A retrospective overview of polydrug abuse in Tunisia

A forensic toxicology investigation was carried out by monitoring a total of 23,672 suspected drug addicts surveying positive rates of consumption for drug of abuse over five years (2014-2018) covering major Tunisian cities. An alarming phenomenon of 'Polysubstance Abuse' has been appeared in the post-revolutionary period (since 2011), was the subject of much debate and media productions.

Socio-demographic information’s from each detained individual collected from judicial requisitions contain data on suspected drug users (gender, age, marital status, job, city) and the reason of arrest. Multiple reasons may be reported by police: Drug seizure, people appear to be affected by drugs and routine control of festive events and nightclubs. An immunoassay screening tests to detect elevated levels of drugs classes in urine samples were performed. These screening assays provide a preliminary semi-quantitative test results. Positives urine specimens were analyzed with GC-MS for confirmation.

Depending on socio-demographic profile of drug consumers and type of substances combination, the prevalence, extent and nature of Polydrug abuse was evaluated. The characteristics of typical polydrug consumer profile, is 20-35 year-old male, single, with a low level of education, and without regular source of income. The most striking finding that can be deduced in this toxicological investigation in comparison to previous findings is the increased use of highly addictive drug combinations such as cannabis with cocaine or with MDMA. Otherwise, recent combinations that did not exist before were identified in 2018, as the dangerous and harmful co-abuse of benzodiazepines with opioids which can have fatal consequences, including prolonged respiratory depression, coma and death.

The novelty observed in this study is the alarming extent of polydrug abuse by emphasizing its evolution over the years. Overall, mixing psychoactive substances depend not only on personal preferences, but also on other factors such as local availability, fashion, and on local practices.