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 162 given wide opportunity to participate in the treatment and rehabilitation of drug users . With the increasing spread of HIV/AIDS among injecting drug users, priority should be given to prevention activities . Control and monitoring of legal drugs and precursors need to be enhanced to prevent illicit use . Those who were involved in the formulation of these policies include the National Narcotics Board and a number of related ministries such as the National Police, Ministry of Justice, Ministry of Health, Ministry of Social Affairs, and Ministry of Education (National Narcotics Board, 2002a) . Law enforcement responses In 1999, the Indonesian Parliament outlawed psychotropic drugs including ecstasy, and imposed penalties of up to seven years imprisonment for cannabis possession and a maximum of 20 years for cannabis trafficking (Narcotics 2001) . Convicted heroin traffickers receive 8–17 years, but considering the low salaries of police officers it is purportedly easy for bribery and corruption to allow traffickers to be freed (Narcotics 1999) . The death penalty was imposed in 1983 upon traffickers and, since 2000, 21 traffickers have been sentenced to death (United States Department of State, Bureau for International Narcotics and Law Enforcement Affairs, 2004b) . However, executions are rare, with only one person executed in 2004, reportedly only the second person officially executed for drug-related offences since 1983 (Centre for Harm Reduction, 2004d) . In the provisions of the law only the maximum penalty is specified, which may be up to the death penalty . Consequently, the minimum penalty can be very lenient . There is a belief that those caught trafficking drugs usually receive a minimum penalty, resulting in days or months of imprisonment and a minor fine (Reid & Costigan, 2002) . The number of narcotic investigations has increased by 5 per cent in 2003 to a total of 3729 . Most investigations have focused on cannabis (39%), while others have been on methamphetamines (27%), ecstasy (19%) and heroin (14%) (United States Department of State, Bureau for International Narcotics and Law Enforcement Affairs, 2004b) . There has been an increased focus on precursor control which involves control measures including document inspection, physical inspection and laboratory test and post-audit [postaudit refers to follow-up checking with the company (i .e . pharmaceutical) that received the precursor chemicals to prove that they used it for the officially sanctioned purpose; document inspection, physical inspection and laboratory work would be undertaken in the transport stages] . Recently a Special Task Force on precursor control has been formed, headed by the BNN Law Enforcement chief (National Narcotics Board, 2002b) . The BNN is the national drug control agency, directly under the President of the Republic of Indonesia, chaired by the national Police Chief, and supported by 25 ministries and agencies . The primary aim of the BNN is to prevent and control drug use, particularly among Indonesian youth, and to protect the general public from the harmful consequences of drug use and illicit drug trafficking . In recent years the BNN has shown greater concern about the rising HIV prevalence among IDUs and has suggested urgent serious attention be given to this area, which culminated in the signing of a memorandum of understanding between the BNN and the National AIDS Commission on HIV/AIDS Prevention and Drug Use Eradication (National Narcotics Board, 2003a, 2003b; National Narcotics Board and National AIDS Commission, 2004) . Although the use of contaminated injecting equipment is widely acknowledged to increase HIV risk to IDUs, injecting equipment related to illicit drug use is confiscated . Officially, needles and syringes are only to be provided or distributed with a government permit . Needle and syringe programs continue to be slow to get started in Indonesia (E . Emrys, personal communication, 2005) . With regard to drug substitution programs, there are two small pilot methadone programs, in Bali and in Jakarta . As of December 2004 there are two additional, prison-based methadone pilots sites being launched in Krobokan Prison (Denpasar) and Cipinang Narcotics Prison (Jakarta) . Drug users can obtain methadone under prescription, with a government permit and proof that it has been legally obtained . Attempting to keep IDUs out of prison, a judge can order a drug user to have treatment, whether or not a crime has been committed . If the drug user is found guilty of a narcotics crime, the sentence will also include the period of treatment . Children facing similar prosecution are provided with special protection, and any punishment imposed must be oriented towards the child’s best interest . Penalties associated with narcotic and psychotropic crimes do not