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The Maldives Police Service signed Memorandums of Understanding with the ports authority, airports company, immigration department, and the customs authority yesterday to use the sniffer dogs to locate drugs. The MoUs outline mechanisms for relaying information, conducting joint operations, and sharing resources, according to police. The MCS was authorised to take the action under import and export laws as well as the Customs Act, the judge noted, and rejected the claim for compensation of losses incurred due to the confiscation of goods. Confusion surrounds the decision to destroy over animals confiscated by authorities last weekend, with both police and the Maldives National Defence Forces MNDF denying responsibility for the move. These claims were promptly rejected by the police, however, who denied having asked the MNDF to terminate the animals. The spokesman went on to suggest that the responsibility for the transfer of the animals lay with the customs department, stating that the legal rationale for the decision could be explained by customs authorities. Naeem denied having been consulted over the care and maintenance of the confiscated animals. The animals — including 11 iguanas, a snake, a sugar glider possum , an owl, a squirrel, and rats — were taken by police in an operation to tackle the number of illegal pets last weekend. Customs regulations list dogs and dangerous animals as prohibited from import, while other live animals entering the country are required to have valid sanitary certificates. The regulation on importing live animals specifies that the procedure for handling animals considered wild or dangerous includes consultation with the Fisheries Ministry and the MNDF, as well as the production of a report, before repatriation or extermination. When asked if the police had allowed relevant time for owners to produce the necessary certificates before the animals were destroyed, Minivan News was again referred to the customs department. I condemn those who import those who import them to Maldives, they should actually take the responsibility. Authorities have confirmed that the endangered slow loris — confiscated during an earlier police operation — was not amongst the destroyed animals. The EPA is currently discussing the potential repatriation of the animal with interested parties. Police have today said they have started a special operation to seize all dangerous animals that are illegally imported to the country. In a statement the police said they had commenced a joint special operation with the relevant government institutions after having noticed that sightings of such animals on streets and other places had become common in the Maldives. Police said that aim of the special operation was to seize all these animals and take them under police charge before a regrettable incident occurs. Furthermore, the police stated that the Ministry of Environment and Energy, the Fisheries Ministry, customs and the Maldives National Defence Force were all involved in the operation. Police have also appealed to the public to inform police if they have any information by contacting the police hotline — , the police emergency hotline — , or police Criminal Investigation Department — On 16 March Police Commissioner Hussain Waheed met with Commissioner General of Customs Ahmed Mohamed and a delegation of senior customs official to discuss the increase in illegal animals being discovered during recent drug operations. A police statement at the time reported that Waheed had told officials that citizens were now in constant fear, noting that the police did not have any role in the airports and other ports. He also said that police now needed to conduct as many operations to confiscate illegal and dangerous animals as to curb drug related crimes. Earlier in March, police discovered a royal python — a nonvenomous snake commonly kept as a pet — following a drugs raid in Himmafushi, Kaafu atoll, on March 4. It has been revealed this week that the ministry is considering destroying the animal after attempts to find a suitable home had failed. According to Ilham, there were three possible options when dealing with the animal — keeping it in captivity, returning it to the wild, or having the animal put down. The first option of captivity was not available in the Maldives, she noted, with no rescue centres, humane societies, or relevant university facilities. As the CITES resolution details a number of other obstacles to keeping the creature in captivity in the Maldives, Ilham explained that the ministry had attempted to find a home for the slow loris elsewhere. Issues soon arose with the transfer to the Czech Republic, however, as the import of the animal could not be approved as it is not in accordance with World Organisation for Animal Health. Alternatively, sea transport proved prohibitively expensive. The second option of returning the animal to the wild was not available in the Maldives, stated Ilham, as the Maldives does not have the wild habitat of the slow loris. Following the discovery of the a number of exotic and illegal animals by police this year, the government has moved to step up customs security , in an effort to stem the flow of illegal animals being trafficked into the Maldives. They will then check with international bodies. Aside from those trafficked, non-native species such as crocodiles have also found themselves in the Maldives, resulting in dilemmas regarding the appropriate way to handle these unusual arrivals. In , a small crocodile — or kimboo in Dhivehi — was found off the coast of a local island. The discovery of two more crocodiles in early raised serious concerns around the containment and treatment of animals in the Maldives. Similar lists of projects have also been devised for customs, the police, and the military. Transport and communication. On December 8, the Transport and Communication Ministry revealed that it would finish drafting plans and begin the groundwork within a days to develop the Ibrahim Nasir International Airport INIA to be able to cater to 5 million passengers. Plans were also made to introduce the nighttime landing of flights in Thimarafushi and Fuvahmulah airports within this period. In the field of land transportation, the ministry pledged to improve local ports, connect islands via seaplane transport and to improve ferry services between atolls. There are further plans to establish a broadband internet policy and to provide fast-speed internet to all inhabited islands. Besides this, the plan also includes the introducing number portability between the two telecom service providers currently available in the country. Just a week after the new administration was established, Vice