Drug Abuse in Lai Chau Province: Rapid Situation Assessment, December 2001

Executive Summary

During the first half of the 1990s, the majority (86%) of those infected with HIV/AIDS in Vietnam were injecting drug users (IDUs). While this percentage had declined to 65.5 per cent by 2000, injecting drug use is still the leading cause of HIV transmission. It is estimated that there are currently 50 to 100 new HIV infections per day in Vietnam1.

However, knowledge about drug use habits, motives and supportive or restrictive contexts are still rudimentary among technical assistance providers. The motives, constraints and habits of IDUs need to be understood to proactively design and implement prevention activities as well as activities targeted at changing high-risk behaviour.

Purpose

The purpose of this research is to make a Rapid Situation Assessment (RSA) of drug abuse in the province and to investigate the context, motives, rituals, habits and lifestyle of injecting drug users in the typical urban setting and in the more remote rural areas.

Methods

Both quantitative and qualitative information has been used from various sources including in-depth and structured interviews, focus group discussions, direct observation and data gathering.

A total of 61 in-depth interviews and six focus group discussions were organized from 10-30 December 2001 in Lai Chau province with:

- Officials of the provincial People's Committee and provincial government agencies and social organizations
- People's Committee and relevant agencies and organizations in three districts: Dien Bien, Tuan Giao and Dien Bien Dong. 
- People's Committee and relevant agencies and organizations in Thanh Binh and Muong Thanh communes and in Dien Bien Phu town.
- Drug retailers -- four people
- Drug abusers: 39 people recruited by snowball technique at three places: Dien Bien Phu town (13), Dien Bien district (14) and Tuan Giao (12).

Main Findings

1. General situation of drug abuse in Lai Chau

Lai Chu and other mountainous provinces in northern Vietnam have a long history of opium cultivation and use. Ethnic minorities in this area believe that opium is magic medicine, which enhances one's health and longevity if used regularly and reasonably. Smoking opium was also a popular cultural ritual among males before 1945. Although trafficking and distribution of opium was later prohibited, several areas of Lai Chau were encouraged to produce opium for import. This partly explains why opium use continued during these years and exploded in the early 1990s.

From 1994 to 2001, the number of drug abusers in Lai Chau oscillated from 8,000 to 12,000. Lai Chau is one of the provinces with the highest number of drug addicts and ranks third overall after Ho Chi Minh City and Hanoi. According to statistics by the Lai Chau Provincial Department of Labour, Invalid and Social Affairs (DOLISA), in 2001 the province had 8,325 drug addicts. Among these, H'mong has the highest proportion (42 per cent), followed by Thai (23.2 per cent), then Kinh with 18.3 per cent and the remaining 16.5 per cent is made up of other ethnic groups, including Lao, Khmu, Xich Mun, etc. Those under 18 make up 6.2 per cent of all addicts, people aged 18-35 make up the largest percentage (51 per cent), and those 36 years old and above account for 42.7 per cent. Drug addicts can be found in every district and town in the province. Within the province, the Phong Tho and Tuan Giao districts have the highest number of addicts: 1,345 and 1,226 persons, respectively.

Since 1990, Lai Chau has developed and implemented policies to replace opium cultivation with alternative crops. By 2000-2001, the area of opium planting was 60.659 hectares (ten times less than the total area in 1990). Money invested to shift to alternative crops dropped from 2,550,000 VND in 1993-1994 to 394,316,000 VND in 1999-2000.

Due to its geographic location on the border with Laos and China, Lai Chau in recent years has become an important intermediate area in the drug trafficking route from these countries into and through Vietnam. Drug rings have developed in communities in Lai Chu, challenging the province's efforts to prevent drug abuse, especially among youth.

Lai Chau has carried out intervention activities to control and limit the production, distribution and use of drugs. Several programmes for detoxification have been implemented. However, according to the local officials, the detoxification courses were not as effective as expected. The treatment course is not long enough to help users quit drugs completely. Financial resources allocated for treatment courses are still modest and are hardly able to meet minimum requirements. Health services do not meet the demand of patients for follow-up care and treatment. Finally, the follow-up activities to support rehabilitation are still limited, so it is difficult to ensure the sustainability of treatment. After treatment, most drug abusers lack stable jobs, and their families lack skills to support their rehabilitation. Socio-cultural activities attracting youth and drug users after treatment are still poor. These factors help explain the high rate of relapses.

