Ineffective rehab programs see relapses in most people treated for drug addiction
A man stands next to a poster warning that drug using is leading to HIV affection at the venue of a meeting on World's AIDS Day in Hanoi. Drug users have increased in Vietnam recently while rehabilitation efforts have proved ineffective. PHOTO: AFP
Do not walk Ho Chi Minh City's bridges barefoot, or even in sandals. Used needles are everywhere.
A Vietweek reporter recently observed two men shooting up on the Cha Va Bridge (which connects districts 5 and 8) in two separate incidents in a short period of time.
One was a young man who walked along the bridge and put the needle in his arm for all to see. Another was a slightly older man who pulled his motorbike over to the side of the road and then shot up on the stairs out of view of traffic. Both men threw their bloody syringes on the ground after using them.
Drug addicts have long gotten high on bridges in HCMC because it is one of the few places in the crowded city – including their own homes where they are often watched by family members – they can shoot up away from the prying eyes of neighbors, family and local residents. Those who might catch a glimpse of them on the bridge are often driving by too fast to notice or do anything.
The more rampant use of drugs on HCMC bridges appears to be reflecting an increase of drug users nationwide. According to the government website, Vietnam had more than 171,000 drug users by the end of 2012, an increase of 12,900 over 2011. Experts say that one main cause is that rehabilitation centers are failing and most of their patients are relapsing.
Bridges to Babylon
Intravenous drug use, mostly heroin, is very common on several footbridges that cross Vo Van Kiet Street in District 5.
When a Vietweek reporter visited footbridge No. 6, a frightened man who was using the stairs warned: “Don’t go there, drug addicts just threatened me.”
The footbridge across Binh Thanh District’s No Trang Long Street near the Tumor Hospital is also a common place for drug users any time of day.
According to a 2010 decree on administrative fines against violations of public security and order, drug use is subjected to fines from VND500,000-VND1 million (US$23.5-47).
Repeat violations, after compulsory rehabilitation, are subjected to jail terms of between three months and two years.
However, many residents said current police efforts are not nearly enough and are in fact barely a deterrent at all.
A resident near the Nguyen Huu Canh Overpass in Binh Thanh District who wanted to be identified only as M. said he has never seen any guards or police confront drug users there.
“Local police just walk by without finding the drug users hiding in the small park under the bridge,” he said.
In the first half of this year, HCMC police arrested 1,519 people involved in drug crimes. A majority of the cases involved drug smuggling while the rest involved organized drug use. Nationwide, there were more than 14,300 people arrested for drug crimes during the period.
The Ministry of Public Security said Vietnam arrested 14,178 people for drug crimes in the first half of this year, up 22.3 percent from a year earlier. The amount of heroin seized by the police in the January to June period totaled 238.8 kilograms, more than double from the same period last year.
According to the Ministry of Labor, War Invalids and Social Affairs, an average of between 75-90 percent of drug addicts treated nationwide have relapsed after rehabilitation. Dien Bien Province has seen up to 97 percent of its rehabilitated drug users return to a life of substance abuse.
In HCMC, more than 2,100 drug users have been sent to compulsory rehab centers in the first half of this year, increasing the total number of people at drug rehab centers to more than 9,000 people.
Nguyen Thi Diep, a daily wage worker at HCMC’s Hoc Mon District said both her two sons died of AIDS they acquired by sharing needles.
“My second son died less than a month after being discharged from the rehab center. He had been discharged earlier in healthy conditions,” she said.
“But he relapsed then and died on the street. He did not tell me but subsequent tests showed he was positive for AIDS,” she said, adding that her daughter-in-law is also a drug user.
Nguyen Minh Quan, another drug user who has been using drugs for five years, said virtually all drug users think they will use drugs again sooner or later after rehabilitation.
“Very few people have quit for long. If they can find a stable job and their family shares their burden, they could forget drugs. But if they suffer some shocking event, they can return to drugs again for relief.
“For example, when their wife leaves them, they can relapse. And if they are infected with HIV/AIDS, they want to indulge in drugs for the rest of their lives without any intention of quitting,” he told Vietweek.
According to Vo Xuan Huy of the Hospital for Tropical Diseases in HCMC, virtually all drug users relapse. If official figures do not reflect that, he said, the numbers are not being correctly reported.
A hard pill to swallow
In a bid to find an alternative to its controversial compulsory treatment centers, Vietnam has since 2008 opened 62 methadone clinics for heroin addicts.
Methadone, a substitution therapy used to treat opioid dependence, helps assuage withdrawal symptoms for heroin addiction and prevent the spread of HIV among injecting drug users.
14,000 drug users have got benefit from methadone treatment program in the last five years, Viet Nam News said last month, citing the Ministry of Health.
However, the figure was quite modest when the program targets treating 80,000 addicts in 30 provinces by 2015, the English daily said.
Meanwhile, a doctor at a methadone center in Hai Phong City who asked to remain anonymous said methadone therapy has been ineffective for many drug users.
“They stealthily spit out the pill after taking it,” he said.
Nguyen Trong An, a senior official at the social affairs ministry, said it was a strange situation.
“Methadone therapy has been carried out for a long time ago abroad. But the history and culture of other countries are different from ours,” he told Vietweek.
“For example in the Netherlands and Germany, it’s no big deal for a drug user to take methadone voluntarily. However, in our country, some places even stipulate that the people taking methadone have to say ‘ahhhhh’ or speak out loud to say good-bye to doctor or medical worker,” he said.
“It sounds really strange at first sight but the measure is to make sure they swallow the pill.”
Evading the law
From a law enforcement perspective, Nguyen Ngoc Tinh, a drug crime police officer in HCMC, said the increase of drug use is partly because of the lax surveillance of drug smuggling.
“Most drug smugglers and gang kingpins are criminals who have already served several jail terms and they are very cunning in coping with anti-drug agencies. It’s very difficult to bust a ring and takes a long time tracking them in interprovincial missions.
“It’s also difficult to bust the smuggling of drugs on buses from the north. And when we discover cases, we can’t arrest the gang’s mastermind. We have mostly arrested only the ones who directly smuggle drugs and those to whom they intended to deliver the consignment,” he told Vietweek.
Vietnam’s drug laws are among the toughest in the world. Under its penal code, anyone convicted of trafficking, illegally producing or transporting 100 grams or more of heroin or cocaine can be sentenced to death.
Despite the tough punishment, the Ministry of Public Security said earlier this year that the situation of drug crime in Vietnam is getting more “complicated,” partly due to the expansion of drug trafficking rings that smuggle drugs from Africa, the Middle East and Central Asia into Southeast Asian countries.
Asked about long-term measures to deal with drug use in Vietnam, Nguyen Van Minh, deputy director of the HCMC social affairs department, said rehab activities at both official rehabilitation centers and with local communities should be improved.
“But the family has to play the main role in preventing their children from relapsing after rehab. Many families don’t care about their addicted children, including how effective they are rehabilitated,” he said.
“How can these people find a job and who can they make friends with?”
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By Khanh An – Nhu Lich – Le Thanh, Thanh Nien News (The story can be found in the October 4th issue of our print edition Vietweek)