President Dr Mohamed Jameel Ahmed announced that the government had begun to solve issues in providing health services to the people. Stating that the lack of the service forced many Maldivians to live abroad for medical purposes, Ameen said that the introduction of chemotherapy facilities in the country was crucial. He added that screening to diagnose cervical cancer would also be introduced -both under a government insurance scheme. The minister further revealed that the government had decided to transfer specialist doctors to the atolls for a period of time which would be allocated by the ministry. Shakeela stated that funds for development are included in the budget, and that the government is also seeking aid from international donors for some of the projects. The plan itself includes work to offer illegal immigrants a chance to change employees, and increasing the number of illegal immigrants who will be deported in The immigration controller also revealed plans to establish an online system of obtaining work visas from Kulhudhuhfushi, establishing a single office to deal with all migrant related work, and a mechanism where e-passports can be issued from two areas of the country. The Maldives Police Services has also created a roadmap of goals they will work to achieve in the first days of the Yameen administration. The roadmap also includes internal work like the establishment of a new system to address complaints against police officers, the creation of a police clinic for health support to officers and their families, and the compilation of a four-year strategic plan on professional development of the force. Police, together with customs, have also initiated programs to tackle the illegal import and abuse of narcotics and serious and organised crimes. Customs — which has also revealed a roadmap for the same period — have on December 12, expressed concern that budget limitations may prove to be an obstacle in the realisation of their goals. The plan further consists of a variety of other projects, including the addition of a helicopter and landing crafts to its fleet, and the establishment of fire stations in the islands of Kahdhoo and Naifaru. The military intend to lay the foundation for a new eight story building where the current Coast Guard offices are, to conduct additional international training for officers — especially with the Indian Army, to provide medical care at low fees for general citizens at the Senahiya military hospital, and the establishment of a day care centre for the use of officers and families. The Criminal Court has asked the state to appoint a defence lawyer for a Filipino woman arrested in Male airport after attempting to smuggle three kilograms of cocaine into the country, as she was not able to afford one. The judge also said the court found it difficult to conduct such serious cases without the respondent having a defence lawyer. On September 17 customs reported that its officers at the Ibrahim Nasir International Airport had seized grams of drugs inside the suitcase of the 33 year-old woman. The customs department said the woman came to Maldives from Rio de Janeiro after transiting in Dubai. Speaking to Minivan News today, Criminal Court spokesperson Ahmed Mohamed Manik said the court had given the woman the opportunity to appoint a lawyer previously, but she had not. According to Manik this was the second chance the court had given her the chance to appoint a lawyer. According to local media, the drugs were stored inside the body of a man who arrived to Maldives from Trivandrum, India. The drugs were handed to police, who have been looking for one more person involved in the case, local media reported. More than staff working for the Maldives Customs Department have signed a petition submitted to Anti-Corruption Commission ACC , alleging that employees had been promoted in violation of regulations. According the petition the Customs Act mandates promotions be given according to specific regulations, which staff alleged had not been respected. The staff members alleged that promotions had been given in a way that would benefit individual persons, and had divided staff in the department. The staff also warned that they would go on strike if the issue remained unresolved for too long. Skip to content. Likes 0 Dislikes 0. The customs had confiscated the shipment due to unpaid taxes. Minivan News was unable to contact customs officials at the time of press. Former President Mohamed Nasheed has taken to Twitter to denounce the decision. Unnatural habitat Following the discovery of the a number of exotic and illegal animals by police this year, the government has moved to step up customs security , in an effort to stem the flow of illegal animals being trafficked into the Maldives. Transport and communication On December 8, the Transport and Communication Ministry revealed that it would finish drafting plans and begin the groundwork within a days to develop the Ibrahim Nasir International Airport INIA to be able to cater to 5 million passengers. Health Just a week after the new administration was established, Vice President Dr Mohamed Jameel Ahmed announced that the government had begun to solve issues in providing health services to the people. She said that this included a complete renewal of the management figures at the hospital. Shakeela promised that the full day programme would be revealed next week. Customs, Police and Military The Maldives Police Services has also created a roadmap of goals they will work to achieve in the first days of the Yameen administration. The woman told the court that she would keep trying to make her family appoint her a lawyer. The customs had seized packets containing suspected illegal drugs from the airport. Page 1 Page 2 … Page 4 Next page.

