“I don't think the Government prioritizes the need for an illegal drugs and alcohol center here in Tonga!" - head psychiatrist Dr Mapa Puloka.

By Katalina Siasau

The unmanaged drugs issue in Tonga is becoming “a new normal”, said Tonga's Head Psychiatrist, Dr. Mapa Puloka, who is seeing illicit drug-related disorders making up 40% of monthly admissions to his psychiatric ward.

"That does not mean the drug issue is managed, but rather it has become a new normal," he told Matangi Tonga in an interview on 18 March.

The 40% prevalence has reached a plateau. Because Tonga has never established an illicit drugs rehabilitation center, the extra workload is beyond the reach of both the public health psychiatric service and the voluntary community support services available.

The impact on small communities is devastating. After 30 years of leading the Ministry of Health’s psychiatric care, Mapa says he is now seeing huge differences within the country due to the skyrocketing impacts of drugs on mental health over the last five years.

In 2019, there was a 70% to 80% prevalence of monthly admissions due to consumption of cannabinoids or methamphetamine, or both.

Since then, Mapa said the percentage had fallen to 40% of monthly admissions, which stayed unchanged.

“Even though our statistics do not show an increase, it does not mean that the issue is managed but rather it has become a new normal," said Mapa.

In the late 1990s when he took over the Psychiatric Unit, substance abuse was mostly due to imported goods, like alcohol, cigarettes, and even coffee and tea.

In the early 2000s, the illicit drug issue started arising within the communities, but drug related disorders were still not a big concern for the Head Psychiatrist.

However, in the years 2015 to 2018, some 20% to 70% of all monthly admissions were due to consumption of cannabinoids and methamphetamine, or both. Mapa said there was also consumption of Jimson Weed and mushrooms, and some cases of sniffing of inhalants. Cocaine was sometimes mentioned.

"In these years, patients talked freely about consuming marijuana, (just like ‘normal’ tobacco) and in 2017, many patients started to talk freely about methamphetamine, up to now," he said.

Drug-related disorders "a double burden"

Patients with a mental disorder are different from patients who use drugs, said Mapa.

"There is double and triple workloads on treatments for the drug-related disorder patient. Adding to that, we also write heaps of legal reports to and from the court," he said.

"We also have a high number of patients that developed mental disorders as a result of using drugs, and some have suffered relapses."

Mapa said he is dealing with a lot drug-related patients who have paranoia and this has become common. Not only do they see things but, in some cases, it has led to the patient acting suspiciously and resorting to violence.

"Drug addiction is common as well."

Drugs trigger a neurochemical reaction that significantly increases the amount of dopamine in the brain, causing happiness and pleasure. Mapa said he has had families coming to him because their son would sell household goods like the TV, radio, and anything they could get their hands on, in order to keep the level of happiness and pleasure (u'a) going.

Mapa sees that the illicit drugs issue is breaking up families and churches, and affecting education.

No drugs and alcohol rehabilitation center

Mapa said there had been plans put forward to establish a drugs and alcohol rehabilitation center in Nuku'alofa, but successive Governments had not shown interest in that.

"I don't think the Government prioritizes the need for an illegal drugs and alcohol center here in Tonga!"

This means that after receiving psychiatric treatments at the hospital the drug-related patients are referred to the voluntary services of the Salvation Army.

Dramatic increase

The Salvation Army, an evangelical part of the Universal Christian Church, is the local organization that deals with most of the rehabilitation of drug-related disorder patients, and individuals associated with drugs in Tonga.

The drugs and alcohol program manager for Salvation Army Tonga, Mele Prescott, pointed out that 80% of their admissions are people who are associated with drugs.

"Eighty percent is a dramatic increase because looking back 15 years, the numbers are not even close," said Mele.

"There are people who walk in here because of other issues like domestic violence (anger issues), and we would always find out that the root cause is drugs."

Mele said they offered different programs for individuals depending on what they needed to help them recover. They also do visitation to the person's family and one-to-one counseling.

She said the community has an important part to play in the person's rehab journey.

"If the person's environment is exposure to drugs, it does not really matter what he does here, because of-course when he goes back to that environment, he’ll be most likely to use drugs."

A major concern for the Salvation Army is that there is no rehabilitation center in Tonga.

Mele said there is a high number of admissions to their programs and no proper facility within which to conduct them. With no rehab center, all they can do now is to provide educational and motivational support to the individual.

Most concerning, the drug and alcohol program manager said, is that they need the rehab center to help fully complete the progress of the individual, to keep them away from drugs during that process.