Bhutan: In conversation with Tshewang Tenzin on recovery and treatment for drug users

The Regional UNODC Office for South Asia recently interviewed Mr. Tshewang Tenzin, Peer Counselor at the Bhutan Narcotics Control Agency (BNCA). A recovering drug user, he gives us insights into trends on drug use in Bhutan, availability of treatment for drug users and what can be done to further improve the service delivery at health centers. Tshewang likes to lead by example for the youth in Bhutan by advocating for a life free from drugs that is happier and healthier.

UNODC: What has been your experience with drugs?

Tshewang Tenzin: When I analyze why I started drugs, I realized that being sent to a boarding school at 13 for seven years was a major turning point in my life. It was very difficult to adjust since the environment was so different from home. Those days drugs were not popular in Bhutan, especially in our school but whenever I went home during vacations, I met my friends who were initiating drug use. They sported long hair styles and dressed like Hippies from the Hollywood movies. I wished to be like them because it was considered being 'cool'. I was only sixteen when I first smoked marijuana. I was always curious about drugs and its 'highs'. At first I didn't like the effect of marijuana. I never realized its consequences and had a feeling that I could stop whenever I wanted to. However the feeling of stopping never came but instead grew. At the age of 18 I shifted to pharmaceutical drugs like cough syrups and pills. Sometimes I switched to alcohol when I didn't get drugs. By 21 I was injecting pharmaceutical sedatives like spasmoproxyvon, tidigesic and pentatazocine etc.

UNODC: Are drugs easily available in Bhutan?

Tshewang Tenzin: Every time I had time, I went to the border areas to buy my "consignment" at cheaper rates. At times I didn't have the money and had to resort to making fake medical prescription to obtain drugs from the medical stores. Somehow, I managed to get the drugs but getting a syringe was difficult - so we often shared one syringe among five drug users. Most of the time I stole the syringes from the hospitals and other institutes. I even obtained a few syringes from the vet by lying to him that my pet dog was sick. Then some of my friends were diagnosed with Hepatitis C while others died of overdose. At that point I reaslied what fear was. Still, when the brown sugar (adulterated heroin) came into the black market, I was as usual curious about it. I sold my shirt and shoes and bought drugs. I had my first 'chase' from inhaling drugs which I liked. I would confine myself in my room for around three days at one stretch 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 me I always wanted to quit drugs and change. I wish I had been more educated about drugs. I wish my community and family were 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.

UNODC: How severe was the problem of stigma and discrimination in your case?

Tshewang Tenzin: I did face severe stigma and social discrimination. My friends and parents considered me to be a 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. I had little chance of getting hired whenever I applied for a job. I was often rejected. Lack of support and understanding from the community at large even when I was making an effort to quit drugs, made me relapse few times even after treatment. I must say though the usual perception of stigma is that it starts from the community, ironically it begins at home by the family members of drug users as a result of lack of awareness about the problem of drug use.

UNODC: What according to you are some of the drawbacks in treating drug users in Bhutan?

Tshewang Tenzin: Many recovering drug users have relapsed after rehabilitation and detoxification. The detoxification unit has had several drawbacks. The most important reason being the lack of follow up of the patients after being discharged in the community. This problem was due to the shortage of resources and trained personnel. The other reason is lack of awareness among drug users who do not come back for follow up care because they believe that they are completely 'cured'. Furthermore, medical providers are generally trained to encourage abstinence only, whether or not the patient desires it or is able to achieve it. However, physicians are likely to encounter patients who are unable or unwilling to achieve abstinence 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 while practicing physicians should be encouraged to seek out programs to become further educated about the problems of injecting drug users' treatment.

UNODC: According to you, what can be done to improve the treatment facilities for drug users in Bhutan? What are you doing to help recovering drug users in Bhutan?

Tshewang Tenzin: Treatment centers are few in Bhutan. They need to be better equipped in terms of service delivery, health practitioners and 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 needs to be strengthened. I, along with a dedicated team of recovering drug users, founded the 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 the drug users at the psychiatric ward on drug use, monitor and support them after they are discharged from the detoxification and other rehabilitation centers to prevent relapse. In the year 2008 itself, 72 drug users, both male and female ranging between 15 to 45 years of age, underwent treatment at the detoxification unit in the Psychiatric Ward while 11 of them were referred for rehabilitation at the border town, in India.

UNODC: Do female drug users also approach the Substance and Alcohol Abstinence Support group for help?

Tshewang Tenzin: These days' women users are much more open about approaching us for help. The stigma against women drug users was very high some years ago. Earlier female drug users were looked upon as being 'loose' or of immoral character and as prostitutes. This was true to some extent as women drug users needed money to support their habit of drug use. However, these days, drug users in Bhutan are no more being discriminated against and the problem is being seen as a disease that requires treatment and attention. Many women users are coming forward for support and help to overcome their drug addiction.

UNODC: Are you aware of UNODC's work in Bhutan in prevention of drug use?

Tshewang Tenzin: Yes, I am aware of UNODC's work specially in the context of drug demand reduction. In fact I work closely with UNODC on the project 'Prevention of Transmission of HIV among Drug Users in SAARC countries'. As I am a peer counselor dealing with the alcohol and drug dependants at the grass roots level, my work is mostly related to UNODC project in Bhutan. Some of us have even participated in the UNODC workshops on awareness about the relation between HIV and drug use. In fact, some of the members of Substance and Alcohol Abstinence Support group have been temporarily engaged to work as peer counselors and outreach workers by the BNCA. Everyone who is aware of UNODC's work in Bhutan is very impressed with the progress made and awareness generated on the harmful effects of drug use.

Brief Profile: Tshewang Tenzin is 31 years and has had three years of sobriety. He is married and gifted with a beautiful son who is two years old. He works as a peer counselor in Bhutan Narcotics control Agency (BNCA) which is a focal agency for drugs and alcohol related issues in the country. He is also one of the founders of the "Substance and Alcohol Abstinence Support group" which consists of recovering drug users, which provides post care services for people with drug and alcohol problems as well as counseling to their families.

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).

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