Drug treatment facilities survey, Tunisia 2020

Substance abuse is becoming a serious public health concern in Tunisia. However, local legal context is remaining repressive with an evident impact on prevention and control of substance abuse and related problems. We aimed to highlight the magnitude of drug treatment demand and describe the health care offer in Tunisia.

Within the framework of the EU4Monitoring Drugs project funded by the European Union, a drug treatment facilities survey was piloted by the National Institute of Health in collaboration with the Tunisian Epidemiological Network in 2020-21. We invited 12 public health care facilities and NGOs involved in drug users’ management to participate in this survey, using the snowball approach. The European Facility Survey Questionnaire addressed facilities characteristics, provided interventions and drug users patients’ characteristics. It was adapted to the Tunisian context and self-administered for online and paper-based data collection. Data seizure and analysis were done according to EMCDDA methodology.

Finally, 9 out of 12 units, including 1348 patients, participated to this survey: 7 public facilities and 2 NGOs, located in Great-Tunis, North-east and Centre-east regions. Only one therapeutic community unit exists in Tunisia. Most of patients were mainly distributed over 3 types of services: 39% in low-threshold unit, 27% in specialized outpatient treatment unit and 18 % in other outpatient units. Opioids other than heroin ranked first as the most used substance by patients (n=452, 45%), followed by cannabis (n=188, 19%), alcohol (n=106, 11%) and heroin (n=80, 8%).

Although the covid-19 pandemic and political context has prevented us to ensure a national coverage; our study is the first Tunisian mapping experience to address the current situation regarding drug treatment facilities. Tunisia's participation as part of this project is contributing to strengthen the establishment of the national information system on drug use (in progress) and promote the mapping extension in Tunisia.