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 278 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) . 279 Country profiles: Vietnam
Situational analysis of illicit drug issues and responses in the Asia–Pacific region 280 Data collection systems in place The two data sources routinely used are treatment demand data and arrest data . Data collected is not disaggregated by drug of choice or administration, so monitoring the drug situation in a more comprehensive manner is not possible . Data have been collected through a school survey of drug use and other studies focused on high-risk groups including IDUs, sex workers and street children . Information about drug use is shared between different agencies and departments and organisations through the National Committee on AIDS, Drug and Prostitution Control, enabling some insight into drug trends . A network of staff from the various cited bodies share information focused on the areas of demand for drugs, supply information and crop cultivation . Summary reports are produced and disseminated regularly, and an annual report is issued by the Standing Office for Drug Control of Vietnam . A national register of death due to drug use is not yet in place (United Nations Office on Drugs and Crime, 2004a) . It is not clear if the HIV sentinel surveillance system and HIV behavioural surveillance surveys are used as data sources to identify drug use trends . A13 .3 Drug supply, production, availability, cost and trade As of 2003, 1000 hectares of opium poppy were reportedly under cultivation . This is mostly cultivated by ethnic minorities for local use: mainly by Hmong highlanders, in the provinces of Lai Chau, Son La, Nghe Anh and other north-western and central provinces bordering Laos and China . These crops produce annually about 10–15 tonnes of opium, only some of which is being converted to heroin . Cannabis is grown in remote parts of the Mekong Delta in the south (mainly in Dong Nai, An Giang, Binh Thuan and Dong Thap) and in some north-western highland areas, especially those bordering Laos and China . While most is grown for commercial hemp, some is cultivated for illicit consumption (Drug Enforcement Administration, Intelligence Division, 2003; United States Department of State, Bureau for International Narcotics and Law Enforcement Affairs, 2004b) . The production and stockpiling of amphetamine-type substances (ATS) are relatively new, found mainly in large cities: one factory producing hundreds of kilograms of methamphetamine was found in 2003 in Ho Chi Minh City . There is a trade in illegal harvesting of sassafras trees, which produce an essential oil called safrole, a precursor chemical for MDMA production . Other precursor chemicals used in the production of illicit drugs, such as ephedrine and potassium permanganate, are known to have origins in Vietnam (Drug Enforcement Administration, Intelligence Division, 2003; Ministry of Public Security, 2005; Ministry of Public Security, Standing Agency in Drugs Control, 2003) . While Vietnam does not produce substantial amounts of illicit drugs, it has for some years been an important transit country, but imported drugs are increasingly servicing the domestic market . Many of Vietnam’s borders are remote and difficult to control and consequently a limited portion is seized at the nation’s border gates . Most heroin and some opium enter the country from the Golden Triangle, from either Thailand or Laos, and mainly going to Ho Chi Minh City or Hanoi . Heroin travels overland and along the Mekong River from Laos through Cambodia — it is known to arrive in Vietnam by boat via the Gulf of Thailand and the South China Sea . Once in Vietnam, heroin is transported by ship, air or post to the Philippines, Australia, Hong Kong, Japan, Singapore and Taiwan . Cannabis is mainly from Cambodia, often trucked to Ho Chi Minh City where it is then distributed to other parts of the country or trafficked into China and on to international markets . ATS, primarily methamphetamines, are trafficked from Myanmar via China’s Yunnan Province, Laos and Cambodia, the destination often being Ho Chi Minh City . Overall, the western border has the main points of drugs entry to the country; most large seizures occurred in these areas . It was reported in 2003 that increasing amounts of heroin and methamphetamine were being trafficked to Australia from Vietnam (Drug Enforcement Administration, Intelligence Division, 2003; Ministry of Public Security, Standing Agency in Drugs Control, 2003; United Nations Office on Drugs and Crime, 2003b, 2004b; United States Department of State, Bureau for International Narcotics and Law Enforcement Affairs, 2004b) . The trafficking of drugs from Cambodia appears to be increasing; in late 2004 it was reported that Vietnam would double its anti-drug force in six south-western provinces in an attempt to curb the flow of narcotics from neighbouring Cambodia (China Post, 2004b) . In 2002, ‘white’ heroin retailed for US$45 per gram . Prices for a single shot of heroin varied throughout the country (United Nations Office on Drugs and Crime, 2004d) . In 2003, a typical price for one dose of heroin ranged between 25,000 and 50,000 VND (US$2–3 .30), and was either smoked or injected (Tran et al ., 2004; Walsh, 2003) . In early 2005 heroin could be purchased from as little as 10,000 VND in Hai Phong City (P . Higgs, personal communication, 2005) . The price of blackwater opium in 2003 was around 12,000 VND . In 2003, the price of methamphetamine on the streets of Ho Chi Minh City was 90,000–200,000 VND per tablet (US$6–14), used mainly by those with access to money (Walsh, 2003) . The typical price of an ecstasy tablet in 2002 was US$18 (United Nations Office on Drugs and Crime, 2004d) . Arrest and seizure data Drug seizures and the number of arrests continue to increase with each year . In 1996, the number of drug-related cases was 3813 and the number of arrests was 6651 . By 2002, the number of drug cases was 14,167 and those arrested numbered 23,199 (Drug Enforcement Administration, Intelligence Division, 2003; Ministry of Public Security, Standing Agency in Drugs Control, 2003) . Hanoi and Ho Chi Minh City are recognised as hot spots for drug trafficking and use; in 2003, more than 3800 cases of drug trafficking were found in these two cites alone (Vietnam News Agency, 2004) . Figures released in 2005 show that between 2001 and 2003 there were 35,296 drug cases and 56,007 offenders arrested (Ministry of Public Security, 2005) . In 2002, drug seizures amounted to 57 .4 kilograms of heroin, 612 .6 kilograms of opium, 243 kilograms of cannabis, 110,232 ampoules of ‘addictive’ pharmaceuticals and 47,852 ‘synthetic tablets’ (Ministry of Public Security, Standing Agency in Drugs Control, 2003) . 281 Country profiles: Vietnam
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