are given separately because of data limitations – see pages 12 for details) Table 3 Alcohol and drug use - Year 2010 Number of patients known to have undergone rehabilitation treatment Gender Number % FEMALE 43 3.3 MALE 1258 96.7 Total 1301 100.0 25 Patterns & Trends of Alcohol and Other Drug Use (PTAODU) , Volume 6. 1.3.2 2010 Most frequently used primary substances reported. For the period January to December 2010, based on 1,258 males patients known to have received treatment at 6 rehabilitation centres , Subutex was the most popular primary substances reported , accounting for 62%, followed by Heroin (21%), and Alcohol (14%) . All these three abovementioned substances, represented 97% of all substances reported. FIGURE 3 Distribution of male patients known to have received treatment at rehabilitation centres in 2010 by primary substances reported Other, 3% Alcohol, 14% Heroin, 21% Subutex, 62% 1.3.3 Age distribution of male patients and primary substances reported. Among the 1,258 male patients reported , 86% were aged between 20 and 49 years, while 9% were aged 50 – 59 years. Males aged under 20 years represented 3% and those aged 60 years and over accounted for 2%. Out of 175 males reported for treatment linked to primary abuse of Alcohol, 35% were in the age group 40 – 49 years, followed by those aged 30 – 39 years (30%), 50 – 59 years (21%), 20 -29 years ( 8%) , 60 years and above represented 3% and less than 1% for no stated age. Within 266 males using primarily Heroin , 42% were in the age group 30 – 39 years, followed by those aged 20 – 29 years (29%), 40 – 49 years (15%) , 50 – 59 years (3%) and less than 1% for no stated age. Among 782 males reported for using primarily Subutex , 36% were in the age group 30 – 39 years, followed by those aged 20 – 29 years (32%), 40 – 49 years (21%), and 50 -59 years ( 9%) . 26 Patterns & Trends of Alcohol and Other Drug Use (PTAODU) , Volume 6. 2010 Table 4 Alcohol and drug use - Year 2010 Number of male patients known to have undergone rehabilitation treatment, by mostly used substances and age of patients Age group (years) Not Stated 10-19 Alcohol % Heroin % Subutex % Other Total % 5 2.9 2 0 0.0 7 0.8 1 0.1 3 11 0.9 2.6 23 2.9 2 32 20-29 14 8.0 2.5 97 36.5 228 29.2 9 348 27.7 30-39 52 40-49 61 29.7 111 41.7 283 36.2 13 459 36.5 34.9 40 15.0 164 21.0 4 269 50-59 21.4 36 20.6 9 3.4 69 8.8 2 116 9.2 60-69 6 3.4 0 0.0 14 1.8 2 22 1.7 70-75 1 0.6 0 0.0 0 0.0 0 1 0.1 Total 175 100.0 266 100.0 782 100.0 35 1258 100.0 1.3.4 Age at first use of primary substances . 29% of male patients know to have undergone rehabilitation treatment , asserted that they started using the primary substances reported when they were aged under 15 years. 37% started between 15 and19 years, 23% started between 20 and 29 years, 7% started between 30 and 59 years and 4% no stated age. Among male Subutex patients only , 70% started using Subutex for the first time when they were still under 20 years. 14% of male alcohol patients reported they started consuming Alcohol under the age of 15 years and 45% for those who started under 20 years . 30% of male Heroin patients started with Heroin when they were aged under 15 years while it was 68% for those having started under 20 years . Overall, 66% of male patients asserted they started with the primary substance reported when they were under 20 years. Table 5 Alcohol and drug use - Year 2010 Number of male patients known to have undergone rehabilitation treatment, by mostly used substances and age at first use of substances Age group (Years) Alcohol % Heroin % Other Subutex % Total % Under 15 years 25 14.3 80 30.1 5 250 32.0 360 28.6 15-19 54 30.9 102 38.3 10 301 38.5 467 37.1 20-29 48 27.4 67 25.2 9 168 21.5 292 23.2 30-39 16 9.1 11 4.1 1 36 4.6 64 5.1 40-49 11 6.3 1 0.4 0 12 1.5 24 1.9 50-59 1 0.6 0 0.0 0 4 0.5 5 0.4 60-69 0 0.0 0 0.0 0 1 0.1 1 0.1 Other / not stated 20 11.4 5 1.9 10 10 1.3 45 3.6 Total 175 100.0 266 100.0 35 782 100.0 1258 100.0 27 Patterns & Trends of Alcohol and Other Drug Use (PTAODU) , Volume 6. 2010 1.3.5 District of residence of patients. For the period January to December 2010, most of the male patients with primarily Alcohol problems reported that their district of residence was Plaines Wilhems with 38%, followed by Port Louis with 18% , Flacq with 9%, Pamplemousses, Rivière du Rempart , Moka and Black River each with around 5% to 7% and finally Grand Port district with 2%. Most of the male patients with primarily Heroin problems reported Plaines Wilhems (61%) as their district of residence, followed by Port Louis (20%), Grand Port (8%), Port Louis (6%) and the remaining five other districts of residence accounted each for 1% - 2 % of total Heroin patients. 