In
Myanmar, thousands of families earn a living farming the crop that feeds the
heroin habit of the world's drug users. But not all of the country's opium is
smuggled abroad.
Pure,
cheap heroin is flooding Myanmar's villages, leaving a trail of death and
devastated families in its wake.
Dr Nang
Pann Ei Kham, the coordinator of the Drug Policy Advocacy Group, talks about
how the fear of corporal punishment and imprisonment prevents many drug users
from seeking help, and the rehabilitation centres where "treatment"
is based on religious teachings.
Her
pressure group includes experts, opium farmers and drug users themselves.
"They
are the ones whose lives, livelihoods and health are directly affected by
repressive drug policies based on criminalisation and forced eradication.
Unfortunately, their voices are too often ignored," she explains.
"I
strongly believe that repressive and punitive approaches only make problems
worse. Drug-related issues should be addressed through policies that are
grounded in public health, human rights and alternative development."
Al
Jazeera: How many people are estimated to be addicted to drugs in Myanmar?
Dr Kham:
The only data that is available in Myanmar is related to the number of people
who inject drugs.
According
to a recent survey conducted by the Myanmar Ministry of Health, there are an
estimated 83,000 injecting drug users in the country. To provide you with some
means of comparison, it is about twice as many as Thailand (40,300), but only
half the estimated number of drug injectors in Malaysia (170,000).
Dr Nang Pann Ei Kham,
coordinator of the Drug Policy Advocacy Group, speaks about the deadly
addiction that is devastating local communities [Dr Nang Pann Ei Kham/ Al
Jazeera]
Al Jazeera: Has drug addiction worsened in
recent years? And, if so, why?
Dr Kham:
It is very difficult to say whether drug use and drug addiction have increased
in recent years. This would require conducting nationwide surveys on a regular
basis, and no such data exists. However, the Myanmar Ministry of Health reviewed
that the estimated number of people injecting drugs rose from 75,000 last year
to 83,000 currently.
That
seems to suggest at least a slight increase.
What
happens is also that drug-related problems were largely neglected and
under-reported until recent years, due to the political context. Journalists
and civil society organisations are now much more free to report about problems
raised by drug addiction. So those have become a lot more visible than they
used to be in the past.
Al Jazeera: What is the most problematic drug?
Dr Kham:
From a public health perspective, heroin is unequivocally the most problematic
drug in Myanmar, because it is most commonly injected. Northern regions, such
as Kachin, Northern Shan or Sagaing Division, are particularly affected.
The most
severe consequences of heroin use include lethal overdoses, the transmission of
blood-borne infections such as HIV, Hepatitis B and C due to unsafe injection
practices and needle sharing, but also family and other social problems.
Some mental
health disorders induced by excessive use of amphetamine-type stimulants, known
as Yaba or Yama in the region, have been reported, too, but little data is
available yet.
Al Jazeera: Is there a stigma attached to being
an addict?
Dr Kham:
There is a huge stigma towards drug users. People often refer to them using
derogatory terms such as "Bein Sar", literally meaning "opium
eater", that would be a Burmese version of "junkie".
If a drug
user turns out to contract HIV/Aids, then he or she is even more discriminated
against. Most people despise, or at least distrust, drug users. So they are
facing immense challenges and difficulties, not least to find a job, even when
they are seeking treatment or recovering.
'They are the ones
whose lives, livelihoods and health are directly affected by repressive drug
policies based on criminalisation and forced eradication' [101 East/Al Jazeera]
Al Jazeera: How is drug use contributing to the
HIV/Aids epidemic?
Dr Kham:
It is actually not drug use itself that contributes to the HIV/Aids epidemic,
but rather the high prevalence of unsafe injecting practices such as needle
sharing. And those can be very effectively reduced if harm-reduction services
are provided at a sufficient scale and users are free to access sterile
injecting equipment without fear of arrest.
Thanks to
harm-reduction programmes, HIV prevalence among people who inject drugs has
decreased from more than 70 percent in the early 1990s, to around 23 percent in
2014, according to statistics released by Myanmar's Ministry of Health.
Despite
the increasing availability of sterile injecting equipment, some drug users can
still be reluctant to carry new needles and syringes, due to their fear of
being arrested, prosecuted and incarcerated. I would argue that more than drug
use itself, it is the criminalisation of drug use that fuels HIV/Aids epidemics
among people who inject drugs.
Al Jazeera: What facilities and treatment
options are available for drug users?
Dr Kham:
Government-run drug treatment centres propose drug detoxification services,
however their number and resources are very limited. Such facilities merely
focus on treating withdrawal symptoms without providing a more holistic
approach of drug treatment that would address broader psychological or social
issues faced by people with a drug dependency problem. Relapse within a few
months is therefore extremely common.
The
government provides methadone substitution therapy with the support of
international donor agencies, which to date remains the most effective
treatment for opiate dependency. This programme has grown steadily over the
years and more than 10,000 drug users are currently benefiting from this
treatment.
Other
types of "treatment and rehabilitation centres" are run by private or
faith-based organisations, which offer therapies that are essentially based on
Bible studies. Those programmes can work for some people, but they hardly meet
the minimum standards one can expect from a treatment centre proper:
"treatment" is often compulsory, sometimes following arrests that
involve corporal punishment, and no medical assistance is provided.
Thousands of families
earn a living farming the crop that feeds the heroin habits of the world's drug
users [101 East/Al Jazeera]
Finally,
local and international NGOs provide harm-reduction services to reduce the most
adverse consequences of drug use. Services include the distribution of sterile
needles, syringes and condoms, but also basic healthcare, HIV-related services
and overdose management. The reduction of HIV prevalence among people who
inject drugs in Myanmar can certainly be attributed to the existence of such
programmes, which are funded by international donor agencies.
Al
Jazeera: What more needs to be done in Myanmar to help drug users?
Dr Kham:
Many drug users are still being harassed, arrested and jailed for numerous
years - not because they are committing serious criminal offences, but just
because they are using drugs. I would, therefore, like to invite our new
government to reconsider the 1993 Narcotics Law and stop regarding drug users
as criminals.
After
years of military oppression, I'm only dreaming to see our already scarce
resources being used to promote access to health and other social services,
rather than jails and prisons to detain even more people.
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