Vietnam officials call community-based drug treatment a failure amid rising crime

Thanh Nien News

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A consultant at Ho Chi Minh City voluntary rehab talks to a patient. Photo credit: Tuoi Tre A consultant at Ho Chi Minh City voluntary rehab talks to a patient. Photo credit: Tuoi Tre


In the 15 months since Vietnam opened its first voluntary drug rehabilitation center, only six addicts have graduated from its three-month program; the other 75 percent dropped out.
Officials worry that community-based addiction solutions from methadone clinics to voluntary rehab have modest results at a time when drug-related crime is on the rise, Tuoi Tre (Youth) newspaper reported.
T.Q.T. is considered an outstanding graduate of the Drug Addiction Treatment and Consultancy Center offered by Ho Chi Minh City's social affairs department
After he finishes his three-month course, he says he plans to stay longer. 
“My mom gave me money to pay the center and asked me to spend more time here. It’s not too boring here so I will,” T. told Tuoi Tre.
He said many addicts have rated the center “5-star,” compared to other private programs and compulsory rehab centers.
“Medicine here doesn’t make you feel like maggots are crawling in your bones. And there’re TV, DVD players, karaoke, a billiard table and a gym.”
T. has been a drug-user for more than ten years and experienced all the nightmares of having to find money to feed his cravings.
The friend that introduced him to the center dropped out and lacks the money to join again, he said.
“I’ve been using for too long, now I want to properly quit. But I’m not sure that I won’t get addicted again after leaving here,” T. said.
He said many of his fellow addicts dropped out after smashing things and kicking doors. “They were very naughty,” he said.
Some later returned only to be turned away.
A guard at the center said most of the patients were forced into the programs by their families.
“We have to be prepared for vandals or escapees at night. But even if we catch them, we can only advise them instead of calling the police as this is a voluntary rehab center,” he said.
Le Van Quy, director of the center, said although the addicts pay to attend, he refuses those  who come back again and again.
“They aren't determined [to get clean], so it’s only a waste of money and effort,” he  said.
Quy said many ask to leave saying they miss their wives, their children, their parents, but in reality they miss their drugs.
“In many cases, we’re a hundred percent sure they will relapse, but there’s nothing we can do," he said. "I feel tormented.”
The center provides treatment regimens that range in length from 15 days to three months, but patients can stay longer if they wish.
Quy said nearly 60 percent of patients sign up for less than 15 days, which only gives an addict enough time to overcome physical cravings.
The center charges VND3.7 million (US$175) for up to 15 days course; VND5.34 million for one month and VND3.35 million the second month; VND4,9 million for the third month.
Quy said the tuition is softer than private rehab centers as it has been calculated to be as close to covering the cost of the program as possible.
Still, he noted, many addicts can't afford it.
One such person, H.M.T., keeps asking his mother to buy him wine to offset his cravings.
T. said he has failed several attempts to get clean on his own.
The 34-year-old went to rehab only to relapse. Now, he's out of money and his father is so fed up he doesn’t care.
HCMC officials expect things to get ugly as community rehab programs fail and new red tape has prevented them from sending criminal addicts to compulsory drug rehab centers.
The new Law on Handling Administrative Violations went into effect on January 1 without any decree or circular on its implementation, they complained. 
They themselves are not determined, so it’s only a waste of money and efforts” -- Le Van Quy, director of HCMC Voluntary Rehab Center, said of his addicted patients
The law maintains that repeat drug offenders must go through compulsory drug rehabilitation for one to two years if they relapse after completing community rehabilitation upon the first offense.
However, the law transfers the power to send them to compulsory rehab from local government to district-level courts and judges say they cannot implement the regulation without the proper government procedural guidance, which was only recently provided.
On the street level, cops have said that drug addicts now roam the streets with impunity, knowing that they cannot be sent to the prison-like rehabilitation centers that drew international criticism.
Do The Minh, head of the anti-crime division at the city’s social affairs department, said the complex regulations have prevented a single drug addict from being sent to compulsory rehab this year.
Minh said the centers currently hold 9,000 patients; around 4,000 of which are scheduled to be discharged by the end of the year.
Methadone opens a door, only too narrow
Families who cannot afford to send addicted relatives to voluntary rehab programs have put them on methadone.
Nguyen Van Khanh, 38, and his brother became heroin addicts in 2000.
According to Khanh the brothers shot their parents’ income up their arms and, eventually, pawned their motorbikes to pay for their habits.
Khanh's brother was sent to a compulsory rehab in 2001; he went the following year.
But they went right back to using after being discharged.
When the methadone program was launched in 2008, it really saved the family, he said.
Phuong, his mother, said the program was new, so she didn’t expect much. “But things changed. Khanh stopped using and started to work again.”
After six years of methadone treatment, Khanh now works a job that pays VND3.5 million a month.
Not many families enjoy such a second chance. The methadone programs that have been sponsored by international organizations in the city are all filled up with nearly 1,600 patients.
The city government plans to expand the treatment to around 8,000 patients by the end of 2015, following instructions from the central government and the health ministry.
The problem is, the expansion coincides with the end of international aid.
Starting next year, methadone users will have to pay around VND10,000 (around half a US dollar) for their doses, in addition to the cost of extra health examination fees. The city is still working on securing supplies for the expansion.
Dr Nguyen Van Hoi, head of the District 6 methadone center which treats more than 300 people, said the therapy has brought clear results--former addicts now work jobs and help their families.
But once they stop treatment, they can quickly start using heroin again, Hoi said.
It only takes some a day of skipping treatment to fall back into heroin use again, he said, noting that some can maintain for five or six days.
“Methadone is not a magic wand. Drug addiction is a mental disease and it only takes a small hit to knock the patients off track. They only need to argue with family members or feel a little disrespected to fall back into addiction,” the doctor told Tuoi Tre.
Dr Pham Van Tru, former deputy director of the Ho Chi Minh City Mental Health Hospital, said methadone is a heroin alternative and it ends up being just as addictive.
The advantage of methadone is that one can gradually reduce the dose to become less dependent, he said.
He said the medicine must be carefully administered based on each patient's circumstances, so the staff in charge of methadone programs must be strictly trained.
Voluntary is not an option
A drug addict arrested in Ho Chi Minh City after attacking his grandmother and younger siblings during a craving. Photo credit: Tuoi Tre

Nguyen Thanh Thai, former chairman of the HCMC government, said the new regulations encourage community-based voluntary rehabilitation for humanitarian purposes, but Vietnam cannot afford to be so kind.
“It’s not acceptable to depend largely on community-based voluntary rehabilitation, especially when the related laws, staff and facilities aren't ready,” Tai told Tuoi Tre.
“In an environment when one can buy drugs easily, it’s hard to talk about community-based voluntary rehabilitation.”
Tai said most drug addicts in the country are young and 80 percent of them are poorly educated (if not illiterate) and unemployed.
He said crime has been on the rise, in a way that's reminiscent of the days before 2001, when the city had more than 30,000 drug addicts and 70 percent of crime was tied back to drugs.
Compulsory rehab fixed the situation then, dropping crime significantly, he said.
“There’ve been opinions that compulsory rehabilitation is a violation of human rights. But it only isolates addicts from the environment where they can use drugs, and not the community as a whole. Their families and friends can still visit them often.”

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