35% of male patients who used Subutex primarily, reported Port Louis as their district of residence, followed by those who reported Plaines Wilhems (34%), Pamplemousses (11%), Black River (5%) and the remaining five other districts of residence accounted each for 2% - 4 % . Table 6 Alcohol and drug use - Year 2010 Number of male patients known to have undergone rehabilitation treatment, by mostly used substances and District of residence of patient. District of residence of patient Alcohol % Heroin % Subutex % Other Total % Port Louis 32 18.3 52 19.5 276 35.3 5 365 29.0 Pamplemousses 12 6.9 9 3.4 86 11.0 6 113 9.0 Rivière du Rempart 13 7.4 1 0.4 17 2.2 1 32 2.5 Flacq 15 8.6 26 9.8 32 4.1 2 75 6.0 Grand Port 4 2.3 0 0.0 16 2.0 6 26 2.1 Savanne 10 5.7 3 1.1 29 3.7 4 46 3.7 Plaines Wilhems 66 37.7 162 60.9 265 33.9 7 500 39.7 Moka 11 6.3 7 2.6 22 2.8 2 42 3.3 Black River 12 6.9 6 2.3 39 5.0 2 59 4.7 Total 175 100.0 266 100.0 782 100.0 35 1258 100.0 Table 7 Alcohol and drug use - Year 2010 Number of male patients known to have undergone rehabilitation treatment, by mostly used substances and regional residence of patient. Geographical region Alcohol % Heroin % Subutex % Other Total % Urban 98 56.0 214 80.5 541 69.2 12 865 68.8 Rural 77 44.0 52 19.5 241 30.8 23 393 31.2 Total 175 100.0 266 100.0 782 100.0 35 1258 100.0 1.3.6 Inpatient treatment at rehabilitation centre . Among 1,258 male patients known to have received rehabilitation treatment at six centres, only 49 patients (4%) went through inpatient rehabilitation . Within the 49 male inpatients , Alcohol inpatients was 51% , Subutex inpatients was 37% , Heroin inpatients was 10% and 2% not stated . 28 Patterns & Trends of Alcohol and Other Drug Use (PTAODU) , Volume 6. 2010 Table 8 Alcohol and drug use - Year 2010 Number of male patients known to have undergone rehabilitation treatment, by mostly used substances and type of service Type of treatment Alcohol % % IN-PATIENT 25 14.3 5 1.9 18 2.3 1 49 3.9 OUT-PATIENT 143 81.7 259 97.4 759 97.1 28 1189 94.5 Heroin Subutex % Other Total % Not stated 7 4.0 2 0.8 5 0.6 6 20 1.6 Total 175 100.0 266 100.0 782 100.0 35 1258 100.0 1.3.7 Behavioral and pharmacological services delivered . Among 1,258 male patients known to have received rehabilitation treatment at six centres , counseling was given to at least 88% of patients while detoxification was given to 80% of male patients. Among males using primarily Alcohol, 66% received counseling only, 12% received detoxification only, 10% received both counseling and detoxification and 3% received traditional medicine . In summary, among males using primarily Alcohol at least 78% received counseling and 21% went through detoxification treatment. Within male primary users of Heroin, 11% received detoxification only, 82% received both counseling and detoxification and 7% received counseling only. In short , 93% of Heroin patients went through detoxification treatment. Among males most frequently using Subutex, 9% received counseling only , 83% received both counseling and detoxification, and 7% received detoxification only. In short, detoxification was provided to 90% of primary users of Subutex. However, considering a total of 1013 male patients known to have gone through detoxification treatment for the year 2010, 70% were primarily on Subutex, 24% primarily on Heroin and 3% on Alcohol. It is to be noted that traditional medicines were provided essentially to those primarily on Alcohol . Table 9 Alcohol and drug use - Year 2010 Number of male patients known to have undergone rehabilitation treatment, by mostly used substances and behavioral or pharmacological treatment Service COUNSELLING ONLY COUNSELLING + DETOXIFICATION COUNSELLING + TRADITIONAL MEDICINE DETOXIFICATION ONLY TRADITIONAL MEDICINE ONLY Other / not stated Total Alcohol 116 17 4 21 2 15 175 % 66.3 9.7 2.3 12.0 1.1 8.6 100.0 Heroin 18 218 0 30 0 0 266 29 % 6.8 82.0 0.0 11.3 0.0 0.0 100.0 Other 9 6 1 11 4 4 35 Subutex 69 652 0 58 0 3 782 % 8.8 83.4 0.0 7.4 0.0 0.4 100.0 Total 212 893 5 120 6 22 1258 % 16.9 71.0 0.4 9.5 0.5 1.7 100.0 Patterns & Trends of Alcohol and Other Drug Use (PTAODU) , Volume 6. 