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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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 .
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Country profiles: Indonesia