Sri Lanka: Heroin use: so easy to start, so difficult to stop
Sri Lanka, the picturesque tear-drop shaped island in the Indian ocean, struggles with emerging drug use and HIV. Drugs, especially heroin is said to have been brought to the island during the opening of Sri Lanka's economy in the late seventies, followed by an inflow of an annual 500,000 tourists in the eighties.
Injecting drug use is still limited in Sri Lanka, as heroin is not always available in good quality. But also because of that, the combined use of low-quality heroin with for example paracetamol, a pain-killer, is common and poses challenges to treatment methods focusing exclusively on heroin. Drug use, possession and trafficking are of public concern and rigidly punished by the law in Sri Lanka. It is estimated that some 12,000 drug users are currently in jail in Sri Lanka without access to treatment. The competent authority, the National Dangerous Drugs Control Board (NDDCB) is now promoting a prison diversion scheme, under which drug users in jail can receive treatment in separate closed settings. With regard to drug users in general, the NDDCB also supports the treatment through so-called low-cost treatment camps.
My mission to Sri Lanka in September 2009 took me to two drop-in-centres. These centers are run by non-governmental organizations, such as the Alcohol and Drugs Information Centre (ADIC) in Negombo and Young Men's Muslim Association in Kandy. Both the organizations have been supported since 2007 by the UNODC's project titled 'Prevention of transmission of HIV among drug users in SAARC countries.' During the last two years, both the organizations have conducted four health camps. From 2008 till date each camp has reached out to 105 drug users since they implemented nine low cost community based camps. During their 15 days stay in the camp, drug users, of course, do not take any drugs and at the same time receive counseling and other treatments according to the drug users' need to cope with withdrawal symptoms and to enable them to stay drug-free after leaving the camp.
ADIC in Negombo works with drug users through counseling and disseminating proper information. One purpose is to demystify m isconceptions about heroin, such as the perceived effects of heroin on sleeping, food, working and sexual relations. A doctor provides medical treatment when necessary. When a drug user staying in the camp starts to suffer from withdrawal symptoms, both the outreach worker and the support group are there to lend a helping hand. The support group is especially important as it comprises recovering drug users who know what it means to go through a cold turkey detoxification. Several of them became drug-free through the health camps. ADIC's work also includes to a great deal relaxation techniques, like massages. It also combines approaches based on faith, psychological support, behavioural changes and most important peer-led initiatives. Outreach workers also work with the families and regular sex partners to address their needs and to encourage them to provide support to the recovering drug user. Presently they reach out to 480 drug users but estimate that in their area there are 4,000 drug users, who need to be reached!
Also the Young Men's Muslim Association in Kandy runs a drop-in centre and conducts health camps for drug users. Around twelve, mainly very young drug users who gathered to meet us, were shy and reserved. But there was one 50 year old man, who narrated about his life of 30 years with heroin, which he calls "the first wife, with whom he got married." He metaphorically describes how his heroin addiction made him sell his TV, fridge, bed, sheets and virtually the roof of his house making him see the stars, thanks to heroin! The health camp is not the first time that he tried to treat his addiction, but he says, the camp was the only method that worked for him. Voluntary participation was key, coupled with the support by peer and support group members, who are there during critical moments of the withdrawal symptoms. He insists that force and rigid rules do not work for drug users and have definitely not worked for him. During the health camp, his mindset was changed, or he calls it "a good brainwash". His compassionate story and empathy for the other young men between 20 and 25 years present there, convey the confidence that such a health camp can make a difference for them also.
The work of UNODC in Sri Lanka on drug and HIV prevention is possible thanks to the contributions of AusAID. UNODC provides technical assistance in Sri Lanka through four different projects in the areas of (i) capacity building in law enforcement, (ii) precursor control, (iii) HIV prevention and care among drug users and (iv) among vulnerable groups in prisons. These projects are possible thanks to the Australian Agency for International Development (AusAid), Government of India (GoI) the Swedish International Development Cooperation Agency (SIDA) and UNAIDS
Written by Cristina Albertin, UNODC Representative for South Asia on her visit to Sri Lanka