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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In 2004, law enforcement agencies throughout
the country seized 239 .4 kilograms of
heroin, 58 .6 kilograms of opium, 1 .021
kilograms of cannabis, 39,467 ATS pills
(unspecified) and 5528 ampoules of pharmaceutical
drugs, including psychotropics . The
quantities of all these drugs have increased
compared with 2003: 57 .4 per cent for
heroin, 46 per cent for synthetic drugs,
39 .2 per cent for cannabis and 79 per cent
for opium (Ministry of Public Security, 2005) .
It is believed that most groups involved in
trafficking in Vietnam are relatively small,
of 5–15 people, often family members or
relatives; it is expected that larger syndicates
will inevitably develop with the increasing
transit of drugs (United States Department
of State, Bureau for International Narcotics
and Law Enforcement Affairs, 2004b) . The
largest known drug organisation network was
discovered in late 2004, with 29 arrested and
suspected of involvement in the trafficking
of 800 kilograms of heroin from Laos and
Cambodia (Associated Press, 2004) .
Crop studies and crop eradication statistics
The Vietnamese Government has for some
years been involved in eradication efforts to
reduce opium poppy cultivation . The area of
cultivation has decreased considerably, from
12,900 hectares in 1993 to around 1000
hectares in 2003 (although United States
authorities believe this figure should be at
least doubled) . Assistance with the eradication
efforts has been largely funded through
UNODC; it has been suggested there should
be more focus by government on socioeconomic
alternatives to alleviate some of
the issues of poverty in these areas to sustain
the eventual demise of opium production
in Vietnam (United Nations Office on Drugs
and Crime, 2003b; United States Department
of State, Bureau for International Narcotics
and Law Enforcement Affairs, 2004b) .
A13 .4 Drug-taking practices,
risk factors and trends
The drug of choice in Vietnam is heroin;
the favoured method of its administration
is injecting, a method which appears to
be increasing (Centre for Harm Reduction,
2004a; Hammett et al ., 2005; Hammett
et al ., 2004; Johnston et al ., 2004; Minh
et al ., 2003; UNDCP, 2002; United Nations
Office on Drugs and Crime, 2004a; Walsh,
2003) . Frequency of injecting varies, but is
commonly 2–3 times per day, with a range
of 1–5 times . While men usually prefer to
inject in the arm, women often inject into
places that are less easy to detect, and
some IDUs are known to inject into their
upper palm, armpit or groin; IDUs often do
not use a tourniquet when injecting and
simply squeeze the arm (Minh et al ., 2003;
United Nations Office on Drugs and Crime,
2002a) . The length of time between starting
the smoking of drugs and initiation
into injecting is getting shorter: the average
time is 2 .8 years for males and 2 .5 years for
females, but a substantial number of both
males and females have been known to shift
to injecting within 12 months (Loi et al .,
2003) . A study in Quang Ninh found drug
users making the transition from smoking
to injecting heroin within seven months on
average (Hien, Long & Huan, 2004) . A major
reason for the shift to injecting is economic,
with inhaling heroin being considerably more
expensive . As one drug user stated: ‘It can
cost me 100–200,000 VND a day to inhale,
while injecting only costs 30–50,000 a day’
(Loi et al ., 2003) .
Of considerable concern is the widespread
sharing of injecting equipment and the unhygienic
methods used by IDUs (Hanoi School
of Public Health, 2001; Lam, 2003; Tuyen,
2004; United Nations Country Team, 2003) .
Various approaches to drug injecting have
been described: one is to dissolve the drug
in water, in a container, and with the only
syringe available take an equal amount from
the container to inject . The syringe itself is
cleaned several times with water, but this
is mostly undertaken to remove any visible
blood . Some use cold boiled water but most
believe any water to be suitable . Bleach is a
rarity, although occasionally some use alcohol
as a disinfectant (Tran et al ., 2004) .
The pooling of money to purchase drugs,
and the sharing of needles is common, associated
with economic necessity, and one of the
major reasons for forming or joining a group
of injectors . Among poor IDUs it is common
to buy a packet of drugs, and when funds
are short to purchase only one needle and
syringe for all . Sharing injecting equipment is
common, particularly so in confined settings .
Reasons for sharing can be ‘situational’, often
linked to poor accessibility, the urgency to
inject and/or insufficient knowledge of the
associated health risks (Anh & Giang, 2004;
Institute for Social Development Studies,
2004; Tran et al ., 2004; Vinh, 2002) .
While most drug users used unboiled, boiled
or sterile water, blood has also been reported
as being used to mix with the drug . The
number of those who share any one needle
varies, but it has been reported that in gaol
around 30–50 would share the same syringe
(Walsh, 2003) . For HIV-negative IDUs entering
these institutions, where most inmates
are HIV-infected, the risk of HIV infection is
very high (Lam, 2003; Nam, Higgs & Reid,
2003) . Opium and heroin smuggled into
gaols, usually by inmates who worked outside
during the day or by family members, can
be purchased, but clean syringes are rarely
available . Drug use inside the provincial
treatment and rehabilitation centres (‘05/06
camps’) is hard to control (Nam, 2003; Nam
et al ., 2003; United Nations Office on Drugs
and Crime, 2002a) .
In recent years Vietnam has seen a rise in the
number of sex workers who are also IDUs .
Many of them are injecting regularly, sharing
needles with regular partners who are drug
users . Condom use is reported to be inconsistent
or poor . Drug-injecting female and
transsexual sex workers with HIV infection
continue to engage in sex work because
of the lack of other income-generation
options . As early as 2000, 50 per cent of sex
workers admitted to the Ho Chi Minh City reeducation
camp were IDUs (Centre for Harm
Reduction, 2004a; Rekart, 2002; Tuan et al .,
2004) . In three provinces female sex worker
IDUs were found to share needles more than
male IDUs; most began injecting drugs before
engaging in sex work (Messersmith, Kane &
Tran, 2004), suggesting entry to sex work
to fund their drugs . One paper suggests that
many sex workers are provided with drugs to
maintain their dependency, and as a result
maintain associations with their suppliers
(Ha et al ., 2004) .
The interactions between sex workers and
the drug-using community through unsafe
sexual relations and/or injecting drugs is
established in various parts of the country;
such risk behaviours are a potential bridge
for HIV infection to the wider community . In
some studies up to 40 per cent of male IDUs
interviewed have reported paying for sex
in the previous 12 months (Economic and
Social Commission for Asia and the Pacific,
2003a; Hellard & Hocking, 2003; Minh et al .,
2003; Nguyen, 2004; Tran et al ., 2004) . The
use of condoms by drug users is poor overall
(Hellard & Hocking, 2003; Lam, 2003) .
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Country profiles: Vietnam