Annual report of the National Observatory on Drugs and Addiction 1 2014 Annual Report of the National Observatory on Drugs and Addiction MOROCCO 2 www.onda-drogues.com The translation of this document has been produced in the framework of the South Programme. The information and views set out in this document are those of the author(s) and do not necessarily reflect the official opinion of the European Union or of the Council of Europe. Neither the European Union nor the Council of Europe institutions and bodies nor any person acting on their behalf may be held responsible for the use which may be made of the information contained therein. 3 Drafting Committee Professor Jallal Toufiq (Director) Professor Fatima El Omari Doctor Maria Sabir Scientific Committee - Professor Abderrahmane Maaroufi: Director of Epidemiology and Disease Control / Ministry of Health - Doctor Soumya Rachidi: Head of the Central Mental Health Department (Programme against Drug Addiction) / Ministry of Health - Professor Mehdi Paes: Addictologist - Professor Fatima Elomari: Addictologist 4 Acknowledgements Our warm thanks go to: y All those who contributed to data collection and technical and logistic support: Ministry of the Interior (Directorate-General of National Security), Ministry of Justice and Freedoms, Ministry of the Economy and Finance (Customs and Indirect Taxation Authority), Ministry of Education and Vocational Training (Medspad surveys), Ministry of Health (Central Mental Health Department). y The Scientific Committee: Prof Abderrahmane Maaroufi Prof Mehdi Paes Dr Soumaya Rachidi Prof Fatima Elomari y The Council of Europe͛ƐWŽŵƉŝĚŽƵGroup y The Pompidou 'ƌŽƵƉ͛ƐDĞĚEd network y The South Programme: programme funded by the European Union and implemented by the Council of Europe y The European Monitoring Centre for Drugs and Drug Addiction y The French Observatory of Drugs and Drug Addiction y Special thanks to Dr Maria Sabir for compiling and inputting the data 5 Contents FOREWORD. 08 PREAMBLE. Brief analysis of the drug situation in Morocco 10 PART A. NEW DEVELOPMENTS AND TRENDS 13 1. Drug policy: legislation, strategies and economic analysis 13 1.1. Introduction 13 1.1.1. Definitions 13 1.1.2. Data collection tools 14 1.2. Legal framework and implementing instruments 15 1.2.1. HistorLJŽĨDŽƌŽĐĐŽ͛ƐƉŽůŝĐLJŽŶŶĂƌĐŽƚŝĐĚƌƵŐƐ 15 1.2.2. Legal framework governing the sale and consumption of alcohol 16 1.2. 3. Legal framework governing the sale and consumption of tobacco 17 1.2.4. Current overall context in Morocco 18 1.2.5. Current legal framework 19 1.2.6. Drug use 20 1.2.7. Drug trafficking and money laundering 21 1.2.8. Legal framework governing harm reduction 24 1.3. National action plan: strategy and evaluation 26 1.3.1. Background to the action plans on mental health and drug addiction 26 1.3.2. National Action Plan against Addiction 2012-2016 29 1.3.3. National Action Plan for Harm Reduction 31 1.3.3.1. Background to harm reduction policy in Morocco 31 1.3.3.2. National Action Plan 2012-2016 for reducing HIV risks among IDUs 34 1.4. National and international co-ordination 37 1.4.1. National co-ordination and the National Observatory on Drugs and Addiction (ONDA) 37 1.4.2. International co-ordination and co-operation 39 2. Drug use in the general population and in specific groups 42 2.1. Drug use in the general population 42 2.1.1. National survey on the prevalence of mental disorders and drug addiction 42 2.2. Drug use in schools 43 2.2.1. MedSPAD survey 2006 44 2.2.2. MedSPAD survey 2009 45 2.2.3. MedSPAD survey 2013 46 3. Prevention 48 3.1. Introduction 48 3.2. General context and main players 50 3.3. Monitoring and data 50 3.4. Legislative framework 50 3.5. National co-ordination 50 3.6. Addiction prevention poli cy - Strategic vision and action plan 2012-2016 51 3.6.1. Strategic objectives of the action plan 2012-2016 52 4. Problem drug use 55 4.1. Specific context of problem drug use in Morocco 55 4.2. Results of the main surveys carried out 58 4.2.1. Rapid evaluation of HIV risks among IDUs (phase I: 2005-2006) 58 4.2.2. Bio-behavioural/RDS surveys Tangier 2009 and Nador 2011 61 4.2.3. Determinants of HIV/AIDS and HCV vulnerability among drug users 61 4.2.3.1. Individual behavioural determinants of HIV and HCV vulnerability among IDUs 61 4.2.3.2. Societal/social determinants 61 6 5. Treatment: demand and supply 63 5.1. General description 63 5. 1.1. Addiction treatment policy and strategy 63 5.1. 