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This document summarizes the key findings of the Maldives' first National Drug Use Survey conducted in Major findings include that the majority of drug users were young unmarried males, and that alcohol, cannabis and opioids were the most commonly used drugs. The study also found high-risk drug use behaviors like injection drug use, unsafe sex, and criminal activity among users. It recommends strengthening prevention, treatment, and harm reduction responses to address the country's drug problem. Read less. AI-enhanced description. Download now Download to read offline. More Related Content. Maldives National drug use survey 1. The designations employed and the presentation of material in this publication do not imply the expression of any opinion on the part of UNODC concerning the legal status of any country, territory or city or its authorities, or concerning the delimitation of its frontiers or boundaries. The contents of this publication are the sole responsibility of name of the United Nations Office on Crime and Drugs and can in no way be taken to reflect the views of the European Union. Lubna Zahir Hussain, Chairperson Ms. Aminath Zeeniya, former Director General Mr. Abdullah Faseeh, Senior Counsellor Dr. Chengappa M. Medical Officer Ms. Hunana Latheef, Senior Counsellor Ms. Idham Fahumy, Survey Manager Mr. Yasir Waseem, Managing Director Ms. Mariyam Niyaf, Consultant Ms. Afiya Ali, Consultant Ms. Aminath Eenas, Consultant Ms. Aishath Laila, Consultant Mr. In addition UNODC would like to thank the enumerators and respondents for their instrumental role in the survey. Cristina Albertin, Representative Dr. Suruchi Pant, Deputy Representative Ms. Sarah Waller, Project Coordinator - Ms. Ravindra Rao, Technical Officer Dr. Abdul Malik, Technical Officer Mr. Debashis Mukherjee, Research Officer Ms. Isheeta Sumra, Communications Officer Ms. Ahmed Rabeeu, Programme Administrative associate Mr. Introduction 05 B. Background 06 I. Objectives of the Study 12 B. Methodological Approach 12 I. Overview 12 II. Questionnaire 15 I. Preparation 15 II. Pilot Test 16 III. Final Questionnaire 16 D. Sampling Methods 17 I. Operational Procedures 21 I. Interviewer Training 21 II. Field Work 21 III. Monitoring and Supervision 22 IV. Data Management 22 F. Data Preparation and Analysis 23 G. Delimitations and limitations of the study 24 H. Household Survey; Atolls 26 II. Caution in Interpreting the Results 36 B. Sample Characteristics and Demographics 36 II. Drug Use Pattern 40 IV. Consequences of Drug Use 46 V. Services 54 VI. Perception of Drug Problems Summary 57 C. About the Survey 60 II. Profile of Drug Users 62 IV. Pattern of Drug Use 63 V. Burden of Drug Use 64 VI. Injecting Drug Use 66 IX. Drugs and Crime 66 X. Supply Reduction 68 II. Demand Reduction 68 III. Harm Reduction 71 IV. An enabling Policy and Legal Environment 72 V. The abuse of illegal substances has been a major problem faced by the Maldives for the past 3 decades now. The country recognised this as a problem for the first time in the late s. Over the years, with the increase in the number of substance abusers, addictive subculture developed gradually. This situation in Maldives warranted for a better understanding of this problem which was why this survey was done. Substance abuse should be viewed as a multi-dimensional problem and needs to have a holistic approach. Realising the scale of this problem becomes outmost essential in this regard. This document contains information on the incidence and prevalence of substance abusers in Maldives. This includes statistics on the estimated number of drug users in the country, the demographic data, and the primary choice of drug and newer trends of substance abuse including the abuse of prescription medications. The document also gives an idea of the patterns of substance abuse, associated high risk behaviours like Injection drug use, criminal activities, and unsafe sexual practices as well as the perception and understanding of the substance abusers. The survey results come from the information collected in the year and This is also the first time in the history of Maldives that such a comprehensive National Drug Use Survey has been done. In spite of the practical difficulties like geographical location of the islands and accessibility, the information accumulated in this survey is commendable. The aim of this study is to quantify the adverse outcomes of drug abuse and express the magnitude of the consequences of drug abuse in this country. The information provided by this survey without a doubt contributes to a better understanding of the nature and extent of the impact of drug abuse and this understanding will help decision makers to identify appropriate strategies to combat the problem of drug abuse in the Maldives. While this report is designed to serve as a tool for policy makers, policy analysts and researchers with questions about the consequences of the extent associated with drug abuse, I would like to caution that the data included in this survey report are not an evaluation of the efficacy or the impact of drug treatment and prevention interventions, rather this data must be used to understand the problems and enormity of drug abuse in Maldives and to find potential interventions to drug prevention and treatments for the future. This survey calls for urgent drug treatment interventions to reach those who are yet to come for treatment. It further highlights the importance to establish primary prevention initiatives and formulate a comprehensive Substance Abuse Prevention Strategy for the country. In light of this survey results, the Government shall initiate a well co-ordinated national response strategy to combat drug supply and drug abuse in the Maldives, respectively to strengthen existing mechanisms and services, and initiate new policies if required. On behalf of the Government of Maldives, I wish to express my appreciation towards the European Union , the United Nations Organization for Drugs and Crime, and all those who were directly or indirectly involved in this enormous and vital task, for their contribution to the collection of data and to the development of this very comprehensive and important document. It is mainly the young boys and girls who are engaging in drug use for a variety of reasons and too many young Maldivians have already died from drug use. Drug use poses serious challenges as it affects foremost the health and life of the drug user, the social well- being of the family and community as well as the economy of the society. The Government of Maldives has taken a pledge to address drug use comprehensively and to build national capacities in drug use prevention and treatment. In order to shape drug use prevention policies, it is critical to have a clear understanding of the nature, scope and substances of drug use in the country. Such understanding must be based on evidence. The survey establishes the number of current drug users and hence, the drug use prevalence in the country. It has also studied knowledge, attitudes and perceptions in the community regarding the drug problem. The findings of the survey will not only allow for a better understanding of drug use among the youth in the country, but will serve as a useful tool for planners, policy makers, researchers and academicians to shape future drug use prevention policies in the country for the benefit of its entire young population. Thus, this study was conducted to estimate the number of drug users and hence, the drug use prevalence in the Maldives. Secondary objectives include identifying patterns and extent of drug use across the country; assess behavioural characteristics associated with drug use; community