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 282 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) . 283 Country profiles: Vietnam
Situational analysis of illicit drug issues and responses in the Asia–Pacific region 284 The first case of HIV was identified in 1990; as of mid-2003 the cumulative number of HIV infections was 69,495 . The HIV epidemic is currently concentrated among IDUs, with 60 per cent of all notified HIV cases . The movement of HIV from high-risk groups such as IDUs and sex workers to other groups in society is now well underway, with 40–120 people infected every day . An estimated 220,000 were believed to be living with HIV/AIDS at the end of 2003 (Hong, Anh & Ogden, 2004; Tuyen, 2004; UNAIDS/World Health Organization, 2004; United Nations Country Team, 2003) . A13 .5 Summary table HIV prevalence among IDUs has increased substantially nationwide from 10 .1 per cent in 1996 to 32 per cent in 2002 . There are, however, sites in Vietnam where sentinel surveillance has reported HIV prevalence among IDUs of 40–80 per cent (Bezziccheri & Bazant, 2004; Cohen, 2003; Ghys et al ., 2003; Tran, 2004; Tran & Pham, 2004) . Coinfection with HIV and hepatitis C (HCV) is endemic among IDUs: a survey in northern Vietnam found that, of those who had HIV, 98 per cent were co-infected with HCV (Vu et al ., 2004; Walsh et al ., 2004) . As well as HIV/AIDS and hepatitis C, other and more unusual diseases associated with sharing injecting equipment have been identified, such as malaria (Chau et al ., 2002) . Estimated number of drug users As of 2004, 170,400 registered drug users . Unofficial estimates vary between 200,000 and 500,000 Main drugs used Heroin, opium, methamphetamine, ecstasy, cannabis, blackwater opium, diazepam, glue Drugs injected Heroin, blackwater opium, diazepam Estimated prevalence of HIV infection among IDUs 60% of the HIV cases are found among IDUs . HIV prevalence among IDUs is 40–80% in at least 8 provinces . A13 .6 Country responses to drugs Agreements and treaties Vietnam is a party to the United Nations Single Convention on Narcotics 1961, the Convention on Psychotropic Substances 1971, and the Convention against Illicit Trafficking of Narcotics and Psychotropic Substances 1988 . In 2002, Vietnam signed the UN Convention Against Transnationals Organised Crime (United States Department of State, Bureau for International Narcotics and Law Enforcement Affairs, 2004a) . Vietnam has signed counter-drug agreements with Myanmar (1995), Cambodia (1998), Laos (1998), China (2001), Russia (1998), Hungary (1998) and Thailand (1998) (Drug Enforcement Administration, Intelligence Division, 2003; United States Department of State, Bureau for International Narcotics and Law Enforcement Affairs, 2004b) . Vietnam is a signatory to the Association of Southeast Asian Nations (ASEAN) declaration for a drug-free ASEAN by the year 2015 . Policy responses Addressing drug control and prevention is a high priority for the Vietnamese Government which maintains a firm commitment to supply and demand reduction . Action plans for anti-drug programs have been implemented since the late 1990s and for 2002–2005 the aim is to reduce the number of drug users by 10–20% annually . Despite the government’s determination to oppose drug use, the national legislation on drug control and prevention has generally been fragmented . As of 2001, the Law on Narcotic Drugs Prevention and Suppression came into force . The new law acknowledges that drug use is a social problem and that drug users should be viewed as needing assistance rather than as offenders or criminals . If a person is found using drugs for the first time, they are detoxified and rehabilitated in the community, but if this does not succeed, they are then sent to a compulsory rehabilitation centre . Policy makers essentially believe the rehabilitation of drug users is the only solution that may explain why the duration spent in a compulsory rehabilitation centre has increased from six months in the past to two years today . 285 Country profiles: Vietnam
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