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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Drug seizures have been reaching record
levels, indicating not only the large amount
of drugs entering the country but also how
much is being consumed . With an increase
in the number of drug-related arrests, it has
been estimated that the flow of trafficked
drugs could amount to Rp1 .10 trillion per
day . In Jakarta alone, the Provincial Narcotics
Agency suggested that 10 out of the 47
districts were now prone to drug trafficking
(Centre for Harm Reduction, 2004g, 2004j;
National Narcotics Board, 2003a, 2003b) .
It has been reported that over the last five
years at least 8 kilograms of heroin were
smuggled through the Soekarno-Hatta International
Airport each month (Centre for
Harm Reduction, 2004e) .
Drug laboratories have been dismantled in
recent years; a highly publicised one was
found in Tangerang, West Java, capable of
producing 150,000 ecstasy tablets per day,
while another smaller factory in the same
area was detected in late 2004 producing
10,000 ecstasy tablets per day for distribution
to the cities of Jakarta, Bandung, Medan
and Makassar (Centre for Harm Reduction,
2004h; National Narcotics Board, 2003a,
2003b) .
Crop studies and crop eradication statistics
The illegal cultivation of cannabis has been
a concern for government authorities for
some years, largely because of the fear that
production of this crop provided a source
of income for insurgency groups opposing
central government rule . Crop eradication
and substitution programs have been undertaken
periodically in Aceh . However, these
have been postponed since the mid-1990s
due to various economic, political and
security constraints in this region (National
Narcotics Board, 2003a, 2003b) .
A5 .4 Drug-taking practices,
risk factors and trends
In 2004, the commonly used drugs and
routes of administration were as follows:
cannabis — smoked; heroin — snorted or
injected; methamphetamine — smoked,
snorted or injected; ecstasy — swallowed;
depressants — swallowed; solvents — inhaled;
codeine — swallowed; and cocaine — snorted
or injected . Cannabis was the drug of choice,
followed by ATS, heroin and sedatives
(National Narcotics Board, 2004b) . Heroin is
most commonly injected, with rates of injecting
appearing to be increasing throughout
the country (Centre for Harm Reduction
and AHRN Country Office Indonesia, 2004) .
However, heroin is not always injected: as well
as smoking and inhaling, an unusual method
of administration in West Nusatenggara is via
self-inflicted shallow cuts to the skin, where
the heroin is rubbed into the wound up to
three times per day (Moore, 2003b) .
Risk behaviours among IDUs were investigated
in a 2002 study involving 650 males in
Jakarta, the second largest city of Surabaya,
and Bandung . While 98 per cent of the respondents
knew that HIV could be transmitted by
the sharing of needles and injecting equipment,
85 per cent reported using needles that
had previously been used by another person
within the past week, and 7 per cent loaded
a drug solution into their own syringe from a
communal syringe used by others . Cleaning
of used syringes and injecting equipment
was inadequate: less than 4 per cent used
bleach to clean injecting equipment between
uses, while 83 per cent used water from a
shared container for cleaning of needles .
After two years of prevention programming
that did not include access to clean needles,
needle sharing in the week prior to the survey
had not changed in Surabaya . The 2004 sur-
veillance data found that around 90 per cent
of those who accessed the outreach program
and those who had not were continuing to
share needles . Bleaching did increase, rising
from 3 per cent to 16 per cent . It was highest
among those who received bleach from the
outreach program, at 47 per cent . Information
from the same surveillance shows the
major response for not carrying their own
needles among those without needles was
the fear of being found carrying a needle
and being arrested; among the respondents
93 per cent in Surabaya and 80 per cent
in Bandung expressed this fear (E . Pisani,
personal communication, 2005) .
Another study found IDUs using old needles
and syringes, and not cleaning injecting sites
prior to injecting (Moore, 2003a) . Syringes and
needles can be purchased from pharmacies in
some parts of the country, but access is often
difficult; in places like East Kalimantan, IDUs
acquire injecting equipment from hospital
refuse or by purchase from private health
posts (Moore, 2003b) .
The widespread sharing of injecting equipment
(sometimes up to 100 per cent of participants
in surveys share unsterilised equipment) has
been an ongoing problem . Most injectors
have used other illicit drugs for two to three
years before starting to inject . While in some
studies all respondents know that injections
can spread HIV, the vast majority either use
someone else’s needle or pass their needle
onto others after they have injected . The
sharing of needles tends to decrease over
time, with most long-time users more likely
to use alone (Pisani, 2003; Pisani et al ., 2003) .
However, not all drug users are aware of the
link between HIV and the sharing of needles:
for instance, among female drug users in
South Kalimantan, where only one of the
seven knew of the risk (Moore, 2003b) .
Drug overdoses are also frequent, generally
receiving minimal if any medical treatment
for fear of police and parents (Djauzi et al .,
2002; Lake, 2004; United Nations Regional
Task Force on Drugs and HIV/AIDS, 2002) .
A recent study in Bali found that, of the 81
participants, 44 per cent had experienced an
overdose at least once and most had known
of friends who suffered from a fatal overdose
(Yayasan Harapan Permata Hati Kita, 2003) .
In 2004, surveillance found 23 per cent of
IDUs in Surabaya and 29 per cent in Bandung
had experienced overdoses themselves, while
84 per cent and 95 per cent respectively had
friends die of an overdose (E . Pisani, personal
communication, 2005) .
Drug users are commonly arrested and gaoled,
and some people start their injecting careers
while incarcerated . In the 2004 surveillance
data, 21 per cent of the IDUs in Surabaya
and 17 per cent in Bandung had been in gaol
at some time in the last year; 31 per cent
of them in Surabaya and 18 per cent in
Bandung injected while in gaol (E . Pisani,
personal communication, 2005) . The use
of drugs among inmates inside prisons is
widespread, but while it is relatively easy
to access drugs (most often as a result of
corrupt authorities), access to clean injecting
equipment is difficult . As a consequence,
widespread sharing of contaminated injecting
equipment is the norm and, with unsafe
sex, the primary reason for the spread of HIV
in prison cells (Dursin, 2002; Pisani et al .,
2003) . A recent study of juvenile offenders
in Medan found most were poly-drug users,
20 per cent injected drugs while in prison,
and common drugs used in the correctional
settings included alcohol (62%), cannabis
(85%), ecstasy (41%) and heroin (20%)
(Fachruddin, 2004) .
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Country profiles: Indonesia