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 2000, there were 56 centres to provide
treatment and rehabilitation and, in 2001,
22,402 people received treatment in these
facilities . During this time the treatment
and rehabilitation offered were reportedly
insufficient to meet the needs of the residents,
and most centres were considered to be
seriously overcrowded . By 2002, there were
46,723 people recorded as treatment cases,
most related to heroin use . At the time only
2 per cent of residents were admitted due
to ATS consumption . In 2003, there were 71
treatment and rehabilitation centres and more
than 700 detoxification bases at the district,
ward and village level (United Nations Office
on Drugs and Crime, 2003b, 2004a) .
In 2003, the network of treatment centres
expanded, with 74 such centres at provincial
level and a further 7100 treatment centres
at the lower level . The capacity of these 06
centres varies from 100 to 3000 residents .
Such centres continue to emerge . A new
centre is being created in Ba Ria-Vung Tau
for around US$6 .3 million, accommodating
up to 2000 drug users, sex workers and
those with HIV . Throughout the nation
drug users are being rounded up and placed
into such facilities or into prisons: in Hanoi
during 2003, there were 1500 drug users in
prison, 3500 in treatment centres and up to
7500 receiving community treatment . In Ho
Chi Minh City the 06 centres held 33,577
residents in 2003 . Part of the rehabilitation
process is job creation, but this has not
been functioning as planned: over a period
of nine months in 2003, out of 9068 postrehabilitation
drug users, only 68 obtained
employment (United States Department of
State, Bureau for International Narcotics and
Law Enforcement Affairs, 2004b) .
It has been suggested that the substantial
rise in the number of 05 and 06 centres is
largely a product of an intensive campaign
of stigma and discrimination towards drug
users and sex workers who have frequently
been labelled as ‘social evils’ and will not be
tolerated (N . Walsh, personal communication,
2005) .
According to MOLISA, in 2004 the detoxification
centres provided treatment for 62,600
drug users, 39 per cent higher than targeted .
In 2005, the government hopes to have
60,000 people go through detoxification and
rehabilitation centres, and ambitiously aims to
have 25,000 provided with employment and/
or living skills by the end of their time in the
centre (Vietnam Economics Times, 2005) .
Harm reduction programs have been piloted
and expanded in Vietnam since 1993 .
However, support for the harm reduction
approach is not uniform, with some local
governments more supportive than others .
There is a strong perception that current
drug control laws are in direct conflict with
the harm reduction approach: this lack of
an enabling environment has been a major
obstacle for the implementation of HIV/
AIDS prevention programs for drug users .
Harm reduction programs are usually of
short duration (one to three years), pilot
in nature and dependent on international
funding: once the funding is withdrawn,
local resources are unlikely to sustain the
programs in their entirety (Vu Doan Trang,
2001) . Stigma and discrimination towards
drug users are endemic and have been a major
impediment to drug users being involved in
project designs in most areas of the country
(N . Walsh, personal communication, 2005) .
There are only a limited number of programs
that attempt to improve access to harm
reduction programs (especially new needles
and syringes) . A number of projects supported
by international organisations have been
working throughout the country and many
have been reported at both International
AIDS Conferences and at International
Conferences on Reduction of Drug Related
Harm (Do, Higgs & Flassenkaemper, 2003;
Eligh, 2004; Lacombe et al ., 2004) . One such
project has taken place in a few districts
located in northern Vietnam where there
have been needle and syringe distribution
and collection through peer eduction and
outreach programs . In 2004, over a period of
nine months 20 peer educators distributed
over 81,000 needles . As a result of an
intensive advocacy program which involved
community buy-in and support from the
commune leaders and local authorities at
the sites (involving commune leaders and
representatives of the police sitting on the
board of management for the projects),
these programs have been able to achieve
about 75 per cent coverage among drug
users (Centre for Harm Reduction, 2004b;
Nguyen, Alford & Higgs, 2005) .
The National Institute of Mental Health in
Hanoi began Vietnam’s first trial of methadone
maintenance therapy in 1996–1997 .
Despite encouraging findings and the Institute’s
recommendation for its introduction,
the Ministry of Health appeared unconvinced
by local and international evidence and the
program remained extremely small-scale (Vu
Doan Trang, 2001) . However, in recent times
interest in the introduction of methadone
treatment programs has once again emerged
and, in 2005, international funds from a
range of donors for a large piloted methadone
treatment program (MTP) are expected .
This program will establish a protocol for
methadone treatment in the country, including
procurement, distribution and management
of methadone . It is believed a comprehensive
approach will be implemented, offering other
services such as counselling and community
support (Harm Reduction Working Group,
2004) . In early 2005 it was announced
that a pharmaceutical company had been
producing naltrexone which blocks the effects
of opiates . The first 10,000 naltrexone 50mg
tablets will be provided to the 05 and 06
rehabilitation centre located in Danang City
(Vietnam Economics Times, 2005) .
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Country profiles: Vietnam