Illicit Drug use in the Asia Pacific Region - Burnet Institute

Situational analysis of illicit drug issues and responses in the Asia–Pacific region
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Crop sizes and crop eradication
All the countries of the Golden Triangle
region — Myanmar, Laos and Thailand —
have witnessed a substantial decline in
opium poppy cultivation, resulting in part
from successful eradication efforts . Myanmar
had an overall reduction of opium output,
linked with a severe drought and the crop
eradication of 2820 hectares in 2004, down
342 per cent from 2003 . Farmers in northern
Thailand are still planting opium illegally,
often amongst legitimate crops to avoid
detection, but overall the opium surveys
reflect recent trends — that opium farming
in the region has decreased significantly .
Myanmar, Laos, Thailand and Vietnam have
supported ongoing efforts to find socioeconomically
viable alternatives to opium
cultivation, to alleviate some of the issues
of poverty among opium growers and to
sustain the eventual demise of opium production
. These programs have often suffered
from unforeseen and untoward deleterious
social effects, and challenges remain for
sustainable solutions .
Drug-taking practices,
risk factors and trends
Historically, opium has been consumed by
smoking . Transitions to the production of
heroin initially encourage the smoking or
‘chasing’ of heroin, but underlie subsequent
moves towards its injection — driven more
by economic factors than anything else .
Injecting predates heroin availability, in
places such as the north of Vietnam where
injection of ‘black water opium’ — the opium
residue after it has been smoked — has
been common . Where heroin is the drug
of choice in Asia, the favoured method of
administration is injecting . The rate of heroin
injecting does, however, vary from place to
place and in different cultural and social settings:
once the initial phase of smoking and
inhalation of heroin has generally passed,
the data suggest around 50–60 per cent of
heroin users inject . This trend towards injecting
heroin is established in all Asian nations .
While there are some common injecting
practices, there are also cultural variations:
while professional injectors are still commonly
found in Myanmar, and less commonly in
Malaysia, this practice is decreasing . ATS are
generally ingested or smoked, but injecting
of ATS, albeit in smaller numbers, has begun
to be identified in Thailand, China, Laos,
Indonesia and Cambodia .
Sharing of injecting equipment is widespread,
accompanied by unhygienic preparation
and disposal practices . Pooling of money to
purchase drugs and sharing of needles are
common practices: economic necessity drives
the social organisation of drug use, a major
reason for the formation or joining of groups
of injectors . Common reasons for the high
rates of sharing needles include ‘situational’
reasons (e .g . incarceration), poor accessibility
of clean injecting equipment, the urgency
to inject, peer pressures and insufficient
knowledge of the associated health risks .
The use of cleaning techniques for injecting
equipment is often crude, often incomplete
and consequently inadequate to prevent the
transmission of blood-borne viruses . While an
increasing number of IDUs are aware of being
at risk of HIV infection through the sharing
of contaminated needles, studies generally
show this knowledge does not extend to all
other drug injecting paraphernalia: sharing
of communal water to dilute the drug and/or
using a common receptacle to draw up the
drug solution are often observed .
There has been a marked increase in polydrug
use, for several reasons: when particular
commonly used drugs are more difficult to
access, often because drug seizures result
in price increases, it is common for drug
users to seek and use a range of alternatives
to achieve the desired effect . In China, for
example, there are currently 15 opiates other
than heroin and 28 non-opiate substances
such as ATS and alcohol that are commonly
mixed and consumed . A consequence of
poly-drug consumption or of increased
purity of heroin is overdose; however, such
data are rarely collected in Asia . For instance,
drug overdoses are reported to be common
in Indonesia, but medical treatment is not
available as a result of fear of law enforcers
and/or parents: a recent study in Bali found
44 per cent of 81 respondents had experienced
a drug overdose at least once .
There is extensive mobility of drug users
both within a nation’s borders and across
those borders in many areas, especially
around the Golden Triangle region, where
ethnic minority groups live on either side of
the border . These groups often have special
travel privileges and family connections
cross-border, and are often involved in drug
trafficking . Such travel is being promoted
by the extensive infrastructure development
occurring across Asia, especially regional
ring roads and rail connections . Since reunification,
there has been extensive travel
between Hong Kong and mainland China:
a recent survey of over 6000 participants
from Hong Kong aged 18–30 years found
20 per cent had used drugs inside mainland
China: the most frequently used drugs were
ecstasy, ketamine, cannabis and heroin .
Drug users in Asia have high rates of multiple
sexual partners and low rates of condom use .
High proportions in Asia buy sex from sex
workers, the vast majority seldom or never
using condoms . A recent survey among IDUs
in Yunnan Province, China, found 88 per cent
had unprotected sex with a regular partner,
while 64 per cent never used a condom with
a sex worker . Increasing numbers of female
IDUs exchange sex for drugs or money to
purchase drugs, often the only way open to
them to raise the funds to purchase drugs .
HIV infection and AIDS are epidemic in
almost all Asian countries, associated with
injecting drug use; in some places, HIV has
become endemic . Among countries with
high prevalences of HIV infection among
IDUs, those with the highest prevalences
include China, Myanmar, Indonesia,
Malaysia, Thailand and Vietnam . In China,
the proportion of all notified HIV infections
in IDUs has dropped from 70 per cent
in 2001 to 44 per cent in 2003, but drug
injecting is still the main transmission route .
This exemplifies a general trend of the virus
moving from the initial core group to the
wider community, transmitted sexually from
IDU — especially where female sex workers
are also IDUs .
A few countries in the region have yet to
experience major epidemics pf injecting
drug use, and subsequent associated HIV
epidemics . However, there are indications
that these epidemics are now happening:
in Cambodia, for instance, the first survey
of homeless young IDUs found 45 per
cent infected with HIV, while in Macao
IDUs represented 60 per cent of the total
number of notified HIV infections in 2004,
an increase from 5 per cent in 2001 . The
prevalence of hepatitis C virus infection
among IDUs is commonly 60 per cent or more
across the region — up to 90–100 per cent
in many places .
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Executive summary