Illicit Drug use in the Asia Pacific Region - Burnet Institute

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Situational analysis of illicit drug issues and responses in the Asia–Pacific region 194 consumption, the new Act 4/2001 provides that the production and trafficking of 19 substances, including ketamine and ecstasy pills, without the approval of the Health Department will result in severe punishment (Social Welfare Institute, 2003) . Unlike in mainland China, there is no specialised compulsory drug treatment centre or program in Macao . Those convicted are sent to a general prison . There is only one prison and it has a special unit created for people with drug-related problems (Social Welfare Institute, 2002) . In 2003, there were 920 prisoners with the number incarcerated in that year being 302: of the 302 prisoners, 25 per cent were drug users (Social Welfare Institute, 2004) . Inmates with drug-related problems are encouraged to attend this unit and to accept a rehabilitation treatment program before discharge . When people are found using drugs, the court or the police can also have the drug user transferred to the government outpatient centre or an NGO program that provides treatment . Sometimes the court can request a drug user to stay in voluntary treatment for one year (Social Welfare Institute, personal communication, 2001) . The treatment method adopted inside the prison is generally the ‘cognitive behaviour therapy approach’ and the length of the treatment and rehabilitation program is one year (Social Welfare Institute, 2004) . The Narcotics Section of the Macao Judicial Police is responsible for issues of drug trafficking, drug use and also the planning of larger operations to prevent drug-related activities . Its missions are supported by other security agencies . The Judicial Police has its own anti-trafficking section and over the past 40 years it has played an important role in the suppression of drug trafficking and consumption (Social Welfare Institute, 2002) . Macao has not established drug courts . In 2003, the second Guandong, Hong Kong and Macao conference on policy to tackle drug abuse and trafficking took place . The delegates exchanged notes on progress of drug control strategies, law making and execution, and drug treatment and prevention . In the same year the third Hong Kong, Macao and mainland China conference on substance abuse, prevention and treatment was held . This conference focused on various issues including drug use tendency, experiences on prevention and treatment, and the results of trans-regional trafficking (Social Welfare Institute, 2004) . Health and treatment responses A two-level health system is funded by the government . Free, universally accessible primary health care is available for all citizens through health centres and more specialised care is available through the central hospital (World Health Organization, 2004b) . The Treatment and Social Rehabilitation for Drug Dependence Division is the main functional sector of Macao’s government, providing services for drug users and assisting with their rehabilitation . In late 2002, it decided that medical treatment services for drug users needed to be enhanced . A protocol was signed with the Health Bureau, resulting in free physical check-ups for drug users and the creation of a Drug Treatment Complex Centre (DTCC) which included an outpatient unit and a short-term in-patient detoxification unit . The DTCC was also set up to provide support for NGO treatment centres, for example in technical assistance and training courses for NGO staff . The outpatient clinic treated 295 voluntary clients in 2002, with the majority being returnees and long-term followed cases . The process at the outpatient clinic is for a social worker to evaluate each client’s case, plan the treatment and arrange medical assistance . The outpatient clinic service includes detoxification, motivation stimulation to cease drugs, medical nursing, family help and training for reintegration into society . Nurses usually follow up the treatment, and detoxification lasts on average 3–4 weeks . The client is requested to attend the clinic 2–3 times per week for assessment and assistance . Social workers follow up with clients post-treatment for rehabilitation (Social Welfare Institute, 2002, 2003) . The DTCC has a primary detoxification unit providing in-patient treatment usually lasting 14 days, in which clonidine and buprenorphine therapies are provided . In the last four months of 2002, 31 clients received detoxification treatment (Social Welfare Institute, 2003) . There are six NGOs providing in-patient treatment for drug users . All follow the traditional ‘spiritual’ detoxification model, which in essence means the ‘cold turkey’ approach of massage, hot baths and prayer . However, some NGOs are beginning to accept the use of medication during detoxification . In addition, there is one self-help association, one group doing outreach (although the details are not available) and one half-way house . Most of these are Christian-based and largely operated by ex-users . The Prevention and Treatment of Drug Dependence Department maintains a close relationship with the NGOs and offers technical and financial support where it is deemed appropriate (Social Welfare Institute, 2001) . There are no NGOs with a focus on harm reduction . In 2002, the Social Welfare Institute financially supported four of the six NGOs providing long-term rehabilitation services, outreach work and self-help group activities for drug users and ex-users . In 2002, the total capacity for long-term residential treatment places was about 66 clients, with the number receiving treatment amounting to 110 (Social Welfare Institute, 2003) . In 2004, the Social Welfare Institute’s financial