2. Main areas of activity of addictology centres in Morocco 65 5.2. Current provision in terms of addiction care 65 5.2.1. Facilities 65 5.2.2. Human resources 66 5.2.3. Residential treatment programmes for drug users 66 5.2.3.1. The National Centre for Addiction Treatment, Prevention and Research (CNTPRA) at Ar-razi hospital in Salé 66 5.2.3.2. The addictology department at Ibn Rochd university hospital in Casablanca 66 5.2.4. The Opioid Substitution Treatment (OST) programme in Morocco 68 5.2.5. Prospects for the methadone programme in Morocco 71 6. Health consequences of drug use 73 6.1. Analysis of the epidemiological situation of infectious diseases related to drug use in Morocco 73 6.2. National response to the spread of the HIV and HCV epidemics 77 6.3. Mortality related to drug use and mortality among drug users 79 7. Harm reduction and social reintegration of drug users 80 7.1. National Strategic Plan against AIDS 2012-2016 80 7.2. Introduction of methadone substitution treatment in prisons 83 7. 3. Social reintegration of drug users 84 8. Drug-related crime and prisons 86 8.1. National policy against drug abuse and drug trafficking 86 8.1.1. Morocco͛ƐĐŽŵƉƌĞŚĞŶƐŝǀĞĂƉƉƌŽĂĐŚƚŽƚŚĞĨŝŐŚƚĂŐĂŝŶƐƚĚƌƵŐƐ 86 8.1.2. Efforts to suppress drug trafficking/Eradication of cannabis crops 87 8.1.3. Movement/Transit of drugs 88 8.2. Drug-related convictions 89 8.3. Prisons 91 9. Drug supply data 92 9.1. ADI (Customs and Indirect Taxation Authority) data 92 9.2. The fight against illegal drug trafficking 93 9.3. The fight against drug abuse 93 9.4. The fight against illegal drug trafficking and drug abuse around schools 94 10. The issue of the legalisation of cannabis for medical or industrial use 95 - Part B: Summary and recommendations 98 SUMMARY 98 RECOMMENDATIONS 99 - Conclusions 100 - Part C. Bibliography and appendices 101 7 Foreword: ͞A review of the state of the nation offers us the opportunity to assess the extent of the progress made͕ƵƐŝŶŐĂůůŬŶŽǁŶŵĞĐŚĂŶŝƐŵƐĨŽƌŵĞĂƐƵƌŝŶŐƚŚĂƚƉƌŽŐƌĞƐƐ͘͟^ƉĞĞĐŚĨƌŽŵƚŚĞ Throne, 2014. For some years, the Kingdom of Morocco has demonstrated a clear political will to address drug use issues in a proactive and pragmatic manner. No one can hope to deal effectively and efficiently with this problem without having an understanding of its nature and magnitude, which presupposes an accurate scientific evaluation of the phenomenon, carried out on a regular basis. You can only deal with what you know, and what you know is what you have measured. This evaluation is the main task of the National Observatory on Drugs and Addiction (Observatoire National des Drogues et Addictions -ONDA). The annual report is its outcome. Through the use of well-established scientific mechanisms, the successive annual reports will help in future to make a detailed assessment of developments in our country and, in so doing, provide reliable data for the drawing up of appropriate custom-made programmes for improved management of addiction issues. In keeping with the wishes of the Kingdom of Morocco, an evidence-based approach was the overriding consideration in the setting up of ONDA, an instrument for data collection, analysis and reporting, serving politicians and institutional decision-makers; ultimately, ONDA is the outcome of a responsible, realistic and objective policy. ONDA͛Ɛ mission is to help policy-makers, and all those involved in this field, to have access to reliable, up-to-date information so that they can take context-specific action in the various areas connected with drug use, namely prevention, treatment, harm reduction and rehabilitation. To succeed in its mission, ONDA works with the different departments involved in both demand and supply reduction. Data collection covers the epidemiological characteristics of treatment requests, conditions secondary to use, use in the general population and certain specific population groups, associated morbidity and mortality, trafficking and seizures. The indicators compiled meet well-known scientific requirements and are consistent with those of international observatories, in particular the European Monitoring Centre for Drugs and Drug Addiction. 8 This first report, ĞĨĨĞĐƚŝǀĞůLJKE͛ƐĨŽƵŶĚŝŶŐĂĐƚ͕ŝƐƚŚĞƌĞƐƵůƚŽĨĚĂƚĂƐŚĂƌŝŶŐďLJƚŚĞDŝŶŝƐƚƌŝĞƐŽĨ Health, Justice and the Interior, via the Directorate-General of National Security, and the Customs and Indirect Taxation Authority. It carries the endorsement of an independent scientific committee known for its scientific credibility. ONDA͛ƐŵŝƐƐŝŽŶĂůƐŽŝŶĐůƵĚĞƐĐŽŵŵƵŶŝĐĂƚŝŶŐ͕ĂƐappropriate, in connection with this report and acting as a discussion partner for the various political, community, institutional and civil society players. ONDA is the reflection of a pragmatic policy in a rights-based country which is adopting a head-on, holistic approach to the problem of drug use, not only in the interests of its citizens suffering from drug abuse and dependence, but also for the purpose of taking targeted preventive measures for the well- being of those not yet affected by this scourge. It goes without saying that this first report cannot be exhaustive. In future it will require additions and further information. But it has the merit of being an initial working document and compilation of data offering a more or less accurate picture of the current drug use situation.