2010 Part II Statistics related to control of dangerous drugs 30 Patterns & Trends of Alcohol and Other Drug Use (PTAODU) , Volume 6. 2.0 2010 Control of dangerous drugs During the period January to December 2010, there were regular monthly arrests of foreigners for dangerous drugs offences, except in May and September. For the same period, monthly arrests of foreigners ranged from 1 to 4 arrests per month . Female offenders were 20% of all foreigners arrested. Regarding nationality of foreigners arrested, offenders were from 6 different nationalities . French accounted for 50% of foreigners arrested , followed by Malagasies (30%) and the remaining 20% were German, Italian , Swiss and Indian. Malagasies were mostly females and were involved in mainly Heroin while French , being essentially males , were involved in Canabis / Hashish. 55% of foreigners arrested for dangerous drugs offences were involved in Canabis / Hashish while 35 % were involved in Heroin, 5% for Subutex and 5% for sedatives. 2.1 Arrests of foreigners FIGURE 4 Swiss, 5% Malagasy, 30% FIGURE 5 % of foreigners arrested due to drugs offences by nationality January - December 2010 % of foreigners arrested due to drugs offences by nationality July 2008 - June 2009 Indian 6% French, 50% African 26% European 32% Malagasy / Comorian 36% Italian, 5% Indian, 5% German, 5% Sedative, 5% Heroin, 35% Subutex, 5% FIGURE 6 % of foreigners arrested due to drugs offences January - December 2010 by type of drug Canabis / Hashish, 55% 31 Patterns & Trends of Alcohol and Other Drug Use (PTAODU) , Volume 6. 2010 Table 10 Arrests of foreigners for dangerous drugs offences, by international region and substances January – December 2010 Region Drug African European Indian Malagasy All regions Heroin 0 1 1 5 7 Canabis 0 6 0 1 7 Hashish Subutex Sedative Total arrests of foreigners 0 0 0 0 4 1 1 13 0 0 0 1 0 0 0 6 4 1 1 20 Table 11 Arrests of foreigners for dangerous drugs offences, by international region and substances July 2008 - June 2009 Region Drug African European Indian Malagasy /Comorian All regions Heroin 6 1 1 9 17 Canabis 2 4 1 2 9 Hashish Subutex 0 0 4 1 0 0 0 0 4 1 Total arrests of foreigners 8 10 2 11 31 Table 12 Arrests of foreigners for dangerous drugs offences Period (July 2008- June 2009) and (January-December 2010 ) July 2008- June 2009 Nationality January-December 2010 Male Female Total % Male Female Total % Malagasy 4 6 10 32.3 3 3 6 30.0 9 1 10 50.0 1 0 1 5.0 1 0 1 5.0 1 0 1 5.0 French 5 0 5 16.1 Ghanaian 2 0 2 6.5 Indian 2 0 2 6.5 South African 2 1 3 9.7 Swiss 2 0 2 6.5 Comorian 0 1 1 3.2 Dutch 1 0 1 3.2 Italian 1 0 1 3.2 Mozambican 0 1 1 3.2 Romanian 1 0 1 3.2 Tanzanian Ugandan German 1 0 1 3.2 0 1 1 3.2 1 0 1 5.0 21 10 31 100.0 16 4 20 100.0 Total arrest of foreigners 32 Patterns & Trends of Alcohol and Other Drug Use (PTAODU) , Volume 6. 2.2 Arrests and seizures for 2010 dealing of dangerous drugs 2.2.1 Arrests for drug dealing For the period January to December 2010, 377 arrests were registered for dealing of drugs compared to 267 arrests for the period July 2008 to June 2009 and 422 arrests for the period July2007-June2008. During the period January to December 2010, 203 arrests (53%) for dealing of drugs were related to Canabis , 96 arrests for Subutex (25%), 42 arrests ( 11%) for Heroin, 33 arrests (8%) for sedatives and 3 arrests for Hashish. During the period July 2008 to June 2009, 168 arrests (63%) for dealing of drugs were related to Canabis , 67 arrests (25%) for Heroin , 31 arrests (12%) for Subutex and 1 arrest for sedatives. The corresponding arrests for dealing of drugs in the previous period July2007-June2008 amounted to 266 arrests for Canabis(63%), 137 arrests for Heroin(32%) and 19 arrests for Hashish(5%). 2.2.2 Dealing of drugs and Seizures For the period January to December 2010, in connection with dealing of drugs , 11.1kg of Cannabis , 3.7kg of Heroin , 20247 units of Subutex , 19317 units of sedatives and 0.1 kg of Hashish were seized. For to the period July 2008 to June 2009, in connection with dealing of drugs , 7.0 kg of Cannabis , 7.9kg of Heroin 418 units of Subutex and 12 units of sedatives were seized compared to the period July2007June 2008 with seizures of 25.1 kg of Cannabis, 10.7 kg of Heroin and 24.2 kg of Hashish. 