Heroin patients can only raise Sh104 for treatment, study finds

Kenya's free methadone treatment programme is facing fresh uncertainty after a study found that most heroin addiction patients can barely afford to pay for the service, leaving the government to shoulder nearly the entire cost of care.

The research shows that people receiving treatment for heroin addiction can only manage about Sh104 per month, far below the more than Sh4,000 spent on each patient every month.

The findings come at a time when concerns are growing over the future of the programme following cuts to overseas health funding by the United States, which has been its largest financial backer.

The study was carried out by psychologist Tina Masai and a team of researchers who interviewed 44 patients receiving treatment at Mathari National Teaching and Referral Hospital in Nairobi, the country's oldest and biggest methadone clinic.

According to the findings, patients reported that they could afford a median payment of just $0.8, or Sh104, every month if they continued travelling daily to access treatment. When asked how much they could pay if services were offered closer to their homes, the amount increased to $2.3, equivalent to about Sh299 per month.

Only two per cent of participants said they would be able to cover the actual monthly cost of treatment, estimated at $32 or Sh4,160.

“The substantial gap between patient perceptions of affordability and service provision costs provides evidence that patient fees alone cannot sustain Methadone Maintenance Treatment (MMT) programmes,” the team said.

Researchers identified transport expenses as the main factor affecting affordability. The study found that the cost of travelling to clinics every day weighed more heavily on patients than their income levels or previous drug use patterns.

The team noted that bringing treatment services closer to communities could improve access while reducing costs for patients.

“Transport burden represents the most significant modifiable barrier, while community-based delivery models show promise for enhancing sustainability,” the team said.

They added: “Findings support maintaining free or highly subsidised services combined with decentralised delivery approaches for sustainable MMT financing in resource-limited settings.”

Methadone treatment was introduced in Kenya's public health system in December 2014 as part of efforts to address rising opioid addiction. The medication helps people dependent on heroin and other opioids reduce and eventually stop drug use.

Although methadone treatment has been credited with lowering illicit opioid use and improving patients' health, social wellbeing and quality of life, the programme continues to face challenges related to stigma, long-term financing and expansion to more areas.

Published in the International Journal of Drug Policy, the study highlights the pressure patients face in meeting even the indirect costs of treatment. Researchers concluded that maintaining free or heavily subsidised care remains critical if the programme is to continue serving those who need it most.

The findings also revealed a gender difference in willingness to contribute towards treatment costs, with women found to be three times more willing to pay for the service than men.