Starting Points: opium

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Jun 4, 2010

Why the Vietnamese Don't Want to Go to Rehab

Image by mkandlez via Flickr

Drug treatment in Southeast Asia is brutal, exploitative, and practically worthless

Joseph Amon, Health and Human Rights Director

Published in:

Foreign Policy

May 28, 2010

This month, nearly 600 drug addicts broke out of a rehabilitation center in the northern Vietnamese city of Haiphong. The addicts overpowered guards at the state-run treatment facility and made a break for it. "We were completely overwhelmed," a security guard told the Associated Press. "Forty of us were not able to prevent them, many with canes and bricks, from escaping." Videos on the Internet show crowds of escapees marching through city streets.

Why were hundreds of patients fleeing treatment? Because in Vietnam, "treatment" looks a lot more like forced labor, complete with beatings and years of involuntary detention. Like neighboring Cambodia, China, Laos, Malaysia, and Thailand, the government of Vietnam has adopted a "get-tough" approach to drug treatment rather than evidence-based treatment. In Vietnam, more than 100 government-run facilities detain between 35,000 to 45,000 people for extrajudicial sentences of up to four years.

Vietnamese in these treatment centers are engaged in what the government calls "therapeutic labor": long hours at menial jobs for below-market wages -- whatever's left, that is, after the centers deduct for the cost of their meager food and Spartan lodging. Those who fail to meet work quotas are beaten. Patients who violate center rules can be locked in solitary confinement. "[T]hey beat people up, kicked the face, kicked the chest," a former resident of a rehab center near Hanoi told the BBC in 2008. "Later, people were made to work very hard. They said work to forget the addiction, work is therapeutic."

Opium cultivation and smoking are not new phenomena in Vietnam. But with economic liberalization and increased migration since the 1980s has come greater economic polarization and drug abuse. It is estimated that there are more than 100,000 injecting drug users in the country today, and nearly one in three is HIV infected.

Drug treatment hasn't kept pace with increasing abuse, and aside from some small-scale programs, allowed by the government but largely funded by other donors, effective treatment is virtually nonexistent. Instead, the government emphasizes compulsory, institutionalized treatment that isn't just inhumane, but also next to useless. Government reports have said that 70 to 80 percent of those who spend time in a center return to drug use. Other estimates put the rate closer to 90 percent -- and when drug users do relapse, they have no place to go, especially not to a compulsory "treatment" center. According to a study published this spring in the Journal of Urban Health, drug users in Vietnam who have been in rehab centers are more likely to be infected with hepatitis C than those who have not. Another study found that detention and fear of police led to greater risk of HIV infection among Vietnamese users.

In fact, Haiphong's escapees probably stand a better chance on the outside, if they can stay there: The city is one of three in Vietnam that is piloting the use of methadone to manage opiate addiction, the preferred approach in most developed countries. Indeed, trials of methadone maintenance therapy were already successfully conducted in Hanoi in the mid-1990s. So why not increase the number of slots in the Haiphong methadone clinic and offer the escapees voluntary enrollment? The U.S. government could help ensure that those who escaped can access services by redirecting its funding, which currently goes to HIV-treatment programs inside these abusive centers (though not the centers themselves), to programs based in the community.

Indeed, were Haiphong to expand access to the community-based drug treatment services it already offers and add counseling, employment prospects, and housing assistance, the city could become a model of humane and sustainable treatment. Those who were only occasional drug users -- and who don't need drug addiction treatment in the first place -- are more likely to find meaningful work and social support networks in the community to avoid becoming addicted. Serious addicts and casual users alike are likely to find better HIV prevention programs and services in the community.

Drug rehabilitation should provide drug users with a chance to regain control of their lives, repair broken relationships, and overcome destructive addictions. Rehab in Vietnam ruptures the lives of drug users, severs social support, and pretty much guarantees a return to drug use after years of abuse. No wonder drug users are escaping.

Sep 2, 2009

U.N. Report Cites Sharp Drop in Opium Cultivation in Afghanistan - washingtonpost.com

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By Joshua Partlow
Washington Post Foreign Service
Wednesday, September 2, 2009

KABUL, Sept. 1 -- Cultivation in Afghanistan of opium, the nation's most lucrative cash crop and a major funding source for the Taliban, has fallen sharply this year in large part because an excess supply of the drug has pushed down prices to a 10-year low, according to a U.N. report scheduled to be released Wednesday.

The Obama administration has changed course on its opium policy here, moving away from eradication efforts favored by the Bush administration that senior officials now say wasted millions of dollars. Instead, funding is being directed toward programs to persuade farmers to grow other crops. But more than those nascent efforts, U.N. officials said, the cause of the decline in opium cultivation this year was a deteriorating market for the drug.