knowledge, attitudes and perceptions towards drug problem. Though the study covered the full range of psychoactive substances from alcohol and tobacco to prescription drugs which are considered to be available in the Maldives, the focus was on illicit drugs including alcohol. Since different methodologies were used to estimate the prevalence in different localities, a national prevalence cannot be estimated from these figures. Majority of the respondents who had ever used drugs belonged to the age group of years. Among the drug users who were interviewed, majority of the population using drugs were unmarried, and half of them were unemployed. In terms of the drug use pattern, this survey confirmed that alcohol, cannabis and opioids were the most common illicit drugs used in the country. It also showed that a large proportion of the community who used drugs used two or more drugs poly drug users within the last one year. It was evident from this study that an overwhelming majority of drug users were males; and confirmed that drug use in Maldives was predominantly a male phenomenon which needs to be taken into consideration while designing intervention programmes. It further elaborated that if the same methodology is applied to study both the genders, it becomes difficult to capture the level of female drug use in the country. It was also noted that half of sexually active drug users had a drug user as a sex partner. This further suggested that the response to drug use problem in the country appeared to be leaning towards the criminal justice system rather than health and social welfare systems. This study revealed that a significant number of drug users were likely to be dependent on certain types of drugs. A large proportion of current drug users were aware of HIV and informed about the phenomena. However, not many of the respondents were informed or had undergone any testing or vaccinations against Hepatitis B, Hepatitis C or Tuberculosis TB. Illicit drug use today characterized as a problem among youth - notably young male. Being unmarried and buying sex is becoming more evident among the drug use population. One of the key impacts of illicit drug use in the society is the negative health consequences experienced by its members. This obviously puts a heavy financial burden on the society. The costs associated with drug related crime are also phenomenal. It is apparent that just the criminal justice system would not be able to address the problem in its entirety. Since the country has a sizable burden of drug use, it is crucial to have a multi-layered and multi-pronged response, with a judicious mix of supply reduction, demand reduction and harm reduction approaches. According to the Maldives Drug Control Master Plan - , drug abuse is a complex and multifaceted problem facing the whole nation, cutting across all age groups and social strata. Hardly a community or a family is free from its harmful effects. Though there are some data from previous studies available on the drug use problem in the Maldives, none of them have adequately addressed the national prevalence of drug use in the country. It is fair to say that the first step in dealing with a problem is to understand its dimensions. In order to be effective however, responses need to be evidence based. The survey provides a description and analysis of the burden of drug use at the national level, as a first step in a systematic approach to dealing with drug abuse in the Maldives. Since it is an initial view of the situation at a national level, it is as comprehensive as possible within the scope of available resources and information regarding the context of the problem. It covers the full range of psychoactive substances. However, the focus has been retained on illegal drugs. The details of the survey design and methods are explained in Chapter II. The balance of this chapter explores the context of drug abuse in the Maldives. Background I. History of Drug Use in the Maldives It is difficult to reliably describe the history of drug use in Maldives due to lack of available historical data. However Francois Pyrard, a French historian and traveller in , suggested that opium use was prevalent among Maldivians of that time Bell, Recent anecdotal evidence also indicates continued use of opium during the first half of 20th century. Drug availability was known to be identified in Maldives in the mids. While many believe that there is a link between drug availability and introduction of tourism which coincides this period, however there is no strong evidence to connect the two. Since this period also coincided with the introduction of drugs into other South Asian countries, it is equally plausible that drugs came with young students returning home from neighbouring countries. Subsequently, cannabis abuse marijuana and hashish took root among the youth. Since then, the drug problem has become a major problem especially among youth. Current Context- Existing Data on the growing drug problem As stated earlier, epidemiological data on drug use situation in the Maldives is relatively scarce. There has not been any nation-wide epidemiological study conducted to explore drug use and its related behaviours so far. The Statistical Yearbook of Maldives reported that a total of persons in and persons in have been detained by the Maldives Police Service in relation to drug use offences. And out of these persons detained, majority were between the ages years. This gives us a clear indication to believe that the youth population is more affected by drug use in the country. The RSA revealed the seriousness of the situation and prompted the elaboration of a national master plan for drug control. Using a combination of. The RSA also found that the age range of drug use initiation was years mean Interviews with drug users revealed that 97 percent were males, with a mean age of Almost half 47 per cent were below the age of 20 years. Though the data was collected from a small sample of drug users recruited through snowballing technique the survey did succeed in establishing the existence of drug abuse in the country and throwing some light on the behavioural consequences of drug abuse. However, the data from the RSA cannot be generalized to the entire country due to chosen methodology in the study. Some recent studies have looked at the prevalence of drug use in targeted groups and also some of the behavioural aspects associated with drug use. Furthermore, drug related offences have been the third most common crime reported to the police Maldives Police Services, Among students who ever had tried drugs, This study also estimated that 5. Records of the Ministry of Justice between and indicated a very low and declining trend of alcohol abuse in the Maldives, with