support (Macao Pataca currency) for the NGO drug treatment sector amounted to the following: operation support (3,023,520) activity support (159,700) and equipment and other support (499,659) (Social Welfare Institute, 2004) . Macao has no needle and syringe programs as, according to the law of Macao, owning injecting equipment, including a syringe, may be unlawful . There are no plans to introduce a needle and syringe program, even with a rising HIV prevalence among IDUs in Macao . Buprenorphine maintenance programs have recently been initiated by the government, for those drug users who are HIV-infected . Methadone maintenance programs may be implemented in the near future but it is not yet clear who would be eligible to receive treatment (Social Welfare Institute, personal communication, 2004) . There is reportedly one government-funded NGO peer education/outreach program for drug users not in treatment, but the details of its operations are unclear . This outreach group, with the support of the government, also provides a type of welfare service (although not directly to drug users) where people are provided with a free lunch, clothes and a place to wash . Clonidine is provided in treatment (Social Welfare Institute, personal communication, 2001; Social Welfare Institute, 2003) . 195 Country profiles: Macao (Special Administrative Region, China)
Situational analysis of illicit drug issues and responses in the Asia–Pacific region 196 Other responses School-based education The Prevention of Drug Abuse Division is the body mainly responsible for anti-drug prevention education in schools . Since 2000 it has been implementing its Healthy Life Education Program, focused on health awareness and drug education for 5–12 year-old school children: reaching 55 schools and around 40,000 students so far . The aim is to enhance each primary school student’s awareness of the benefits of a healthy lifestyle and of the dangers associated with drugs and other substances . In 2002, around 50 per cent of primary schools participated . In 2002, 30 anti-drug talks with nearly 8000 students from 21 primary and secondary schools were undertaken . In 2003, over 15,000 kindergarten and primary school students from 40 schools participated (Social Welfare Institute, 2003, 2004) . Community development In 2002, there were 22 anti-drug talks offered to NGOs with the participation of young people and parents . In 2003, 70 professionals including teachers and social workers participated in training courses focusing on anti-drug messages . Each year there is an International Day Against Drug Abuse and Illicit Trafficking involving a series of antidrug activities to raise public awareness of drug problems and to encourage a movement against drugs through exhibitions, posters, radio and television advertisements and stall activities . In 2003, 10 anti-drug exhibitions were held in various schools and communities throughout Macao (Social Welfare Institute, 2003) . International funding Macao does not appear to receive any international funding for implementing any project about drug issues (Social Welfare Institute, personal communications, 2005) . A7 .7 References Aceijas, C ., Stimson, G ., Hickman, M . and Rhodes, T . (2004) . Global overview of injecting drug use and HIV infection among injecting drug users . AIDS 18: 2295–2303 . Belo, M .I . (1996) . Development and implementation of drug policy in Macao . Paper presented at Cultural Variations in the Meaning of Harm Minimisation: their implications for policy and practice in the drug arena, Curtin University, Perth, 7–9 May 1996 . Judicial Police (2004) . Judiciary Police Statistics . Macao: Judicial Police . Kwan, F .V .C . (2004) . Gambling attitudes and gambling behaviour of residents of Macao: the Monte Carlo of the Orient . Journal of Travel Research 42(February): 271–278 . Perl, R .F . (2003) . Drug Trafficking and North Korea: Issues for U.S. Policy . Washington DC: Congressional Research Service, Library of Congress . Public Health Laboratory (2001) . HIV/AIDS Situation in Macao: quarterly HIV/AIDS statistics (January–March 2001) . Macao: Public Health Laboratory, Department of Health . Public Health Laboratory (2004) . Reported Cases of HIV/AIDS in 2004 . Macao: Public Health Laboratory, Department of Health . Reves, S . and Cotta Guerra, A . (1963) . The Centre for Treatment and Rehabilitation of Narcotic Addicts in Macao . UNODC Bulletin on Narcotics 1: 1–10 . Also available at http://www .unodc .org/unodc/bulletin/ bulletin_1963-01-01_1_page002 .html . Social Welfare Institute (2001) . Overview of Drug Use Situation in Macao . Macao: Prevention and Treatment of Drug Dependence Department, Social Welfare Institute . Social Welfare Institute (2002) . Report on Drug Control in Macao: 1991–2000 . Macao: Social Welfare Institute . Social Welfare Institute (2003) . Report on Drug Control Macao, 2002 . Macao: Social Welfare Institute . Social Welfare Institute (2004) . Report on Drug Control in Macao, 2003 . Macao: Social Welfare Institute . United Nations Office on Drugs and Crime (2004a) . Statistics on drug trafficking trends in East, South-East and South Asia, Oceania and worldwide: Twenty-eighth Meeting of Heads of National Drug Law Enforcement Agencies, Asia and the Pacific . Bangkok: UNODC . United Nations Office on Drugs and Crime (2004b) . World Drug Report. Volume 1: Statistics . Vienna: United Nations . World Health Organization (2003) . HIV/AIDS in Asia and the Pacific Region . Manila: WHO, Western Pacific and South-East Asia . World Health Organization (2004) . Country Health Information Profile: Hong Kong, SAR, China . Manila: WHO, Western Pacific and South-East Asia . 197 Country profiles: Macao (Special Administrative Region, China)
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