Drug report in Southeast Asia
The assumption that reducing opium production would lead to less drug use has been proven wrong. It has instead contributed to a pattern of an increased use of stronger drugs and more harmful patterns of use.
THE Southeast Asian drugs market is going through a process of profound transformation. The decline in opium cultivation has led to a shortage of heroin on the regional market, resulting in a reduction in quality and an increase in price. Drug users are therefore under pressure either to quit or look for more affordable substitutes. While some people shift to 'yama' (methamphetamines), more drug users have started to experiment with pharmaceutical replacements, principally opioids and benzodiazepines. The assumption that reducing opium production would lead to less drug use has been proven wrong.
Repressive drug control policies and the criminalisation of drug users in the region have further contributed to a pattern of an increased use of stronger drugs and more harmful patterns of use. Users have moved from smoking opium to injecting heroin and pharmaceuticals, and from orally ingesting methamphetamine pills to smoking and injecting dissolved pills. There are also strong indications that smoking and injecting the even more addictive crystal meth/ice is gaining ground.
One of the most worrying consequences of increased injecting drug use is the transmission of HIV and other blood-borne infections through the sharing of syringes. Globally, over three million injecting drug users are estimated to be living with HIV. Southeast Asia is one of the regions with the highest HIV rate among drug users, in particular places in Burma's northern Shan State and Kachin State, and in Yunnan Province in China, where up to 90 per cent prevalence has been reached.
The only effective way to reverse the HIV/Aids epidemic is a comprehensive package of harm-reduction measures to reduce needle sharing among drug users, to counsel on safer drug use and sex practices, and to offer treatment to reduce or end drug use. Low threshold drop-in centres, voluntary alternative (non-prison) sentences and decriminalisation of drug users are essential components of any package aimed at reaching high-risk groups.
Only China has made an effort to scale up substitution treatment and needle exchange programmes, although there remain serious shortcomings in the quality of the services provided. In all other countries in the region, coverage is still dramatically and unacceptably low.
In Thailand and Vietnam, needle exchange services can only operate underground, unregistered or quasi-legally as legislation prohibits their implementation. In Laos and Burma, too, the law formally prohibits the provision of needles and syringes. In practice, though, needle exchange is permitted in Burma where 24 sites are currently operational. According to the latest Unaids estimates in Southeast Asia as a whole, only a tiny 3 per cent of injecting drug users in need of harm-reduction programmes have access to them.
Most countries in the region have mandatory registration systems for drug users, supported by legislation and enforced by sanction. Criminalisation and law enforcement are still the usual ways of attempting to control the drug markets and Southeast Asia has some of the world's most repressive policies against drug users.
The region has seen rapidly rising prison populations and annual increases in arrests. Drug laws across the region are extremely harsh, and penalties are disproportionately high, including for minor offences. The death penalty for trafficking offences is still practiced in China, Vietnam, Malaysia and Singapore. The dark episode of the 'war on drugs' in Thailand, launched by the Thaksin government in February 2003, led to the extra-judicial killing of an estimated 2,300 alleged drug users and small traders within three months.
In this extremely repressive context, it is worrying that the Asean Senior Officials on Drugs (ASOD) are not willing to work with civil society, refuse to acknowledge the link between injecting drug use and HIV/Aids, and have not responded to several invitations to collaborate with the Asean Task Force on HIV/Aids.
Understanding how the market responds to policy interventions is necessary to avoid the displacement of drug-related problems from one area or substance to another - the so-called "balloon effect". Poorly-designed policies can have severe, unintended negative or even counter-productive effects. Understanding the reasons why people grow or use drugs is basic for any policy on drug control to be effective and sustainable.
National and local authorities in the region should realise that these are complicated problems and that there are no quick fixes or one-size-fits-all solutions. Long-term vision and sustainable change is needed but, at the same time, there are a number of urgent problems that need to be addressed now. Understanding the dynamics of drug markets is essential to making rational and effective policies. A review of drug laws in the region to "humanise" them is urgently needed, which places basic human rights and proportional sentences high on regional and national policy agendas.
There is therefore an urgent need to harmonise drug policies with HIV policies. Only a very small proportion of injecting drug users in need of harm-reduction programmes actually has access to services. Even fewer have access to anti-retroviral treatment (ART). Continuing and long-term support for harm reduction and drug treatment programmes, and ART for drug users living with HIV/Aids should be prioritised. Current levels of international assistance are insufficient.
Governments and local authorities in the region, especially in Burma and Laos, also need to change their policies and laws on drug use, to become more treatment oriented, to provide more user-friendly services, and to follow harm-reduction approaches. Repressive legislation that criminalises drug users only hampers access to prevention, treatment and harm-reduction services.
Martin Jelsma, a Fellow of the Transnational Institute, coordinates TNI's Drugs & Democracy programme. Tom Kramer is a researcher with the same programme and an independent consultant.
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