"Overall, you could say we are now profiting from a fantastic market correction," said Jean-Luc Lemahieu, head of the Afghanistan office of the U.N. Office on Drugs and Crime (UNODC). "There is just too much supply around, so the attractiveness is diminishing."

The area under opium poppy cultivation fell this year by 22 percent, to 123,000 hectares, or about 304,000 acres, the second consecutive year of decline after a rapid growth of opium farming since the war began in 2001, according to the United Nations' 2009 Afghanistan Opium Survey. Twenty of the country's 34 provinces are considered poppy-free, two more than last year.

Much of the decline was in Helmand province, in the south, where U.S. Marines have launched an offensive against the Taliban. Helmand still accounts for nearly 60 percent of all opium grown in Afghanistan, and drug money continues to fuel the Taliban and the corruption that plagues the Afghan government.

Although the area under opium cultivation declined sharply, the drop in the production of the drug was less dramatic because farmers were able to extract more opium per poppy bulb. Driving both declines, officials said, is a drop in prices to levels not seen since the Taliban ruled Afghanistan from the late 1990s to late 2001. The report found a 40 percent drop in the total value of opium produced, down to $438 million, or 4 percent of Afghanistan's gross domestic product. This helped push more than 800,000 people out of the opium business.

"There's only so much the Taliban can store in the caves," Lemahieu said.

The amount of surplus opium still stashed in Afghanistan is staggering, officials said. The U.N. report said the world's annual demand for opium derivates such as heroin is not more than 5,000 tons, but the drug stockpiles in Afghanistan may be double that. And these stockpiles are durable, Lemahieu said, able to last in good condition for 10 to 15 years. In some areas along the border with Pakistan, opium is used as currency, he said.

The drug industry is so prevalent in places such as Helmand that coalition commanders there say it is often difficult to distinguish between Taliban members, drug traffickers and criminal gangs, all of which take part in the business.

Col. George Amland, deputy commander of the 2nd Marine Expeditionary Brigade, which operates in Helmand, said that "all those people will coexist very happily as a partnership, while there is a level of chaos," but that his troops are attempting to interrupt and split the networks.

The U.N. report praised Afghan and NATO troops for destroying tons of chemicals, seeds, drugs and 27 labs this year, as well as for moving away from eradication as a policy.

"You've seen some pretty sizable operations down south in Helmand," said Col. Wayne Shanks, a U.S. military spokesman in Kabul. "Our presence there and our activities in the area may have contributed to some of those figures" of declining opium cultivation.

U.N. officials estimate that the Taliban collects at least $125 million a year from opium production, including by taxing farmers and levying "protection" fees for cargo trucks transiting its territory. There are also signs that the group is increasingly involved in the high-end value aspects of the business, including converting opium to heroin and trading in precursor chemicals, such as acetic anhydride. Antonio Maria Costa, executive director of the UNODC, wrote in the report that there is "growing evidence" that "some anti-government elements in Afghanistan are turning into narco-cartels."

Still, officials said the Taliban is wary of compromising its Islamic ideology and placing in jeopardy funding sources from other Muslim countries by fully committing to the drug trade, Lemahieu said.

"Mullah [Mohammad] Omar is still the leader of the Taliban, and he is not a drug trafficker," Lemahieu said. "That ideological sharpness is so important for them. So you cannot compare them yet with the FARC," he said, referring to the Colombian guerrilla group heavily involved in cocaine trafficking.

The U.S. and British governments are rushing to develop programs before the planting season begins in October to encourage Afghan farmers to grow crops such as wheat and fruit instead of opium. The programs offer vouchers to buy cheap seeds and provide farm workers with infrastructure jobs. The U.N. report said a rural development program to employ farmers needs to be as ambitious as the military offensive.

"There is no need to bribe farmers to stay away from drugs: market forces are already doing this," the report said.

Jul 21, 2009

In One Afghan Province, Votes for President Could Turn on Loss of Poppy Income

By Pamela Constable
Washington Post Foreign Service
Tuesday, July 21, 2009

FAIZABAD, Afghanistan -- The economic fortunes of Badakhshan province, a remote and wildly beautiful corner of far northeastern Afghanistan, have risen and fallen over the past seven years with the production of opium poppies.

Not long ago, emerald fields with nodding pink poppy flowers were everywhere, and Badakhshan was one of the country's fastest-growing poppy producers. Today, its golden hills are dotted with freshly harvested wheat stacks, and its 95 percent drop in opium production last year has been hailed as a model by international anti-drug officials.

For many communities, however, the loss of poppy income has meant a return to desperate rural poverty. As national elections approach on Aug. 20, with President Hamid Karzai seeking reelection against a field of 40 challengers, the decision among Badakhshan's voters rests partly on whether they give his government and its international backers credit or blame for the end of the poppy boom.