2.3 Arrests and seizures for possession of dangerous drugs 2.3.1 Arrests for drug possession For the period January to December 2010, there were 1415 arrests registered for possession of drugs compared to the period July 2008 to June 2009 with 1593 arrests and 1917 arrests for period July 2007 to June 2008. During the period January to December 2010 , 577 arrests (40%) for possession of drugs were related to Canabis , 564 arrests (39%) for Subutex , 165 arrests (11%) for Heroin , 99 arrests (6%) for sedatives , 8 arrests for methadone and 2 arrests for Hashish. During the period July 2008 to June 2009, 546 arrests (34%) for possession of drugs were related to Canabis , 831 arrests (52%) for Subutex , 137 arrests (9%) for Heroin 70 arrests (4%) for sedatives and 9 arrests for Hashish. The corresponding arrests for possession of drugs in the previous period July2007June2008 was 619 arrests for Canabis(32%), 507 arrests for Heroin(26%) , 418 arrests for Subutex (22%), 281 arrests for Opiods (15%) , 70 arrests for sedatives(4%) , 21 arrests for Hashish ( 1%) and 1 arrest for Ectasy. The corresponding arrests for possession of drugs in the previous period July2007-June2008 was 619 arrests for Canabis(32%), 507 arrests for Heroin(26%) , 418 arrests for Subutex (22%), 281 arrests for Opiods (15%) , 70 arrests for sedatives(4%) , 21 arrests for Hashish ( 1%) and 1 arrest for Ectasy. 33 Patterns & Trends of Alcohol and Other Drug Use (PTAODU) , Volume 6. Table 13 Arrests for dealing of drugs , January to December 2010 DRUG DEALING CASES TYPE OF DRUGS NO. OF CASES Cannabis 203 WEIGHT KG UNIT 11kg091.14 Heroin 42 3kg703.54 Hashish 3 0kg102.60 Subutex 96 20247 Sedatives 33 19317 TOTAL 377 Table 14 Arrests for possession of drugs , January to December 2010 POSSESSION OF DRUGS CASES TYPE OF DRUGS NO. OF CASES Cannabis 577 Heroin 165 Hashish 2 Subutex 564 Methadone 8 Sedatives 99 TOTAL 1415 34 2010 Patterns & Trends of Alcohol and Other Drug Use (PTAODU) , Volume 6. 2010 Table 15 Arrests for dealing of drugs , July 2007 - June 2009 Arrest Drug July 2007 - June 2008 Seizures July 2008 - June 2009 July 2007 - June 2008 Units July 2008 - June 2009 Number % Number % Weight Weight Units Cannabis 266 63.0 168 62.9 25.1 kg 7.0 kg Heroin 137 32.5 67 25.1 10.7 kg 7.9 kg Ectasy 0 - 0 - White Lady 0 - 0 - Subutex 0 - 31 11.6 418 Sedatives 0 - 1 0.4 12 Opiods 0 - 0 - Cocaine 0 - 0 - Hashish 19 4.5 0 - Total arrests 422 100.0 267 100.0 24.4 kg Source : Mauritius Police Department Table 16 Arrests for possession of drugs , July 2007 - June 2009 Possession cases Drug July 2007 - June 2008 Seizures July 2008 - June 2009 July 2007 - June 2008 Number % Number % Weight Cannabis 619 32.3 546 34.3 0.62 kg 0.48 kg Heroin 507 26.4 137 8.6 0.02 kg 0.004 kg Ectasy 1 0.1 0 - White Lady 0 - 0 - Subutex 418 21.8 831 52.2 1978 22,722 Sedatives 70 3.7 70 4.4 1201 1825 Opiods 281 14.7 0 - 181 Cocaine 0 - 0 - Hashish 21 1.1 9 0.6 1917 100.0 1593 100.0 Total arrests Source : Mauritius Police Department 35 Units July 2008 - June 2009 Weight Units 22 0.01 kg 0.01 kg Patterns & Trends of Alcohol and Other Drug Use (PTAODU) , Volume 6. 2010 Part III Intravenous Drug Users and HIV and trend of HIV / AIDS in the Island of Mauritius 36 Patterns & Trends of Alcohol and Other Drug Use (PTAODU) , Volume 6. 3.0 3.1 2010 Trend of HIV / AIDS in the Island of Mauritius Monthly HIV trend in 2009 and 2010. The monthly average number of newly detected HIV cases reported was 45 cases per month for the year 2008, 46 cases per month for 2009 and 47 cases per month in 2010. Figure 7 Republic of Mauritius Monthly new cases of HIV /AIDS detected in 2009 and 2010 60 54 44 45 36 58 57 55 49 43 41 51 51 53 52 58 42 41 39 43 39 43 39 Dec-… Nov-… Oct-10 Sep-10 Aug-… Jul-10 Jun-10 May… Apr-10 Mar-10 Jan-10 Feb-10 Dec-… Nov-… Oct-09 Sep-09 Aug-… Jul-09 Jun-09 May… Apr-09 Feb-09 Mar-09 23 Jan-09 70 60 50 40 30 20 10 0 Source : Ministry of Health & Quality of Life 3.2 Annual HIV trend (1987- 2010 ) 800 100000 921 80000 548 568 525 600 436 400 433 60000 40000 225 200 Tests HIV+Male Year Source : Ministry of Health & Quality of Life 37 20000 HIV+Female 2010 2009 2008 2007 2006 2005 2004 2003 2002 0 2001 1999 28 1998 1997 1996 24 50 2000 20 1995 1994 1992 10 1991 1989 1988 1990 4 0 1993 1 112 135 98 HIV+Both sexes Number of tests 1000 Figure 8 Republic of Mauritius Yearly new cases (Mauritian) of HIV / AIDS notified ,1987 - 2010 1987 Number of new HIV+ cases The annual number of newly detected HIV+ cases registered, was on average 544 new cases annually for the three years 2007, 2008 and 2009. In 2010, 568 newly detected cases were registered. Since October 1987, when the first case of AIDS was registered, the total number of HIV/AIDS cases detected, up to the end of December 2010 in Mauritius, amounted to 4,787 (3862 males and 925 females ). 