Bhutan: In conversation with Dr. Chencho Dorji on Treatment for Drug Users

UNODC: Dr. Chencho as you are a psychiatrist and Technical Advisor to the National Mental Health Program in Bhutan, could you tell us the kind of treatment or detoxification methods and rehabilitation centers that are available for drug users in Bhutan?

Dr. Chencho: Drug use is a fairly recent phenomenon in Bhutan. The first few cases came to public knowledge in the late 1980s when a few students who were studying outside Bhutan came back with those habits. At that time, the common drugs abused were cough syrups containing codeine. Gradually, we saw cases of adolescents inhaling petrol and glue (dendrite) and consuming pain killer tablets containing synthetic opioid such as dextropropoxyphene. A few cases were even making a solution of these pain killers with distilled water and injecting it intravenously. I have personally treated a few cases of Injecting Drug Users (IDUs) who came with cellulitis and thrombophlebitis. At around the same time, cannabis use also started. There have been cases of brown sugar (adulterated heroin) and amphetamine abuse, but drugs like cocaine have not entered the Bhutanese market. Alcohol has been used as a gateway drug as well as "fall-back drug" when other drugs are not available. Anecdotal evidence available in the country suggests that the drug use population is growing and many users have succumbed to overdoses of drugs. A national baseline assessment on drug use is being carried out in the country right now and this study will give us a clearer picture of drug use situation in Bhutan. As of now, Bhutan does not have a separate drug detoxification, treatment and rehabilitation centre. The Psychiatry Department in the National Referral Hospital in Thimphu has treated more than 100 people so far. Few people have been admitted in the rehabilitation centres in India too. There are plans to open a separate drug detoxification, treatment and rehabilitation centre in Thimphu in the coming months. The Government is looking for funding and technical assistance to establish these new centres.

UNODC: Do drug users approach you themselves for treatment? What approach or treatment do you use for drug users and what is the difference to earlier rehabilitation programmes ?

Dr. Chencho: Due to lack of awareness, stigma and discrimination, drug users do not actively seek help or treatment on their own from hospitals or health workers. They are usually brought in by their relatives and family. They also come sometimes when they develop health problems related to drug use, such as, cellulitis due to Injecting Drug Use (IDU). Although, we have a very small ward of 10 beds only for both psychiatry patients and drug users, we usually keep drug users in the ward for at least one month so that we get enough time to detoxify them, rule out any co-morbidity especially mental disorders, offer psychological counseling and cognitive behavioural therapy, Buddhist techniques like meditation and contemplation. We have a good success rate with the cases we have treated so far. More than 50 per cent of them have abstained from drugs for more than one year. We also offer outpatient treatment, counseling and support through self-help groups.

UNODC: Is the Government of Bhutan helping in the setting up of treatment centers for drug users?

Dr. Chencho: The Ministry of Health, Government of Bhutan has plans to open a national detoxification and treatment centre in Thimphu very soon. There are also plans to open such centres in the regional referral hospitals and in hospitals in the border towns in the future. Efforts are also being made to mobilize resources and funding to train doctors and health workers on detoxification, treatment and counseling.

UNODC: Does the Government of Bhutan have a national drug control framework? Has it ratified or is party to the United Nations Convention against Illicit Traffic in Narcotics Drugs and Psychotropic Substances, 1988?

Dr. Chencho: Bhutan has come a long way in addressing the emerging drug problem amongst its young generation, from denial in the beginning, to accepting and recognizing the drug problem, and now taking concrete steps to address this new problem in our society. Bhutan is a signatory to all the three UN Conventions on Drug Control. The Bhutanese Parliament signed the Narcotic and Psychotropic Substances, and Substance Abuse Act 2005. This Act gave birth to the formation of the Narcotic Control Board and Bhutan Narcotic Control Agency (BNCA). The BNCA is now spearheading the Government of Bhutan's coordinated response on matters related to drug supply and demand reduction.

Brief Profile of Dr. Chencho: He is one of the senior most Psychiatrists in Bhutan. He is also the Technical Advisor to the National Mental Health Program in Bhutan. A significant part of his work includes working with drug users. He did his MBBS from the Armed Forces Medical College, Pune University, India after which he completed his Doctor of Medicine (MD) from Colombo University, Sri Lanka. He also did a one year specialization in community psychiatry in Australia and one year specialization in drug use treatment, education and prevention from the Bloomberg School of Public Health, Johns Hopkins University, USA

UNODC supports the Bhutan Narcotics Control Agency (BNCA) to implement programmes on drug demand reduction, prevention, care and treatment and rehabilitation of drug users. Currently, it supports the BNCA in its first ever National Baseline Assessment of Drugs and Controlled Substance use in Bhutan (2009-2010) under the joint UN (UNAIDS, UNODC and WHO) Regional Project - Prevention of Transmission of HIV amongst Drug Users in SAARC Countries.

The current UNODC work in Bhutan is possible through the contribution of the Australian Agency for International Development (AusAid).