just 17 cases reported in Statistical Yearbook However, recent statistics and studies show that alcohol consumption is increasing in the Maldives. For instance, the current prevalence of alcohol consumption among school children aged years, was 6. A recent prison based study conducted in the Maldives showed that the third most common illicit substance consumed was alcohol UNDP, The prison based study also found that majority of the. Among this group, majority of them had used heroin On Drug seizures, Maldives Customs Services have reported that 13kg 15 cases in , 9kg 9 cases in , and 6kg 13 cases in were seized Maldives Customs Services, The data also indicated that the type of drug seized most in was cannabis, followed by heroin. These records further showed that seizures were very low during In , seizures increased considerably The statistics for the first eight months of showed a continuation of the rising trend with seizure of heroin According to Maldives Customs Services, most seizures have been made at the international airport. Genesis of this study Problems Associated with Drug Use: Drug Use and Social Functioning Society has a vested interest in understanding the relationship between drug use and social functioning in order to effectively target prevention efforts. According to a number of researches, illicit drug use imposes a significant social burden and has been associated with a range of adverse outcomes such as reduced educational attainment, criminality, mental health problems and delinquency Fergusson et al. Various studies had implied that low educational attainment is potentially a cause or result of drug abuse where the latter has been more significant. Some review of longitudinal studies examining illicit drug use and psychosocial harm revealed consistent associations between cannabis use and low educational attainment, as well as some inconsistent associations with psychological and behavioural problems. However, these concluded that the evidence to date cannot support or disprove causal relationships e. According to the Annual Report , on the state of the drug problems in European Union, social conditions of drug use were distinct by substance used; where the worst conditions were found among heroin and opiates users. Because of their precarious social conditions, drug users also had problems related to labour status. According to the report, unemployment rates of the drug users were very high compared with the general population Also finding a job was difficult and was rare for drug users to keep a job for long or to progress in a career. Prolonged abuses of drugs have been shown to alter gene expression and brain circuitry, which in turn affect human behaviour. The impact of addiction can be far reaching. A focused study of more than youth has directly linked teenage drug use with health problems in later in life. This study indicated that individuals who had used drugs as teens reported more health problems during adulthood such as respiratory, neurobehavioural, and cognitive problems Brook et al. Drug use is also considered a significant risk factor for HIV infection. That is drug and alcohol intoxication affect judgment and can lead to unsafe sexual practices, which put people at risk for getting HIV or transmitting it to someone else. Another health risk of drug use particularly for injecting drug use is the spread of Hepatitis C. In this study they found that 0. Although the prevalence of Hepatitis C is still low, this result implies that the virus is already circulating among the injecting drug users. This study had recruited only selected samples, and did not provide population size estimates hence it cannot be generalised to general IDU population Corpuz, Mental Health The ill effects of drug use which leads to detrimental health problems both at individual and national levels are well known. There has been no comprehensive study of co-morbidity in the Maldivian population, but evidence of the relationship comes from a number of sources. People with a psychiatric illness are more likely to have a substance use disorder than people without a psychiatric illness. The association between mental. People with such co-existing disorders are not a homogeneous group, they suffer a range of disorders which vary in their severity and which fluctuate over time. Disorders may be primary, secondary or independent of each other but they are nevertheless intrinsically connected and increasingly being identified as intertwined problems. Strong evidence has emerged showing early drug use to be a risk factor for later substance abuse problems; additional findings suggest that it may also be a risk factor for the later occurrence of other mental illnesses. A study highlights this complexity, with the finding that frequent marijuana use during adolescence can increase the risk of psychosis in adulthood, but only in individuals who carry a particular gene variant Caspi et al. It is also found that having a mental disorder in childhood or adolescence can increase the risk of later drug abuse problems, as frequently occurs with conduct disorder and untreated attention-deficit hyperactivity disorder ADHD NIDA, Drug use, crime and offending behaviour Many believe that drug abuse is strongly associated with offending behaviour. However, this is a complex issue where it is difficult to draw a conclusion regarding a definite cause- and-effect link between the two phenomena. All that aside, the scientific studies conducted over the past two decades provide evidence which tends to show that drug use is one of a number of factors that may explain why some people commit criminal acts. However, they do not represent all or even most illegal drug users, especially in the case of marijuana users. In other words, illegal drug use does not necessarily lead to an increase in crime, even among people who are regular users or have developed an addiction. Factors that may explain both drug use and criminal activity include various social, psychological and personal factors. Having said that, several studies have found that many offenders incarcerated, have been intoxicated by either alcohol or illicit drug or both at the time of their offence Brochu et. This study had not explored whether those who were serving a sentence for offences such as robbery, theft, assault committed these crimes while under the influence of any drugs. The RSA reported that almost a third of the drug users were also involved in dealing in drugs and many admitted to stealing from their homes. Hence there was an urgent need to conduct a study which could aid in formulating appropriate evidence-based policies and programmes to deal with drug problems. Objectives of the Study The purpose of the research was to identify