477 Mauritians registered as HIV/AIDS cases were known to have passed away since 1987. In Figure 8 below , the observed sharp rise of reported HIV/AIDS cases in Mauritius is most likely due to increased HIV testing carried out, particularly among IDU in various institutions (prison, rehabilitation centres, outreach services). Patterns & Trends of Alcohol and Other Drug Use (PTAODU) , Volume 6. 3.3 2010 Female HIV trend ( 1998 – 2010 ) Figure 9 below shows the gender-wise evolution of the HIV cases reported annually in Mauritius during the last decade. The percentage of annual new female HIV cases decreased from 44% in 1998 to 12% in 2004. However, annual increase in the percentage of new HIV female cases detected was observed as from 2005 to reach a figure of 25% in 2008 . It was 20% and 24% in 2009 and 2010 respectively. 60% Figure 9 Island of Mauritius ( 1998-2010 ) Trend of annual new female HIV+ cases detected as a percentage of all new cases and sex ratio (males per female) 44% 8 40% 40% 8 6 5 24% 20% 12% 2 1 10 3 0% 4 2 0 1998 1999 2000 2001 2002 2003 2004 % Female 2005 2006 2007 2008 2009 2010 Sex ratio ( males per female) Percebtage new HIV+ female cases The sex ratio (males per female) of registered new HIV+ cases was 1 male per female in 1998 then increased to 8 males per female in 2004 followed by a gradual decrease up to 3 males per female in 2010. Sex ratio (Males per Female) Source : Ministry of Health & Quality of Life 3.4 Annual trend of Intravenous drug Users (IDU) The percentage of intravenous drug users (IDU) on total HIV cases reported in Mauritius, was 20% in the year 2000, then increased to 86% in 2003 and continued to increase to reach a peak of 94% in 2005. From 2005 there has been a constant decrease to 76% in 2010. Figure 10 Republic of Mauritius Evolution of reported new cases of Intravenous Drug Users(IDU) HIV + as a percentage of total new cases 2000- 2010 100.0% 80.0% 70.0% 63.6% 60.0% 76.0% 51.0% 40.0% 20.0% 94.0% 85.8% 12.0% 20.0% 21.5% 5.9% 0.0% 2000 2001 2002 2003 2004 2005 2006 Intravenous drug user(IDU) Source : Ministry of Health & Quality of Life 38 2007 2008 2009 2010 Heterosexual Patterns & Trends of Alcohol and Other Drug Use (PTAODU) , Volume 6. 3.5 2010 Trend of HIV tests carried out. From the year 2004 to 2010, the number of HIV tests carried out annually among high risk group(HRG) has been around 11, 000 – 23,000 tests yearly . For the same period, among low risk group (LRG) the annual HIV tests carried out ranged between 66,000 – 72,000 tests yearly. [High risk group comprises prison inmates, sex workers, drug users, TB patients amongst others. Low risk group comprises blood donors, pregnant women, dialysis patients, cardiac surgery patients, outgoing citizens requesting visa amongst others]. Figure 11 Low risk group High risk group Republic of Mauritius Number of HIV tests carried out by low and high risk groups ( 2003 - 2010 ) All groups Number of tests 88000 66000 44000 22000 0 2003 2004 2005 2006 2007 39 2008 2009 2010 Patterns & Trends of Alcohol and Other Drug Use (PTAODU) , Volume 6. 2010 Part IV Overview of alcohol issues in Mauritius. - Alcohol beverage trade - Alcohol consumption, alcohol abuse impact on health status of individuals and on health care system - Annual trend of inpatient treatment following Alcohol abuse in public and private health care institutions. - Annual trend of deaths due to Alcohol use and abuse. 40 Patterns & Trends of Alcohol and Other Drug Use (PTAODU) , Volume 6. 4.0 2010 Alcohol 4.1 Alcoholic beverages production and trade . From official external trade data, in 2010 , imports of alcoholic beverages amounted to 4,781,000 litres, On the other hand, exports in 2010 figured up to 6,634,000 litres. The total local production amounted to 55,793,000 litres. Figure 12 - Alcoholic beverages imports (Litres) 6,000,000 4,000,000 4,781,000 3,844,000 3,031,000 2,882,000 2005 2006 3,283,000 2,676,000 2,000,000 0 Figure 13 2007 2008 2009 - Alcoholic beverages exports (Litres) 8,000,000 6,634,000 6,516,000 6,000,000 4,620,000 3,877,000 4,000,000 2,000,000 2010 1,178,000 1,346,000 2005 2006 0 2007 2008 2009 2010 Source : Central Statistics office ( 2010 figure is provisional) Table 17 Alcoholic beverages production - 2009 and 2010 ( nearest ‘000 ) Alcoholic beverages production (Litres) Local production Import Total local production and import Export Net( local production + imports) - Exports (A) (B) (A) - (B) Source : Central Statistical Office and MRA Custom Department. 