2. Profile of drug addicts: personal characteristics, determining factors, rituals, habits and lifestyles.

• For most drug abusers in Lai Chau, drug use begins with opium rather than other synthetic substances. The production of opium and its traditional use are factors in its widespread abuse. Opium smoking is still popular in Lai Chau, and often leads to smoking and injecting heroin.
• Drug abuse is caused by social and psychological factors, such as group pressure, gender stereotypes, concept of masculinity, influence of social environment -- including family, workplace and community -- and the lack of knowledge of the dangers of drugs.
• It is not difficult for the abusers in Lai Chau to obtain drugs. This challenges intervention activities aimed at behaviourial change for preventing drug abuse and supporting treatment.
• The involvement of some abusers in drug rings is a serious problem. It widens the system of trafficking and supplying drugs, which may increase the number of abusers acting as retailers and entice new drug users.
• Many interviewed drug abusers practice high-risk behaviour regarding HIV/AIDS infection. They share syringes and needles and do not practice safe sex. These findings imply that the abusers lack knowledge of HIV/AIDS and are not fully aware of their responsibility for themselves and for the community, suggesting that harm reduction activities should be enhanced.
• Most interviewed drug abusers in Lai Chau practice a careless lifestyle. The focus of their life is satisfying their addiction at the expense of their families. This suggests the need for well-organized rehabilitation activities, combining education and job creation.
• Drug abusers in Lai Chau have spent huge amounts of money on drugs, not including the cost of long term damage to their health. This is a real loss for the economy of Lai Chau, which already faces many difficulties.
• Treatment and rehabilitation efforts, such as detoxification centers, community-based courses and individual treatment, seem to be ineffective. The main reasons for this include short treatment time and lack of resources and skills for follow-up support to sustain behaviourial change.
• Family and community play an important role in prevention, treatment and control of drug use. To enhance this role, the family and community also need to be provided with information, skills and resources to support treatment activities and to ensure sustainability of the treatment results.

3. Recommendations

3.1. General recommendations

• First, the effectiveness of socio-economic development programmes in Lai Chau needs to be improved. This will contribute to poverty reduction and job creation.
• Second, the network for drug prevention and control needs to be strengthened. This includes training for staff and leaders, setting up the coordinating mechanisms among different government agencies and improving the monitoring, evaluation and quality of activities. 
• Finally, it is necessary to design and implement culturally sensitive drug prevention and control programmes. This may include traditional methods of drug treatment, an appropriate information, education and communication (IEC) strategy, consideration of socio-cultural characteristics, maximizing the use of community relations and good management of the limited budget.

3.2. Recommendations for drug abusers

IEC and awareness-raising

• Continue IEC activities to eliminate the custom of opium use, especially among youth. Eliminate the myth that smoking opium is beneficial to one's health and that using opium does not affect the possibility of contracting HIV/AIDS.
• Raise awareness that opium smoking can lead to heroin abuse and, consequently, the use of other synthetic substances, increasing the risk of contracting HIV/AIDS. Continue IEC activities to improve knowledge on HIV/AIDS for drug abusers.
• Raise the awareness and sense of responsibility among drug abusers for practicing safe injection and safe sex to protect themselves, their families and their communities.
• Widely disseminate this information in the province to raise people's awareness about drug abuse prevention and to mobilize more active participation in intervention activities, especially in their families and communities.

Strengthening the role of family and community

• Mobilize the community to detect, control and limit the activities of drug rings. Family and community should pay more attention to supervising the behavior of drug abusers and educate them to stop selling drugs.
• Relevant government agencies and social organizations should organize IEC activities on legal issues related to drug trafficking for abusers and their families.

Promote harm reduction and other intervention programmes

• Improve the provision of facilities supporting safe injection and safe sex -- i.e., widen access to clean needles, syringes and condoms.
• Promote activities facilitating job creation for drug abusers.
• Encourage drug abusers to participate in social activities, including organizing peer groups or peer clubs. 
• Widen recreational activities and facilities for youth. Diversify IEC activities, for example, to develop informational music videos or plays on drug abuse prevention and HIV/AIDS.
• Intervention activities should start by addressing factors that lead to drug abuse rather than relying solely on education about the dangers of drug abuse. 
• Psychologists, sociologists, educators, social workers, family and former abusers should be used to design intervention programmes. 
• Interventions should be closely integrated to ensure effectiveness and sustainability.

Improving treatment and follow-up activities

• Organize follow-up support for abusers after treatment, such as maintaining the necessary medicines for recovery, creating jobs and organizing social and recreational activities.
• Organize activities to improve knowledge and raise awareness on preventing drug abuse and supporting treatment for family and community.
• Mobilize the community's contribution to lengthen the detoxification courses in the community and in the centres.
• Support poor families in treatment of drug abusers.