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 142 A survey involving 95,788 school students found 2 .6 per cent had used heroin at least once: this was a slight increase when compared to similar surveys with the proportion in 1996 (2 .1%) and in 1992 (0 .4%) . For students who have ever used psychotropic substances, there was a 4 .1 per cent increase when compared with the proportion in 1996 (2 .7%) . Of those ever having used psychotropic substances, 45 .6 per cent used ecstasy, followed by cannabis (41 .7%) and ketamine (36 .5%) . Cannabis and ecstasy were more common among the older students, while cough medicines and solvents were used by the younger students . For those having used heroin, the most common source of money was pocket money (39 .5%) followed by an illegal source, commonly theft (28 .5%) . Sex after drug consumption was common (nearly 30%) but the use of condoms was not reported . Accessing heroin was considered easy/very easy by 10 .5 per cent of all students and 13 .9 per cent found it easy/very easy to obtain psychotropic substances (Lau, 2002) . Recent studies show an increasing number of females, particularly aged less than 21 years, using illicit drugs (Wan & Rassool, 2003) . A study of drug use among females showed the negative consequences of drug use, with problems related to mental and physical health, involvement in crime, violence and arrests and convictions (Narcotics Division, 2004d) . The main way of taking ecstasy was by swallowing and ketamine by snorting . With methamphetamine, called ‘ice’, a common method was to chip off a piece of the crystal and dissolve the drug in a drink . However, the main method was via fume inhalation and the approach was similar to ‘chasing the dragon’ (Laidler et al ., 2000) . A longitudinal study of chronic drug users showed that, in the first series of interviews of 124 drug injectors, 90 (72 .6%) did not share their needles with others and in following interviews over various time intervals the rate of not sharing diminished further between 82 .4 per cent and 84 .8 per cent (Cheung et al ., 2003) . The Annual Street Addicts Survey (ASAS) first commenced in 1992 . In 2002, the proportion of drug users injecting in the ASAS was 80 per cent . In 2001, the ASAS found that 20 per cent of injectors, 10 per cent of methadone users and 5 per cent of those attending in-patient treatment shared their needles (Department of Health, 2002) . The rate of equipment sharing over the years has declined and current sharing may be a result of complacency among IDUs towards the high risks associated with sharing and/or the continuing low incidence of HIV infections among IDUs (Choi & Lee, 2000; Department of Health, 2002) . Of concern were unsafe practices for cleaning of injecting equipment, as shown in the 1998 street survey: 65 per cent of IDUs did not clean their injecting equipment appropriately (Ch’ien, Lo & Mau, 1998) . The use of alcohol and bleach for cleaning requires continuous promotion . Many people assume needle and syringe sharing was rare as a result of disposable needles and syringes being available without a prescription at pharmacies for HK$1 for a 10cc syringe (US$0 .13) and HK$2 for a 20cc syringe (US$0 .26) . Approaches to 24-hour convenience stores to stock needles and syringes have not been successful, as store owners are afraid drug users may frighten away ordinary customers from their premises at night (Reid & Costigan 2002) . The first HIV infection in Hong Kong was reported in 1984 . As of 2003, there was a cumulative total of 2244 confirmed HIV infections and 669 AIDS cases . In 2003, there were 229 HIV notifications and 56 AIDS cases . The major route of transmission by exposure category is through sexual contact but 4 per cent were linked to injecting drugs in 2003 . From April to September 2004 there were 11 new HIV cases due to injecting drugs . From 1984 to September 2004 there were 81 HIV notifications in which the mode of transmission was by injecting drugs . Injecting drug use as a risk factor for HIV infection makes up less than 5 per cent of all reported cases, but the situation is volatile . It is predicted there will be an increase in HIV infection A4 .5 Summary table among drug users, particularly now with universal HIV testing programs introduced into all methadone clinics in 2004 (Department of Health, 2004a, 2004b; Lee, 2004a) . The proportion of HIV infections among drug users has increased from not more than 3 per cent before 1998 to 10 per cent in 2003 and 2004 (Lee, 2004b) . It is estimated that there could be 2500–3000 HIV-infected people among the 6 .7 million population of Hong Kong (WHO, 2001) . Testing of drug users in treatment shows a rate of hepatitis C in 2000–2001 of 46 .2 per cent, a decrease from 73 .9 per cent in a previous study undertaken with the Department of Health in 1991–1992 (Department of Health, 2004c) . Estimated number of drug users 36,384 (2001) — updates not available Main drugs used Heroin, ecstasy, methamphetamine, ketamine, cocaine, cannabis, cough mixtures, solvents Drugs injected Heroin Estimated prevalence of The absolute number of HIV infections HIV infection among IDUs among drug users has increased to over 10% in 2002 and 2003 . 143 Country profiles: Hong Kong (Special Administrative Region, China)
