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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Between 1970 and 1990 the main drug
used in Vietnam was opium, including the
injection of ‘blackwater opium’; since the
mid-1990s heroin has become the drug of
choice and the popularity of amphetamines
has been increasing (Ministry of Health &
UNDCP, 2000; UNAIDS & UNDCP, 2000) .
The injecting of drugs became increasingly
popular, accompanied by widespread sharing
of injecting equipment, and leading to the
emergence of an HIV/AIDS epidemic . In 1993,
among the total annual reported cases the
proportion of HIV infection among injecting
drug users (IDUs) was 87 per cent . While this
proportion has been decreasing, the levels of
HIV infection among IDUs have remained
high throughout the 1990s (Chung, 2000;
Ministry of Health & UNDCP, 2000; National
AIDS Committee, 1998; Nguyen, 2004b) .
A13 .2 Prevalence of drug use
and profile of drug users
Estimations of the number of drug users
vary, as there are differing classifications
for drug ‘addiction’ and differing reporting
requirements between organisations and
departments . Whether the statistics are
from the Ministry of Public Security (MPS),
Ministry of Health (MOH) or the Ministry
of Labour, War Invalids and Social Affairs
(MOLISA), what is not disputed is that the
number of registered drug users is increasing
each year . In 1997, it was nearly 70,000,
rising to 100,000 in 2000; by June 2003 it
was 152,000, of which around 1000 were
pupils and students (Drug Enforcement
Administration, Intelligence Division, 2003;
Ministry of Public Security, Standing Agency
in Drugs Control, 2003; United Nations
Office on Drugs and Crime, 2003b) .
Figures released by the Ministry of Public
Security in 2004 showed 170,400 registered
drug users nationwide (Ministry of Public
Security, 2005) . There are no official
estimates available on how widespread
drug use is in the general population, but
the real figure is far greater than those
who have registered, according to some
sources (United States Department of State,
Bureau for International Narcotics and Law
Enforcement Affairs, 2004b) . In the late
1990s MOLISA estimated 185,000–200,000
drug users, of whom 69,000 were injecting
drug users (IDUs) (UNAIDS & UNDCP,
2000) . Unofficial estimates of the number
of drug users vary between 200,000 and
500,000 (0 .02–0 .06% of the population)
(Drug Enforcement Administration, Intelligence
Division, 2003) . The number of IDUs
is elusive, but recently reported estimates
range from a low of 70,000 to a high of
156,00 with a mid-range of 113,000 (Aceijas
et al ., 2004a) .
There has been no nationwide survey to
measure drug use in the general population;
in 2001, a school survey randomly interviewed
20,000 students from 119 educational institutions
and found 26 per cent of the students
knew of someone who used illicit drugs; the
use of other substances including sedatives
and tranquillisers (but excluding alcohol and
tobacco) was reported by 4 .2 per cent of the
respondents (United Nations International
Drug Control Programme, 2002b) . Another
out-of-school survey of 650 youth (90% aged
18–25 years) who were either unemployed
or under-employed was undertaken; more
than 50 per cent were from Hanoi or Ho
Chi Minh City . The results show 37 per cent
used some kind of drug and 32 per cent
used heroin followed by opium, cannabis,
cocaine, sleeping tablets and tranquillisers
(United Nations International Drug Control
Programme, 2002b) .
Urban centres have the greatest number of
drug users: in Ho Chi Minh City, for example,
the number of registered drug users has
increased from around 17,000 in 2001 to
20,000–30,000 in 2003; 80 per cent of
these are aged 18–25 years, and most are
IDUs who inject 2–4 times per day (Centre
for Harm Reduction, 2004a; Walsh, 2003) .
Nationwide, it has been estimated that 52
per cent of drug users are under 25 years and
82 per cent are less than 36 years . Most IDUs
start their drug use when aged 15–24 years
(Nguyen, 2004a; United Nations Country
Team, 2004) .
There are a number of subgroups of current
IDUs for whom opiates, especially heroin,
remain the drug of choice . The pre-1975
cohort mainly resides in southern and central
Vietnam, most being in their late 40s, sometimes
using opium occasionally mixed with
benzodiazepines . Younger IDUs are found
throughout the country, their choice of drug
being heroin . A third group is female sex
workers who also inject drugs, in various
parts of the country (HIV/AIDS Program,
1997; Giang, 2000; Long, 1999) . Street
children (defined as less than 18 years of age,
earning a living on the street, and without
family support or guardian) are increasing in
number, but current estimates are unreliable:
in 2000, they were estimated at 20,000, of
whom nearly 3500 were registered as drug
users in 1999 . In 2001, a survey was undertaken
with 400 street children: 17 per cent
used illicit drugs, of whom 77 per cent used
heroin (United Nations International Drug
Control Programme, 2002a) .
The drug of choice is heroin among the
youth, particularly in the urban centres, while
opium use remains popular mainly among the
elderly and ethnic minorities groups in rural
areas, especially in the north-west regions .
Other drugs used include cannabis, MDMA
and methamphetamine, with the last two
becoming increasingly popular nationwide .
The use of MDMA and methamphetamines is
not confined solely to youth, but is expanding
into the general population: government
officials have found these substances in 53
of the 61 provinces of Vietnam . High proportions
of registered drug users are unemployed
or under-employed, but it has been observed
that a significant number are employed in the
public sector . Cannabis is used but its popularity
is not widespread . Cocaine is seldom
used, likely due to poor availability . The use
of glue as an inhalant appears to be increasing
. ‘Blackwater opium’ is still used, injected
by older users . A variety of pharmaceuticals
are used to enhance the effects of opium or
heroin, including diazepam, promethazine,
pethidine, morphine, phenobarbitone and
procaine (Ministry of Public Security, Standing
Agency in Drugs Control, 2003; United
Nations Office on Drugs and Crime, 2002b,
2003b; Walsh, Higgs & Crofts, 2004) .
In the late 1990s private pharmacies were
increasingly taking over distribution of licit
drugs, and much drug dispensing was done
without the need for prescriptions (Chuc &
Tomson, 1999) . It is possible this problem has
not been curbed, thus ensuring easier access to
the purchase of licit drugs for illicit purposes .
The use of ketamine emerged in 2003 in major
cities throughout the country, mainly found
in nightclubs (United States Department of
State, Bureau for International Narcotics and
Law Enforcement Affairs, 2004b) .
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Country profiles: Vietnam