"The authorities promised our people jobs and projects if they stopped growing poppy, but that never happened," said a teacher here in the provincial capital, who gave her name as Aria. "We know that opium is un-Islamic and makes people addicted, but what about the farmers and their families? When we grew poppy, the people were doing well. Now they are suffering."

Aria was one of several thousand people at a recent campaign rally for Karzai's most prominent challenger, former foreign minister Abdullah Abdullah. He spent a weekend this month barnstorming Badakhshan in a battered, Soviet-built military helicopter that crossed the snowcapped Hindu Kush mountains, swooped into narrow valleys and landed in wheat fields across the vertiginous province.

In speeches in village mosques, soccer stadiums and shady groves beside rushing mountain streams, Abdullah made vague promises to bring jobs, economic development and better government. But his major selling point was his role in Afghanistan's "holy war" against the Soviet Union during the 1980s, when he was an aide to the now-deceased mujaheddin leader Ahmed Shah Massoud.

"The people here know me, because I used to come on horseback and bring medical supplies in the early days of jihad," said Abdullah, 50, an ophthalmologist who graduated from medical school in Kabul in 1983 and became an adviser to Massoud two years later. Karzai named him foreign minister in 2002, but he was abruptly removed from the cabinet in 2006. Though fond of finely tailored Western suits during his run as foreign minister, Abdullah dresses in the locally popular salwar-kameez -- a tunic with baggy trousers -- when he is out on the campaign trail.

In each community where the green helicopter touched down -- it was provided by the central government in accord with official election policy -- crowds hoisted posters of Abdullah with Massoud, who was killed in 2001. His remarks included tributes to local martyred comrades and sentimental stories from the long-ago war, and he was constantly interrupted by impassioned shouts of "Long live jihad!" from men and boys in the crowd.

"We believe in jihad, and we do not want our Islamic values to be destroyed by the foreigners," said an elder named Rahim in the town of Jurm, who introduced the candidate and referred to his wool cap, traditionally worn by northern Islamic fighters. "As long as the pakul is on his head, he will follow the way of jihad and stand up for all the mujaheddin."

Yet despite their emotional identification with Abdullah, many people interviewed after or outside the rallies said they planned to vote for Karzai, who has ruled the country with strong international backing since early 2002. They said that the president has not visited their province in a long time but that he is a proven national leader with access to large amounts of foreign assistance.

"I would say 80 percent of the people in this district support Karzai," said Mohammed Issah, 36, a mullah in Baharak, a town surrounded by wheat fields and fruit orchards. "His government has brought us roads and security. Our people are living in harmony, and there is no more poppy, which we know is the enemy of our religion. It is our tradition to be hospitable to all guests, but that does not say how we will vote."

In Faizabad, a sleepy town that is largely inaccessible in winter, opinions were mixed. Some inhabitants bitterly blamed Karzai's government for the lack of economic development, noting that the local airstrip is still a Soviet-made metal platform, the main road is only now being paved and donkeys remain the principal form of transportation.

Several women here said that the state of provincial health care is a disgrace and that many pregnant patients die in childbirth because it is so difficult to reach hospitals. For years, according to U.N. reports, the levels of infant and maternal mortality in Badakhshan have been the highest in Afghanistan and on a par with those in many sub-Saharan African countries.

Other residents disputed the criticisms, saying that conditions have improved noticeably during the Karzai era and that international charities have been able to operate safely because the region is more secure than many other parts of the country.

"In the past, we had no roads or cars, and now we have a lot of them. In the past, we had a lot of poppy, and now it's gone," said Abdul Haq, 43, a shopkeeper who had pasted a campaign poster of Karzai to his wooden shutters. "We hear there is fighting in other places, but here we have 100 percent security. That is enough for me."

In some ways, Badakhshan's unusual geography has created a political anomaly. Its remoteness has made it both virtually impervious to the predations of Taliban insurgents based in the distant south and exceptionally devoted to its local leaders.

The governor, a Badakhshan tribal elder named Abdul Majid, has been credited with spearheading the anti-poppy drive by personally appealing to farmers across the province. The campaign in Badakhshan has proved more successful than in many other parts of Afghanistan, a country that produces more than 90 percent of the world's illicit opium.

Although Majid was appointed by Karzai, he has said he received little help from the central government in fighting drugs. Roadside signs in several towns touted the U.S. government's "alternative livelihoods" program for poppy farmers, but community elders complained that they had received scant assistance to develop legal crops.

"We have no work here, and all our young men go to Iran to find jobs," said Abdul Samad, an elder in Kesham district who hosted a picnic for Abdullah in a thriving grove of poplar, pear and pine trees. But Samad said that the grove had been funded by a Norwegian charity and that local farmers had neither the seeds nor the irrigation to replicate it. "We need a strong Muslim leader, a real mujahed, to bring us jobs and justice," he said.