Situational analysis of illicit drug issues and responses in the Asia–Pacific region 144 A4 .6 Country responses to drugs Agreements and treaties Hong Kong is a party to the Single Convention on Narcotics 1961, the Convention on Psychotropic Substances 1971 and the Convention against Illicit Trafficking of Narcotics and Psychotropic Substances 1988 (Narcotics Division, 2004c) . Policy responses The strategic approach to deal with the drug problem is led by the Narcotics Division of the Security Bureau . The strategy is broadranging, in that it includes legislation (involving law enforcement, police and customs), preventive education and publicity programs, treatment and rehabilitation services, research and external cooperation and exchange of information with others involved in narcotic matters . The Commissioner for Narcotics acts on the advice of the Action Committee Against Drugs (ACAN) . ACAN is an advisory body on policy matters that focuses on illicit drugs . It has a chairman and 17 unofficial members selected for their experience and expertise in the fields of social and community work . There are also two government officials, the Commissioner for Narcotics and a representative of the Director of Health . The Director of the Central Narcotics Bureau of Singapore is also invited to ACAN as part of a reciprocal arrangement between the Singapore and Hong Kong Governments . ACAN constantly reviews government projects related to drug issues and helps to enlist the support of the public to fight against drug use . There are also three subcommittees — Prevention Education and Publicity, Treatment and Rehabilitation, and Research . These subcommittees are each headed by an ACAN member . There are 64 subcommittee members from various fields ranging from social work to the legal and commercial sectors . There is also a Drug Liaison Committee, comprising 25 members, whose role is to facilitate coordination and communication between the Commissioner for Narcotics and voluntary agencies (Narcotics Division, 2004c) . Law enforcement responses The Hong Kong Government has gone to great efforts to suppress illegal drug supply for over 45 years by vigorously imposing sentences from the Dangerous Drugs Ordinance for those in possession of illicit drugs . For major offences involving trafficking or manufacturing of dangerous drugs, the maximum penalty is a fine of HK$5 million (US$641,040) and life imprisonment . The maximum penalty for possession of dangerous drugs is a fine of HK$1 million (US$128,208) and seven years imprisonment (Narcotics Division, 2004c) . Possession of 10 grams of heroin can result in a 2–5 year sentence and up to 12 grams of methamphetamine can bring a 3–7 year sentence . Cannabis guidelines show possession of over 500 grams of cannabis resin can result in a 4–8 month sentence and the cultivation of cannabis or opium poppy brings a fine of HK$100,000 (US$12,821) and 15 years imprisonment . Managing a divan incurs a fine of HK$5 million and 15 years imprisonment (Laidler et al ., 2000; Narcotics Division, 2001, 2004c) . The Narcotics Division has recently revised a Code of Practice for Dance Party Organisers as of 2003 in order to guide organisers of these events in the prevention of drug use and other crimes (Narcotics Division, 2004c) . While there are strict penalties for trafficking, the government has also focused upon demand reduction, particularly in the area of treatment and rehabilitation . The Correctional Services Department (CSD) administers mandatory treatment programs . Drug users who are sentenced to prison can be made by the court to enter compulsory treatment: the length of stay can be from two months to a maximum of 12 months . This is followed by compulsory 12-month statutory after-care supervision . If illicit drug use is detected during this supervision period, the person can be called back to the centre for further treatment . The CSD operates three treatment centres, one for men (capacity for 964 inmates) and the other two for women (capacity 190) . The total number of inmates admitted into the compulsory drug treatment scheme was 1283 inmates, similar in number to 2002 (Laidler et al ., 2000; Narcotics Division, 2001, 2004c) . Health and treatment responses The Hong Kong health care policy states that no one should be denied adequate medical treatment due to lack of funds . As a consequence, the Department of Health and hospital authority provides a range of services and facilities to meet the needs of the public . Complementing these services are those offered by the private sector (World Health Organization, 2004b) . There are various facilities for people who voluntarily seek treatment and rehabilitation, many operated by NGOs . In 2003, there were substance abuse clinics in six hospital authorities’ agencies offering drug treatment to 745 clients . The overall aims of the residential programs are detoxification, treatment, rehabilitation and the after-care of users requesting help to stay drug-free . In 2001, the total number of voluntary residential beds was 1122 for males and 138 for females . The number of people admitted into these establishments has increased in recent years . The Society for the Rehabilitation and Aid for Drug Addicts (SARDA) operates four residential treatment centres (for male and female patients), five halfway houses and post-discharge socio-medical care to more than 2000 people each year . Through an affiliated organisation, the Pui Hong Self Help Association, SARDA also runs a supportive employment service providing direct work opportunities to those rehabilitation patients in need . SARDA also provides counselling services to each of the 20 government methadone clinics focusing on both demand and harm reduction . At the end of 2003 nearly 2000 methadone clients received SARDA’s counselling services (Narcotics Division, 2001b; 2004c; Laidler et al. 2000) . Other treatment and rehabilitation centres include the Caritas Wong Yiu-nam Centre, Barnabas Charitable Service Association, Christian New Being Fellowship, Finnish Evangelical Lutheran Mission Ling Oi Centre, Glorious Praise Fellowship, the Christian Zheng Sheng Association, the Drug Addict Counselling and Rehabilitation Services, St Stephens Society, Wu Oi Christan Centre, the Hong Kong Christian Services PS33, Hong Kong Christian Service Jockey Club Lodge of the Rising Sun and Operation Dawn (Laidler et al ., 2000; Narcotics Division, 2001, 2004c). Methadone treatment programs have been in operation since 1972 and both maintenance and detoxification options are available for outpatients . In 2003, there were 20 clinics (most have facilities that also provide primary health care for all community members) scattered throughout Hong Kong 145 Country profiles: Hong Kong (Special Administrative Region, China)
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