2010 figure is provisional ‘@ Data on local production are from the MRA Custom Department. 41 Year 2009 Year 2010 53,859,000 55,741,000 2,676,000 4,781,000 56,535,000 60,522,000 4,620,000 6,634,000 51,915,000 53,888,000 Patterns & Trends of Alcohol and Other Drug Use (PTAODU) , Volume 6. 4.2 National 2010 indicators on Alcohol use . 4.2.1 National prevalence on alcohol consumption In 2009, the Ministry of Health and Quality of life carried out a national Non-Communicable Diseases (NCD) Survey among adults aged 20 years and above. The study showed that the proportion of respondents reported consuming alcohol was 49% ( 66 % among male adults and 34% among female adults). Those classified as ex-drinker , that is, who had stopped for more than 6 months, accounted for only 2% ( 2% among male adults and 2% as well among female adults ). 4.2.2 Trend of national prevalence on abusive alcohol consumption For the abovementioned study , those who were consuming 3 or more drinks in a single day for 2 or more days per week or those who were drinking more than 5 drinks daily were classified as abusive drinker. The trend of crude prevalence of abusive alcohol consumption among male adults for different similar national surveys was 18% in 1987, 14% in 1992, 16% in 1998, 19% in 2004 and 16% in 2009. Among female adults the prevalence of abusive alcohol consumption was 2% in 1987, 2% in 1992, 0.5% in 1998, 2% in 2004 and 0.6% in 2009 4.2.3 National age indicators on abusive alcohol consumption The 2009 national study also revealed that the prevalence of abusive alcohol consumption by age group for males , was 12% among those aged 20-29 years , 16% among males aged 30-39 years, 19% among males aged 40-49 years, 16% among males aged 50-59 years, 13% among males aged 60-69 years and 9% for 70-79 years. For females it was ; 1% among females aged 20-29 years, 0.9% for 30-39 years, 0.4 % for 4049 years, 0.4% for 50-59 years, 0.6% for 60-69 years and 0.6 for 70-74 years. Figure 14 Island of Mauritius (1987 - 2009 ) National Non-Communicable Diseases Surveys Prevalence of Abusive Alcohol Consumption (adult 20 years and above) Prevalence ( %) 25% 20% 19% 18% 16% 14% 15% Male 16% Female 10% 5% 2.1% 1.6% 0.5% 1.9% 0.6% 0% 1987 1992 1998 Survey year 2004 2009 4.2.4 Mauritian family monthly consumption expenditure on alcoholic beverages and tobacco The latest official figures on Household Budget Survey (HBS) of the Central Statistical office dated back to 2007. According the HBS report 2007, out of the total local sales of alcoholic beverages and tobacco, 80% were consumed by households. The report showed that monthly expenditure on alcoholic beverages and tobacco as a percentage of household monthly total consumption expenditure , was 9% in 2002 and 10% in 2007. It was also demonstrated that, regarding monthly consumption expenditure , alcoholic beverages and tobacco ,as an item , was ranked in 4 th position of importance just after food, secondly transport and thirdly household utilities like water, electricity, housing , gas and fuel. 42 Patterns & Trends of Alcohol and Other Drug Use (PTAODU) , Volume 6. 4.3 Treatment 2010 in public and private health care institutions following use and abuse of alcohol. ` 4.3.1 Trend of Alcohol cases treated as inpatients in Government Hospitals (General & Psychiatric). The average annual number of cases (admissions and re-admissions) treated as inpatients in Government Hospitals, due to Alcohol, was 6623 per year for the period 2004 to 2006 and was on average 6784 annual cases for the period 2007 to 2010. In 2010, the annual number of cases was 7106. 