the burden of the drug problem in the Maldives. The primary objective of the survey was to estimate the number of drug users, and hence the prevalence of drug use in the Maldives. The secondary objectives include; understanding the drug use pattern among different demographic groups; extent of drug use in the country; assessing behavioural characteristics associated with drug use and studying the attitude, awareness and perceptions towards drug issues in the community. Methodological Approach I. Overview Extensive literature review of local and international researches was undertaken on methods, approaches, definitions, standards and limitations during the preparatory stages of this study There are two methods used to estimate the prevalence of drug use. That is direct and indirect methods. Direct methods includes enumeration of known drug users using population surveys based on a representative, random sample of the population of interest. Examples of this approach to study the prevalence of drug use were abounding in the literature reviewed. Similarly, a household survey on a nationally representative sample of males in the general population was carried out in India Ray, While surveys yield valuable information, there are some limitations such as budget and logistical burden of conducting, administering and analysing large scale household surveys. Additionally household surveys by nature are not able to tap into specific populations such as homeless persons, prisoners, hospital patients, etc. Thus, there is a need to explore other techniques, which are more suitable for studying a hidden population like drug users such as indirect methods. The most common indirect methods used in similar research studies in other countries were Capture Recapture method and Multiplier method. It was based on the principle that a proportion of a sample of a given population, if captured, marked and released back into that population it would reappear in a later sample. The proportion of marked members caught in the second sample represents the proportion that the original marked sample was to the total population. When this technique was applied to drug users, comparisons were made between partial sets of drug users in order to establish the number of overlaps between two or more partial populations. This method is based on the assumptions that the samples are random; all individuals have the same probability of being included in the sample. The time period and populations are the same in both capture and recapture, identification of individuals is done accurately and sufficient identification information is available to avoid double counting. While the main advantage of this method is its low cost due to usage of existing secondary data, the unavailability of this secondary data becomes its main disadvantage. The benchmark is then multiplied by an appropriate multiplier to estimate the total of the whole drug using population. It is usually used to estimate the ratio of known to unknown users. Although, it is a time consuming and a complex process, network analysis yields valuable results. A single methodology was unlikely to generate a comprehensive scenario of drug use in a country like the Maldives. Hence, a combination of research techniques was implemented in this study. Results from the two segments were combined to arrive at a National level estimate of the number of drug users and thus the prevalence of drug use in the Maldives. Explanation for each segment is as follows. The estimated figure was derived by multiplying the number of people who attended the institution or service over a certain period by the inverse of the proportion of the population who said that they attended the specified institution or sought services during the same period. Illustration showing: Multiplier method Two types of data i. Secondary data used were institutional data available from records maintained at Maldives Police Services. Questionnaire I. Apart from the above mentioned questionnaires, a specific schedule of thematic questions was used in the focus group to guide discussions. In the process of questionnaire design, exhaustive desk-research was done using similar studies conducted in different parts of the world. All the questionnaires were pretested prior to finalising; and the pre-final questionnaires were shared with TWG for comments. Household Questionnaire Form A included basic questions on housing information and household composition. The individual questionnaire Form B1 was executed to all members in the household within the age bracket of 15 to 64 years. It also included screening questions to identify whether the individual has ever used a drug. Those who. The drug user questionnaire Form B2 included questions on different themes such as substance misuse and behaviour and drug using network. It also included questions on problems associated with drug use such as social functioning; physical and mental health; and crime and offending behaviour. Injecting drug use and high risk behaviour; treatment, support and care are also themes included in the questionnaire. Amendments were incorporated to the survey tools based on the outcome of the pilot survey and discussions were held with all enumerators, reviewing the problems and challenges encountered. Final Questionnaire The questionnaire was amended after the pilot was carried out and these were discussed in the TWG before the endorsement of the final questionnaire in SSG. Sampling Methods I. Sample Design: Household Survey i. A household survey was carried out to represent the Atoll population. The first step was to stratify the islands into two strata. The purpose of stratification was to divide the population into relatively homogeneous groups thereby reducing the total variation within the group. Stratification was done by the atoll capital and by non-capital islands. It was believed that in most of the cases atoll capital had better access to various social services while non-atoll capital islands had limited facilities. Second step was to identify the islands to be enumerated. All the atoll capitals were included in the sample while for the non capital, a further stratification was done to represent all the 20 administrative Atolls and from each atoll one island was selected based on Probability Proportionate to Size PPS method. Third step was to select the enumeration blocks and households. Inclusion criteria - for respondents: yy Between years of age; yy Willing to participate in the survey; yy Ability to be engaged in meaningful communication. Sample Size Since a national representative prevalence estimate for the country was not available and as there were very limited studies undertaken on this subject, several assumptions had been