distinguish between drug users and drug dealers . Consequently, it is possible that those in possession of narcotics or psychotropics, no matter the amount, may receive a similar penalty to traffickers, such as a prison sentence or a hefty fine (Venning, 2003) . Health and treatment responses An increasing number of drug users in Indonesia have experienced drug treatment and rehabilitation . In 2004, a surveillance survey found among the respondents 14 per cent in Bandung and 24 per cent in Surabaya had been in rehabilitation, with just over one-third more than once in the last year; with a mean and median rehabilitation episode in the last year of two (E . Pisani, personal communication, 2005) . Various drug treatment approaches have been implemented in Indonesia including medical detoxification, therapeutic communities, substitution programs, residential chemical dependency programs, and recently the introduction of drug treatment into correctional and detention centres . Medical and rehabilitation activities are under the control of the Ministry of Health, while social rehabilitation and care services for recovering drug users are coordinated by the Ministry of Social Affairs . Non-residential care is managed by the provincial/district Social Affairs Officer and the community . In 2001, just over 7000 people received services in government drug treatment centres, while fewer than 1000 patients were admitted to NGO treatment centres . The Ministry of Health has instructed that all government mental hospitals, teaching and general hospitals need to provide 10 per cent of their bed capacity for drug users (National Narcotics Board, 2002b) . There is only one government hospital in the country that specialises in treatment of those with substance-related disorders, the Drug Dependence Hospital, Jakarta (Rumah Sakit Ketergantungan Obat), commonly known as RSKO . It opened in 1972 and, as of 2000, up to 38,000 patients had received treatment as either in- or out-patients . The number of cases has been rising substantially: in 2002, 4694 drug users received treatment . RSKO had a capacity of only 40 beds as of 2002, but it is believed this may have increased in recent years (Sudirman & Hastuti, 2002; United Nations Office on Drugs and Crime, 2004a) . As of 2002, there were six residential care centres under the Ministry of Social Affairs located in Jakarta, West Java, East Java, Central Java and North Sumatra . Nonresidential centres are in 13 provinces . As a result of the dramatic increase in the number of drug users, there has been a surge in the 163 Country profiles: Indonesia
Situational analysis of illicit drug issues and responses in the Asia–Pacific region 164 number of privately owned treatment centres — increasing in Jakarta alone from 10 in 1999 to 60 by 2000 (National Narcotics Board, 2002b) . The current number is likely to be even greater . While many centres claim to be detoxification centres, recovery centres, therapeutic communities and behaviour modification institutions, it is probable that many involved in such operations have little understanding of the complexity of addiction (Gordon et al ., 2000) . The costs of private treatment are well beyond the means of most drug users in Indonesia . However, a community-based support care and treatment program in a slum area in Jakarta provides cheap or free detoxification for teenagers; its detoxification service mainly deals with withdrawal symptoms, at a cost in 2002 of Rp75,000 (about US$7) for each patient . It was mainly focused on home detoxification provided by a local community health centre (Djauzi et al ., 2002) . As of 2002, the Ministry of Justice and Human Rights has introduced into ten correctional facilities and detention houses special correctional centres for drug-using prisoners, partially targeting young prisoners . The issue of HIV infection inside prisons has caused increasing concern . As of 2003, 14 narcotics prisons were established (although only two are fully functional) . In 2003, the Department of Justice and Human Rights (now changed to the Department of Law and Human Rights) established a Working Group in HIV and Drug Use in Prison, which included members from the General Directorate of Corrections, National AIDS Commission, Department of Health, Social Welfare, several NGOs and donor agencies . It cannot be confirmed if there is representation from provincial AIDS commissions (E . Emrys, personal communication, 2005) . Harm reduction strategies inside prisons are being considered; leading this, the Bali prison authorities have recently agreed to provide condoms, bleach for the cleaning of needles and syringes, and to introduce methadone substitution programs (Angela, 2004; National Narcotics Board, 2002b) . Buprenorphine was introduced into four cities in 2001, and the manufacturers of the drug encouraged private practitioners to