91% of the 7106 cases in 2010 were male cases against 9% female cases. Considering the last three years, 2008, 2009 & 2010 , alcohol inpatient cases (admissions + readmissions) at the specialized Brown Sequard Psychiatric Hospital , represented 29% of all Alcohol cases treated as inpatients in all Government Hospitals. It should be understood, that there might have been patients moving from Government General Hospitals to the specialized Brown Sequard Psychiatric Hospital and inversely within the same period of time. Thus, this information should be regarded as a proxy indicator of the burden of alcoholic patient treatment and its impact on the country‟s whole health care system and resources . Table 20 on next page shows the situation in private clinics. Source : Ministry of Health & Quality of Life Table 18 I SLAND OF MAURITIUS, ALCOHOL-RELATED DISEASES CASES TREATED AS INPATIENTS IN GOVERNMENT HOSPITALS ( 2001 - 2010) Including re-admissions Brown Sequard Psychiatric Hospital All Government Hospitals General Hospitals YEAR Male Female Total Male Female Total Male Female Total 2001 2952 244 3196 3758 312 4070 6710 556 7266 2002 2760 257 3017 3499 323 3822 6259 580 6839 2003 3144 250 3394 3941 359 4300 7085 609 7694 2004 2320 231 2551 4054 338 4392 6374 569 6943 2005 2128 241 2369 4102 335 4437 6230 576 6806 2006 1913 167 2080 3733 308 4041 5646 475 6121 2007 1671 188 1859 4143 401 4544 5814 589 6403 2008 1771 190 1961 4553 434 4987 6324 624 6948 2009 2010 2018 1752 256 219 2274 1971 4327 4690 401 445 4728 5135 6345 6442 657 664 7002 7106 43 Patterns & Trends of Alcohol and Other Drug Use (PTAODU) , Volume 6. 4.3.2 2010 Alcohol-related diseases treated in Government Hospitals Out of the previously mentioned 7106 cases of alcohol-related diseases treated as inpatients in all Government Hospitals for year 2010, 69% were cases of dependent abuse of alcohol, persistent use of alcohol and alcoholic psychosis, 14% were alcoholic gastritis, 6% cirrhosis and liver diseases linked with alcohol and 11% were cases of non-dependent abuse of alcohol. Table 19 ALCOHOL RELATED DISEASES Cases treated as in-patients( including follow-ups) in all Government Hospitals (Including Brown Sequard Psychiatric Hospital) YEARS 2001 - 2010 DEPENDENT ABUSE OF ALCOHOL , PERSISTENT USE YEAR OF ALCOHOL and NON DEPENDENT ALCOHOLIC LIVER DISEASES ABUSE OF ALCOHOL ALCOHOLIC and CIRRHOSIS OF LIVER (with ( Acute intoxication) GASTRITIS ALCOHOLIC PSYCHOSIS FEMALE TOTAL MALE TOTAL ( K70.0 - K70.9 ) + ( K74.0 - K74.6 ) FEMALE TOTAL (General Hospitals + B. Sequard Psychiatric Alcohol) (F10.0) ( F10.1-F10.5) MALE or without mention of ( K29.2 ) ( General Hospitals only ) MALE FEMALE TOTAL ( General Hospitals FEMALE ( General Hospitals only ) Hospital) MALE TOTAL only ) MALE FEMALE TOTAL (General Hospitals + B. Sequard Psychiatric Hospital) 2001 5201 376 5577 431 44 475 702 41 743 376 95 471 6710 556 7266 2002 4670 381 5051 602 73 675 678 41 719 309 85 394 6259 580 6839 2003 5453 410 5863 579 77 656 698 64 762 355 58 413 7085 609 7694 2004 4355 375 4730 1046 100 1146 695 67 762 278 27 305 6374 569 6943 2005 4613 400 5013 707 88 795 634 42 676 276 46 322 6230 576 6806 2006 4460 314 4774 399 86 485 524 24 548 263 51 314 5646 475 6121 2007 4093 362 4455 515 94 609 866 57 923 340 76 416 5814 589 6403 2008 4734 445 5179 387 62 449 797 61 858 406 56 462 6324 624 6948 2009 4817 468 5285 441 69 510 833 60 893 254 60 314 6345 657 7002 2010 4501 435 4936 674 114 788 897 65 962 370 50 420 6442 664 7106 Source : Ministry of Health & Quality of Life Table 20 below shows the situation in Private Clinics Attendance (Including admissions) due to Alcohol use and abuse in Private Clinics, 2004 - 2010 YEAR MALE FEMALE TOTAL 2004 129 24 153 2005 103 24 127 2006 92 22 114 2007 96 23 119 2008 136 35 171 2009 126 48 174 2010 240 72 312 44 Patterns & Trends of Alcohol and Other Drug Use (PTAODU) , Volume 6. 4.4 2010 Annual trend of deaths due to Alcohol use and abuse. 4.4.1 Patterns & trend of deaths registered in whole Island of Mauritius due to Alcohol The number of deaths registered due to alcohol was 252 in 2010 representing an average of 265 annual deaths due to alcohol registered between 2006 and 2010. For the last five years, there has been 250 – 300 annual deaths registered due to Alcohol . Considering data for 2009 and 2010, 77% of deaths registered due to alcohol-related diseases were attributable to alcoholic liver diseases including cirrhosis , while alcohol dependent syndrome represented 23%. Deaths registered in whole Island of Mauritius due to Alcohol, occurred mainly in the age group 40 years and above . Female deaths registered in whole Island of Mauritius , due to Alcohol, represented 14 % of all deaths registered due to Alcohol. Table 21 ISLAND OF MAURITIUS , ALCOHOL-RELATED DISEASES DEATHS REGISTERED IN WHOLE ISLAND 1996 – 2010 , ( by cause and sex ) 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 252 242 192 193 155 187 198 251 218 207 225 225 264 232 217 Female 27 24 23 19 23 23 24 41 35 28 23 33 30 41 35 Total 279 266 215 212 178 210 222 292 253 235 248 258 294 274 252 Male Source : Ministry of Health & Quality of Life Figure 15 Island of Mauritius (2010) Distribution of registered cause of deaths due to alcohol-related diseases Alcohol Dependence Syndrome 25% Alcoholic liver diseases 45% Source : Ministry of Health & Quality of Life 45 Cirrhosis of liver ( + or - mention of alcohol) 39% Patterns & Trends of Alcohol and Other Drug Use (PTAODU) , Volume 6. 