Interview with counsellor at Bhutan Narcotic Control Agency
20 August 2009 - The UNODC Regional Office for South Asia recently interviewed Tshewang Tenzin, peer counsellor at the Bhutan Narcotic Control Agency. A recovering drug user, Mr. Tenzin talks about drug use trends, the kind of treatment available to drug users and ways of further improving service delivery at health centres in Bhutan. Mr. Tenzin strives to act as an example for the youth of Bhutan by advocating a life free from drugs.
What has been your experience with drugs?
When I analyse why I started using drugs, I realize that being sent to boarding school at 13 for seven years was a major turning point in my life. It was very difficult for me to fit in because the environment was so different from the one I was used to at home. In those days, drugs were not popular in Bhutan, especially at our school, but whenever I went home for vacation, I met with friends who were using drugs. Their hair was long and they dressed like the hippies in Hollywood movies.
I wanted to be like them because they seemed so cool. I was 16 when I first smoked marijuana. I had always been curious about drugs and getting high. At first, I did not like the effect of marijuana. I told myself that I could stop whenever I wanted to. But I never did feel like stopping; instead, the feeling of wanting more grew. At the age of 18, I started taking pharmaceutical drugs like cough syrups and pills. Sometimes, I switched to alcohol when I didn't have drugs. By 21, I was injecting pharmaceutical sedatives like Spasmo Proxyvon, Tidigesic and pentazocine.
Are drugs easily available in Bhutan?
I used to go to the border areas to buy my "consignment" more cheaply. When I didn't have enough money, I had to write out fake medical prescriptions to get drugs from pharmacies. I somehow managed to get the drugs, but getting a syringe was difficult, so I often shared a syringe with other drug users. I also stole syringes from hospitals and other places. I even got a few syringes from the vet by lying to him about my dog being sick.
Then, some of my friends were diagnosed with hepatitis C. Others died from overdosing. At that point, I realized what fear was. Still, when the "brown sugar" (heroin) came into the black market, I was curious about it. I sold my shirt and shoes and bought drugs. I would stay in my room for about three days at a time and inhale brown sugar. By the time I wanted to stop, I felt it was too late. Drugs had become a necessity, a craving for my body and mind. Nevertheless, deep inside I always wanted to quit drugs and change. I wish I had been more educated about drugs. I wish my community and family had been more aware about the consequences of drugs. There was a time when I thought I was insane and wanted to commit suicide. I would promise myself not to inhale drugs, but I just couldn't stay away from them.
Did you face stigma and discrimination?
My friends and parents thought I was bad company. Every time I visited my relatives, they would want me to leave immediately. I have faced stigma and discrimination, even as a recovering drug user. When I applied for a job, I was often rejected. Not having support and understanding from the community around me when I was making an effort to quit drugs made me relapse a few times even after treatment. I must say, though, that the usual perception of stigma as a problem that starts in the community is not right; ironically, it begins at home, among the family members of drug users. This is mainly because they are not aware of the problem of drug use.
What are some of the problems that drug users face in getting treatment in Bhutan?
Many recovering drug users relapse after rehabilitation and detoxification. The most important reason is that there is no follow-up once patients have been discharged and have gone back into the community. There just aren't enough resources and trained personnel. The other reason is that drug users tend not to come back for follow-up care because they think that they have been completely "cured". In addition, medical service providers are generally trained to encourage abstinence only, whether or not the patient wants it or is able to achieve it.
Physicians encounter patients who are unable or unwilling to abstain from drugs, unable to access treatment or who continue to use drugs despite treatment. I think there is a discrepancy between what is taught formally in medical schools and what is encountered in practice. Medical schools should plan curricula to close this gap and practicing physicians should be encouraged to educate themselves about the problems involved in treating injecting drug users.
What can be done to improve treatment facilities for drug users in Bhutan? What are you doing to help recovering drug users in your country?
Treatment centres are few in Bhutan and those that exist need to be better equipped. An integrated health service system for drug users post-rehabilitation is needed. I feel that prevention must always be a fundamental tool in addressing drug use. It should involve not just gathering facts and broadcasting anti-drug messages, but also creating a deeper and strong resistance throughout society. Primary health care delivery systems, especially among injecting drug users, need to be strengthened.
I, along with a dedicated team of recovering drug users, have founded a substance and alcohol abstinence support group for drug users and alcoholics. I am the overall coordinator of the group. The main purpose of this group is to educate drug users in the psychiatric ward on drug use. We monitor and support them after they are discharged from the detoxification unit and other rehabilitation centres with the aim of preventing relapse. In 2008, 72 drug users (both men and women) aged 15-45 underwent treatment either at the detoxification unit in the psychiatric ward or at a town along the border with India.
Do women drug users also come to your substance and alcohol abstinence support group for help?
These days, women are much more open about approaching us for help. The stigma against women drug users was very high some years ago. They were seen as being "loose" or of immoral character and as prostitutes. These days, however, drug users in Bhutan are not discriminated against anymore and the problem is seen more as a disease that requires treatment and attention. Many women who use drugs are coming forward for support and help to overcome their drug addiction.
How do you cooperate with UNODC?
I work closely with UNODC on a project for preventing the transmission of HIV among drug users in countries that are part of the South Asian Association for Regional Cooperation. I am a peer counselor dealing with alcohol and drug dependants at the grassroots level. Some of us have participated in UNODC workshops to raise awareness about the relationship between HIV and drug use. In fact, some members of the substance and alcohol abstinence support group have worked on a temporary basis as peer counselors and outreach workers for the Bhutan Narcotic Control Agency.
Tshewang Tenzin is 31 years old and has not used drugs for three years. He is married and has a 2-year-old son. He works as a peer counselor for the Bhutan Narcotic Control Agency and is one of the founders of the substance and alcohol abstinence support group, which is made up of recovering drug users providing services for people with drug and alcohol abuse problems, including counselling to their families.
UNODC supports the Bhutan Narcotic Control Agency implementation programmes on drug demand reduction, prevention, care and treatment, and rehabilitation. UNODC is currently supporting the Agency in carrying out its first-ever national baseline assessment of drugs and controlled substance use in Bhutan (2009-2010).
The work of UNODC in Bhutan is made possible by the contribution of the Australian Agency for International Development.