prescribe the medication to drug-dependent patients . This has proven problematic as most of the 40,000 private medical practitioners in the country have little or no experience in substance abuse management nor understanding of drug issues (Moore, 2003a; National Narcotics Board, 2002b) . A methadone pilot project was introduced in 2002 in Jakarta and Bali, with positive results: there was a reduction of criminality, fewer heroin-related deaths and a reduction of risk behaviours associated with the spread of HIV among those satisfactorily maintained on methadone . This has led for a push towards the introduction of methadone into Indonesia . As of late 2004 it was available only in two hospitals, one in Bali and the other in South Jakarta, servicing a small client group (Centre for Harm Reduction 2004h; Emrys, 2004; National Narcotics Board, 2002b) . Currently methadone is not scheduled like buprenorphine . The authorities have permitted the use of methadone for research purposes only . The step to making it officially available for prescription outside research settings has not yet been taken (E . Emrys, personal communication, 2005) . The introduction of needle and syringe programs (NSPs) remains controversial as an approach to dealing with the rising HIV infection among the nation’s IDUs . A number of small NSPs have operated in Jakarta and Bali since 2000, relying on local government and police support (and maintaining a low profile) . Then from about 2003, a series of small NSPs were established in Makassar, Bandung and Jakarta, which reported to and received approval from vice-governors of provinces in their roles as heads of provincial AIDS commissions . Despite these efforts, adequately scaled distribution of clean needles to IDUs is not yet sanctioned by national authorities (E . Emrys, personal communication, 2005) . While the various harm reduction approaches have been gathering momentum in recent years, only 5–10 per cent of all IDUs in the country have access to any form of harm reduction and consequently the challenge ahead is enormous (Angela, 2004; Atmosukarto, 2004) . Other responses School-based education As of 2002 there has been training of junior and senior high school teachers, school principals and student leaders on drug issues and HIV prevention . In 2002, 120 teachers and 580 student leaders from six provinces and 350 university students from various districts in Jakarta were selected for this educational package . Since 1999 a life skills program, including education on how to reject the use of drugs, has been integrated into the school curriculum . A major drug prevention program features the establishment of student groups to promote and endorse drug-free activities in schools and universities . Additionally school talks about drugs linked in with the Ministry of Education were held in collaboration with some NGOs (Moore, 2003a; National Narcotics Board, 2002b) . There is no evidence of the impact of these initiatives . Community development Parenting education programs for drug prevention at grass roots level have been initiated since 1999 . An important feature of these programs is the Parent Peer Education group, which informs parents about drug issues in the neighbourhood, the effects of drugs and the promotion of a healthy drugfree lifestyle . The hope for the program was that parenting education would prove the gateway to community mobilisation for drug prevention . In 2002, the Ministry of Social Affairs established Coordination Teams on Drug Prevention in all provinces of the country . It was reported that 1620 community leaders have received training in mobilising communities for drug prevention . The BNN has introduced a national plan to train national NGOs about drug use prevention, with a focus on women’s groups and community leaders in every province (National Narcotics Board, 2002b) . Again, there is no evidence of the effectiveness of these programs . Advocacy groups The National Network of Harm Reduction Organisations, Jangkar, plays an important role in addressing the issue of HIV/AIDS in relation to IDUs and promotes harm reduction in the country . As of 2005 the network was made up of 38 NGOs focused on drug use and HIV/AIDS (Centre for Harm Reduction, 2005) . The Burnet Institute’s Centre for Harm Reduction and the Asian Harm Reduction Network both established offices in Jakarta from 2003 . Their purpose is to help promote and be supportive of political, policy, regulatory and social environments for harm reduction initiatives aimed at controlling the further spread of HIV and other adverse public health consequences associated with unsafe drug use and sex practices . 165 Country profiles: Indonesia
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Illicit Drug use in the Asia Pacific Region - Burnet Institute

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