2010 Annex I About NATReSA A Trust Fund for the Treatment and Rehabilitation of Drug Addicts was set up in June 1986 following the report of the select committee on drug addiction in 1985. In 1996, the drugs related problems were reviewed by a committee and consequently there was a reorganization of the said Trust Fund into NATReSA, National Agency for the Treatment and Rehabilitation of Substance Abusers in December 1996. NATReSA was operating since July 1997 as a statutory body under the aegis of the Ministry of Health & Quality of Life (MOH & QL), until December 2000 when NATReSA was transferred at the Ministry of Social Security , National Solidarity, Senior Citizen Welfare and Reforms Institutions (MSS). After a passage under the MSS, NATReSA was redirected back and is currently under the auspices of the MOH & QL The main objectives of NATReSA are to co-ordinate and facilitate efforts at National level towards the implementation of program for the prevention of substance abuse and the treatment, and rehabilitation of substance abusers. To complement existing facilities for prevention of substance abuse, treatment and rehabilitation of substance abusers. To mobilize resources locally and overseas for the treatment and rehabilitation of substance abusers. To set up and manage institution for the treatment and rehabilitation of substance abusers and provide after-care services for the rehabilitation of substance abusers, and finally to advise, guide and help voluntary social organizations engaged in the prevention of substance abuse, and in the treatment and rehabilitation of substance abusers. The area of activities of NATReSA comprises : o Substance abuse prevention and ideograph project in schools with the collaboration of the Ministry of Education and Scientific Research. o Youth substance abuse reduction and prevention among the youth with the collaboration of the Ministry of Youth and Sports . o Family substance abuse prevention programs and family with the collaboration of the Ministry of Women, Family Welfare and Child Development. o Vulnerable groups /community based organization and NGOs . o Workplace /sectors and trade unions substance abuse reduction and prevention in the workplace with the collaboration of the public and private sectors. o HIV/AIDS prevention and control among Users of Mauritius with the collaboration of the Ministry of Health & Quality of Life, AIDS Unit and other NGOs. o Recreational alternatives and quality of living project with the collaboration of the Ministry of Arts and Culture and the Ministry of Youth and Sports. o Community Alcohol/drug reduction and prevention campaigns with the collaboration of the Sugar Industry Labour Welfare Fund, Social Welfare Division, NGOs, Forces Vives, etc o Local Authorities substance abuse prevention with the collaboration of the Municipalities and District Councils. 46 Patterns & Trends of Alcohol and Other Drug Use (PTAODU) , Volume 6. 2010 References Annual Digests of External Trade Statistics - Central Statistics Office. Non-Communicable Diseases(NCD) Survey, Island of Mauritius - 2009 – Ministry of Health & Quality of Life. Annual Health Statistics Reports –Ministry of Health & Quality of Life. Household Budget Survey - 2006/2007 - Central Statistics Office. Survey on IDUs & Female Sex Workers - 2009 - Aids Unit , Ministry of Health & Quality of Life (Provisional ). HIV / AIDS Action Plan for Injecting Drug Users (IDUs) - 2004 - Ministry of Health & Quality of Life. National Multisectorial Quality of Life. HIV and AIDS Strategic Framework [NSF 2007 – 2011] - 2007 - Ministry of Health & Digest of Crime, Justice and Security – 2009- Central Statistics Office. Economic and Social indicators-Issue 917-August 2011.Central Statistical office.(Crime & Justice) Economic and Social indicators-Issue 865-November 2010.Central Statistical office.(Tourism) 47 Patterns & Trends of Alcohol and Other Drug Use (PTAODU) , Volume 6. 2010