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Sisattanak District Hospital expands community based treatment facilities

Vientiane, Lao PDR (31 October 2019)
- Today, the community based treatment centre for drug use and dependence at Sisattanak District Hospital opened a new counselling facility to better serve its patients. Hospital staff and government officials discussed the benefits of the new counselling room with representatives from the United Nations Office on Drugs and Crime (UNODC) and The Bureau of International Narcotics and Law Enforcement Affairs (INL). The discussion concluded with a short handover ceremony between UNODC officer in charge for Lao PDR, Mr. Erlend-Audunson Falch, and the director of Sisattanak District Hospital, Dr. Khonesavanh Thephavong.

The UNODC-WHO Programme on Drug Dependence Treatment and Care, (GLOK32) was established in 2009 to offer support to countries in relation to drug dependence treatment. Through this program, UNODC has worked closely with Sisattanak District Hospital since September 2014, when they opened the first community-based treatment centre for drug use and dependence in Lao PDR. Following the success of the pilot program at Sisattanak DH, community based treatment centres have opened in 28 district hospitals across six provinces in Lao PDR. Throughout the program's existence, Sisattanak DH has been a model for other institutions to follow. By expanding the treatment centre's counselling facilities, doctors can offer patients greater privacy when seeking counseling and support, making community based treatment more accessible to people in the surrounding area.

Before 2014, only mandatory drug treatment through the criminal justice system was available to drug users. Mandatory treatment provides in-patient care and traditional remedies for dependent drug users, however 90% of people who use amphetamine type stimulants are not fully dependent and do not require such significant intervention. For these reasons, UNODC has encouraged the Lao government to move away from mandatory treatment and instead offer evidence-based care in community-based treatment centres.

Centres like Sisattanak offer people who use drugs a place to seek care that fits their lifestyle without fear of being imprisoned. Community care is voluntary; described by Dr. Soulivanh Phengxay, UNODC's Program Manager for drug demand reduction, "community based treatment is a voluntary system - it should be designed to cater to the health needs of people who use drugs ensuring that drug treatment is accessible and adequate."

Community care considers all aspects of a patient's history using drugs, including the frequency and duration of drug use. Through comprehensive case management, the treatment model also addresses environmental factors that put patients at risk of using drugs, and those factors that may put them at risk of relapsing. To mitigate these factors, community based treatment offers a range of services to patients that can include bringing family into the counselling and recovery process when appropriate, vocational training, and housing support. Together, these intervention options help build a patient's recovery capital-a measure of the security of their recovery from addiction and resilience to possible relapse.

Cooperation between UNODC and the Ministry of Health has produced positive results, as noted by Mr. Falch: "The success of this program and the government's commitment to evidence based treatment are promising and very needed, especially when there is such a tremendous need to support people affected by drug dependence in communities across Laos." By expanding community based treatment to hospitals and clinics across Lao PDR, the government is making effective, evidence-based care accessible to more people.

Despite this progress, more needs to be done to reduce demand for stimulant drugs (like yaba tablets and crystal meth), and to support the people who use them. Over its five years in operation, Sisattanak District Hospital has served 382 patients. Across Lao PDR, 606 people who use drugs accessed services in community-based treatment centres, which is much lower that the estimated number of stimulant users in the country. Outreach activities must continue to encourage more patients to seek care voluntarily and improved information about drug use is needed. Lao PDR has never conducted a national drug use survey, which makes planning interventions at the national level very difficult.

Existing community-based treatment centres must also expand the services they provide. Some centres do not offer vocational training or housing support, nor do they provide referrals to these services. This limits intervention options and the ability to support the full recovery of patients. With the average age of new stimulant users falling in recent years (some patients begin using drugs as young as 12 or 13 years of age), reducing the demand for drugs, and providing effective treatment options for people recovering from drug use disorders is vital for the long-term health of people in Lao PDR. By supporting the improvement of evidence-based treatment, the international community can help the Lao government reduce the damaging effects of drug use across the country, and reduce the vulnerability of the next generation.