adopted in the design process. While data requirements for RDS analysis were minimal, there were three fields which were essential for analysis. In this survey, 43 seeds were selected and each of them was given a unique serial number. In this survey, each seed was asked to recruit 3 more users, and this continued until the required sample size was achieved. Since, no previous prevalence estimates were available; expert opinions were sought and discussions were held with key data providers and stakeholders to arrive at an anticipated prevalence. Thereafter, on the basis of following formula, the sample size was arrived at. Based on the calculations it was decided to enrol - drug users for the RDS Survey. Objectives of this component were to study and understand following: yy Social stigma, community knowledge, attitudes towards drug use problem; yy Community perceptions in drug related issues; yy Drug use behaviour, drug related high risk behaviours and; yy Behaviour change associated with drug use. Operational Procedures I. Interviewer Training A total of 60 interviewers were recruited and trained through a week long extensive training program with two sessions per day, each with three hours of contact time. The program was designed to cover all aspects of field operation and to transfer knowledge to ensure quality data collection. Lectures were delivered by relevant stakeholders to sensitize enumerators on substance use, abuse and dependence, illicit drug use and crime, approaches in managing drug abuse and government policy targets in managing drug abuse along with studies undertaken in Maldives about Illicit drug use. Special lectures on interviewing techniques, code of ethics, roles and responsibilities of enumerators, rapport building with respondents, and interacting with female drug users were also included in the training. Question by question training on all four questionnaires, including the objectives and purpose of the survey was followed by mock interviews to test their skills, knowledge and understanding of content taught. Questionnaire schedules developed for the survey were used as a basis for these lectures. An evaluation was done at the onset of the training and at the end which helped the survey management team in selecting enumerators. After the training, 38 enumerators and 12 supervisors cum enumerators were selected for field work. Field Work 1. Household Survey - Atolls Field work in the Atolls commenced on 31st October ; split over four rounds from October to February Enumerators were provided with Census block maps along with household listings. Selected addresses were marked on the sheets which also served as control sheets for the field operation. Enumerators were instructed to visit a selected household at least three times before considering a replacement from the list provided. Similarly, individuals were approached thrice before concluding the interview as unsuccessful. Enumerators travelled to the selected 39 islands and more than 3, households were visited. From those households 13, screening questionnaires were filled for individuals of age years. Teams spent on average a week in an island although on a few islands it took more than two weeks to complete field work. Respondents were rewarded with mobile phone recharge cards for successful interviews and successful recruitment. Various control sheets and logs were carefully maintained and monitored at all stages. All the FGDs were conducted by a moderator and a co-moderator. All the sessions were audio recorded after taking consent from the respondents. Life story events of drug users have also been recorded. The mandate of SSG was to oversee and endorse different activities planned and to monitor the progression of work. A number of sessions of the SSG were conducted at different intervals and all activities were reviewed and endorsed prior to implementation. Daily progress updates from teams were gathered, compiled and circulated among concerned personnel, SSG and others on a weekly basis. Data Management To computerize the collected data, a special data entry program was developed. The program had the entry fields on exact same image of the printed questionnaires, for easier readability and accuracy. The application had a range of built in procedures to ensure robust verification and validation of the data keyed in. A dry run of about 2 questionnaires by each trainee was keyed in and checked for consistency. Minor issues identified during this process were fixed and data entry commenced on April It took 25 days to complete data entry of all the questionnaires. To ensure consistency and plausibility of the data several checks were carried out during the data entry process and if errors were identified, the data entry operators were prompted to cross-check the information they had entered with that on the forms. This reduces the number of data transcription errors to an acceptable level while allowing obvious errors to be corrected at an early stage. Data Preparation and Analysis Before data analysis, a carefully designed, three step data-cleaning process was carried out; 1. Screening Phase - systematically looking for problems with the data; 2. Diagnostic Phase - identifying the condition of the suspect data; and 3. Treatment Phase - deleting or editing the data or leaving it. For household survey, the data was analysed using SPSS v All variables are pre-coded with answer codes along with their corresponding value labels. All audio recordings of the FGDs were transcribed, analyzed, common themes then identified and responses were grouped accordingly. In order to present the data in an easily readable fashion, tables, cross tables and graphic illustrations were made using MS. Excel and other desktop applications. All variables on the questionnaires for both Household and RDS survey were analysed individually and along with other related variables. However, findings and result presentation was mainly focused to address predefined objectives. Delimitations and limitations of the study The primary aim of this research study was to estimate the number of drug users and percentage prevalence of drug users in the country. At the same time analysis were carried to find out the following: yy Employment and income; yy Substance use and behaviours; yy Drug using networks; yy Problems associated with drug use; yy Injecting drug use and high risk behaviours; yy Treatment; yy Perception and Opinion. Limitations of this study were the inherent limitations of the research techniques such as, the study was based primarily on self-report and no objective evidence of drug use was employed. In addition, household surveys are notorious to underestimate the prevalence of drug use since many drug users may simply not be