In Asia, growing support for voluntary treatment for illicit drug users

Kuala Lumpur (Malaysia), 24 September 2012
- Faced with increasing illicit drug use, particularly of amphetamine-type stimulants (ATS), and persistent use of heroin and plant-based drugs, governments in East and Southeast Asia currently detain an estimated 300,000 people in some 1,000 compulsory centres for drug users (CCDUs).

Throughout the region, however, there are concerns about human rights violations, sub-standard conditions, forced labour, physical/sexual violence, a lack of access to health care and an increasing awareness that CCDUs fail to address drug use as a chronic relapsing health disorder. This has led governments to look at evidence- and rights-based alternatives to CCDUs.

High-level delegations from Viet Nam, Cambodia and Myanmar recently visited Malaysia to study that country's innovative open access Cure & Care 1Malaysia Clinics.

These were established in 2010 when, in response to high-relapse rates associated with CCDUs, the Government began gradually to move away from CCDUs and introduced a number of evidence- and community-based treatment (CBTx) services for illicit drug users. Since then, Malaysia has made considerable progress in the provision of drug treatment.

Organized by UNODC's TREATNET programme in partnership with the Malaysian National Anti-Drugs Agency (NADA) and in collaboration with AusAID's HAARP Programme, Family Health International (FHI 360, USA) and the Substance Abuse and Mental Health Services Administration (SAMHSA) in Viet Nam, the programme included visits to a range of Malaysian drug treatment services and a workshop on community-based treatment.

Overall, the participants were impressed by what they heard and observed. There were lively debates with clinic clients. Staff helped the visitors explore the practical implications of community-based drug treatment implementation for their own countries.

Viet Nam, whose delegation of 23 high-level officials was the largest of the three visiting countries, will submit to the Government, in December 2012, a plan to change its compulsory detention 06 centers and expand voluntary, community-based treatment programmes.

"Vietnam is developing a policy framework to support the transformation of 06 centers," said Mr. Nguyen Van Minh, Director of the Department of Social Evils Prevention in Viet Nam. "This visit to Malaysia has provided us with examples on which we can build."

The places visited included the pioneering Cure & Care (C&C) Clinic in Kuala Lumpur. Set up by NADA in 2010 in response to the growing drug problem, the C&C Clinic represents a shift in Malaysia's approach to drug treatment and a move away from institutionalized punitive rehabilitation. C&C Clinic is now one of many such treatment clinics in Malaysia.

Delegates also visited C&C Services Centre Chow Kit, a community-based, drop-in service launched in 2011, is a successful partnership between NADA and the non-government organization Salam Foundation. Its clientele are current and ex-drug users. Chow Kit provides basic support services - food and a place to rest, bathe and wash clothes - and an outreach programme, counseling, medical check-ups, methadone maintenance therapy, spiritual and moral education, and support for integration.

A representative from Myanmar - which is currently expanding access to methadone-maintenance treatment - says he was surprised at what he learnt. "The Malaysia's Government didn't change the law," said Lt. Col. Zaw Lin Tun. "Within the existing legal framework they developed an open system with community based services and comprehensive inter-agency collaboration."

At a workshop, panelists Mr. Dato Zaman Khan (Chairman of the Malaysian AIDS Council, former Director General of Prisons), Ms. Nazira Nasaram (NADA), Dr. Faziba Binti Yuswan (Ministry of Health) and Dr. Adeeba Kamarulzaman, (Research, University of Malaya) highlighted the need for partnerships and advocacy work and stressed the importance of commitment and support from all stakeholders involved, particularly higher level officials.

A member of the delegation from Cambodia - which has committed to expanding community-based treatment to 350 communes by 2016 - found this approach helpful. "We learned that strong leadership at both the national and community level is required to promote changes in drug treatment approaches," said the delegate. "We also learned that drug treatment should be integrated with health and other services to better respond to drug users' multiple needs. The main challenge is helping the community think differently about drug abuse."

Before returning home, each delegation discussed next steps for implementation in their country, and agreed to hold a follow-up workshop to brief their local partners on the Malaysian experience and plans to promote implementation of community-based treatment services in their countries.

Within the United Nations, UNODC is the lead agency providing assistance to its member states to tackle their drug-related problems in all their manifestations. In order to deliver community-based drug treatment initiatives, UNODC - through its Global TREATNET programme - has partnered with other UN agencies including WHO and UNAIDS, as well as national and provincial authorities in Cambodia, Myanmar and Viet Nam. Funds for UNODC Global TREATNET in Southeast Asia are provided through the generous support of the Governments of Sweden and the United States of America.