residing in households or may be institutionalised at the time of survey in prisons or in rehabilitation centres. However, one principal limitation was that two different kinds of final outputs were generated by using two different techniques, i. Yet another limitation would be the assumption that records in law-enforcement and drug treatment services correspond exactly to the population being studied through RDS. Ethical Issues Before launching the data collection, survey approval was taken from the Department of National Planning, the Ministry of Finance and Treasury. Additionally, the following are to be noted: yy All the respondents provided informed consent prior to the interview. Identity of the respondents has been kept confidential throughout the study. The chapter also looks into drug use pattern among different demographic groups; extent of drug use in the country; behavioural characteristics associated with drug use and attitude, awareness and perceptions towards drug issuse in the community. Household Survey; Atolls Sample Description In the Atolls, the sample size was 3, households, which resulted in achieving more than the targeted population of 10, individuals. Enumeration was successfully carried out in 3, households, a response rate of The target age group for the survey was years. A total of 13, individuals were listed as eligible persons to be surveyed. The significant differences in female and male composition in the screened sample may have been due to the nature of employment of male members in the households. These percentages showed similar trends with the Census results. The age distributions of other age groups were also comparable with Census data. The objective of the screening form was to identify drug users in the household. As a result of vigilant screening, a total of individuals were identified as eligible i. Out of these, individuals i. It is also worth noting that due to the small number of female drug users identified in the atoll sample, meaningful conclusion about the age structure of the current female drug users in Atolls was not possible. The use of Opioid Pharmaceuticals, Cocaine, Amphetamine type Stimulants, Sedatives and tranquillizers, and Hallucinogens seemed to be less prevalent in the Atolls. The prevalence of drug use, estimated for the Atolls was 2. This figure was arrived after accounting for the sex ratio of Census The prevalence estimate implied that, if people between 15 - 64 years of age in the Atolls are randomly selected it is likely that two of them will be current drug users. Sample Description A total of 43 seeds females 4, males 39 were identified as primary seeds for the data collection based on the distribution across different drug categories Refer table 5. Table 7: Population of proportion of current drug users by five year age distribution Age Group in years Estimated Population Proportions 0. Also presented in the table are the corresponding data on number of drug users registered for these services. Of current Drug Users 1. Journey 0. MPS Police Arrests 0. DRC Rehab 0. Detoxification 0. Out of all the data sources, the data from DRC Rehab appeared to be most suitable to be used as a multiplier since a it was most specifically related to drug users and b was also maintained more rigorously as compared to other sources of the data. Due to the use of different methodologies in estimating prevalence in different localities, estimating a single prevalence figure for the whole country was not possible. Opioids other than pharmaceuticals was found to be the second most common type of drug used in the Atolls, followed by alcohol. This study also showed that a large proportion of the drug using community used more than two or more drugs poly drug users within the last one year. This study provides baseline information to understand the drug situation in the country. One should be careful in interpreting indicators in terms of percentages, if the total denominator is significantly low for instance, reporting data on female drug users in the survey. For the same reasons, in some cases gender comparison may not be meaningful as the survey was largely dominated by male drug users. Sample Characteristics and Demographics As mentioned earlier, in this survey two approaches were used. Household survey was conducted in 39 islands visiting a total of 3, households of which 3, households were surveyed, equivalent to a response rate of A total of 13, people were eligible for the interview within these households, and a total of 10, were screened for the interview process. Between these female recruiters, they additionally recruited 9 females and 20 males. Drug users additionally recruited by male recruiters were 12 females and males. A total of current drug users were interviewed in the survey. While the majority of the current drug users in Atolls were between the age group of years. Among current drug users cocaine and hallucinogens users was negligible. Socio-Economic Status Analysis based on the drug users showed that education status of the general population and drug user population was not much different. A large proportion of the drug users as well as the general population had completed their secondary level. This may be due to the fact that a large proportion of drug users are below the age of 29 years. The industry with the second highest proportion of current drug users employed in the Atolls was the construction industry. Table 11 presents percentages of the population aged 15 - 64 years who used each of 9 categories of drugs within three time frequencies; ever used i. After cannabinoids and Alcohol, the next most commonly used drug category was Opioids. Poly-drug users Poly-drug use - a pattern that has already been observed in many drug-using populations was also found to be common in the Maldives. There are different rationales for mixing different drugs during one consumption period. Drugs, which when taken together can have cumulative or complementary effects, and also may be mixed to increase the overall psychoactive experience. Additionally, offsetting the negative effects of a drug can be another reason to take an additional substance. Finally, when the preferred drug is not available, another may be used as a substitute. It was common among drug users to have tried a number of drugs. It was noted that most of the Alcohol drinkers used more combination of drugs compared to other type of drug users. Figure 11 illustrates age of initiation of drug use by locality showing a clear stepwise progression of drug use. Similarly in Atolls, 74 percent of drug users obtain drugs from friends, while the second highest source of drug was recorded as from dealers. Download now.

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