Experts call for more community-based drug treatment

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Users sentenced to a rehab center in Ba Ria-Vung Tau abuse drugs regularly

Drug addicts in the central city of Da Nang are esscorted back to their rehab center after 164 of them escaped on February 19.

Drug addicts sentenced to compulsory rehabilitation often continue using drugs, according to experts who say that a more local approach to the problem is needed.

Police in the southern coastal province of Ba Ria-Vung Tau are investigating Nguyen Hoang Son, 26, who is being treated for drug addiction at the provincial Education - Working - Vocational Training Center. Son, who was sentenced to compulsory rehab at the center for drug crimes, has since been accused of processing drugs at the center.

Son, who was admitted to the center on June 29, was found on July 1 using drugs with 21 other patients. He confessed to having taken drugs at the center, though he said they didn't work.

Son was not the first or last patient to have been caught taking drugs at the center. On June 25, Tran Van Doi was allowed to leave the facility for his relative's funeral and was caught bringing heroin into the center when he returned.

Last December, Vu Ngoc Khai, a security guard at the center, was caught red handed taking drugs hidden in an eye-drop bottle for patient Pham Khac Hoang, who later used it with four other patients. Hoang confessed that he had asked his wife to give Khai the drugs three times in total, according to police. Khai was fired for the act.

According to the Ba Ria-Vung Tau provincial labor department, the center also wrongfully discharged 88 patients between 2009 and 2010.

Nguyen Dinh Them, the center's deputy director, said he was aware of rumors that patients could bribe the center [officials] for between VND10 million (US$480) and VND30 million to be released early. However, he said hard evidence of such a case has yet to be detected.

The violations and rumors at the Ba Ria-Vung Tau center has prompted concerns over whether compulsory drug rehabilitation is capable of helping to effectively reduce relapse rates and drug crimes and help drug users live normal lives after treatment.

According to a 2004 decree on compulsory treatment for drug users, drug users 18 years old and above are admitted to centers for between one and two years of compulsory rehabilitation if they abuse drugs after being fined by local authorities, or after undergoing home-based rehab programs. The decree also stipulates that all homeless people caught using drugs would be put in compulsory rehab centers. 

A new decree taking effect Thursday (September 8) added that all foreigners, women of more than 55 years old and men of more than 60 years old would not be given compulsory rehab terms.

Rehabilitated drug users are monitored by local authorities for between one and two years after their release, which is referred to as "post detoxification management," but experts say there is no system able to completely eliminate drug use or relapse. They argue that compulsory rehabilitation isn't the best way to mitigate drug abuse problems and call for a more community-based approach to the issue.

Theodore Hammett, Chief of Party at USAID's Health Policy Initiative Vietnam, said compulsory treatment centers are counterproductive for several reasons.

"Most importantly, they cost a lot of money and they don't work- relapse rates for people released to the community are 80-90 percent and returnees are not generally able to find viable employment," Hammett told Thanh Nien Weekly.

"The "˜vocational training' provided in the centers does not prepare residents for well-paying jobs and they still face heavy discrimination in employment," he said.

Nguyen Dinh Hoa, director of Drug Rehabilitation Center No. 2 in Hai Phong City's Tien Lang District, said the center had to grow its own food for more than 800 patients.

The municipal authorities provide each patient with between VND240,000 ($11.5) and VND290,000 for meals each month.

But it's not enough, Hoa told the Dan Viet (Viet People) newspaper. "If we don't work, we'll starve."

Hoa also said that at least 80 percent of all patients relapse and many patients return to the center shortly after being discharged.

The northern port city of Hai Phong has 5,416 drug users and another 2,723 others suspected of using drugs, one of the highest rates among out of 63 cities and provinces nationwide.

Although Vietnam's officially stated relapse rate has decreased since 2000, it is still at 75 percent. Globally, most estimates put the relapse rate at greater than 90 percent, according to the Assessment of Compulsory Treatment of People Who Use Drugs in Cambodia, China, Malaysia and Vietnam conducted by the World Health Organization in 2009.

Nguyen Duc Phan, director of the Hai Phong Anti-Social Evils Agency, said more than 98 percent of drug users don't have a permanent job.

"Rehab centers often teach patients to grow mushrooms or raise animals, which are not skills that help them find jobs easily," he said.

An international expert with 36 years experience working in alcohol and drug treatment, who wished to remain anonymous, said compulsory treatment centers could cause unexpected "side effects".

"Non-dependent drug users mingle with dependent drug users in the centers and learn more about substance use"¦ Consequently there is a risk of greater experimentation with drugs when the person leaves the center," he told Thanh Nien Weekly.

He also said that admitting drug users to centers would spoil their productivity and increase stigma from society.

"There is also a loss of contact with the family as well as the loss of social support and the consequent distress this causes to the family is substantial. Young people detained for long periods of time in the centers are at the peak of their potential productivity in terms of education or employment productivity."

"Several people have expressed the view that the centers further stigmatized drug use which pushes it further underground and runs the risk of increasing harms associated with drug use including the spread of HIV," he said. "So they do not appear to either deter people from using drugs, provide a therapeutic response or reduce the harm associated with drug use."

USAID's Hammett urged for further use of methadone as a better way to treat drug users than compulsory treatment centers.

"Research from around the world demonstrates that methadone maintenance treatment (MMT) is effective in helping opiate addicts reduce their craving for drugs, reduce or cease drug injection, reduce criminal activity, stabilize their lives, re-establish family ties that might have been broken, and avoid acquiring or transmitting HIV infection," he said.

"Although MMT does not work for everyone, it does represent a much more cost-effective alternative to compulsory center-based detoxification and labor," he said, adding that Vietnam already plans to scale up MMT dramatically in the next 5 years.

In February, 164 drug addicts overpowered guards and escaped from a detention and rehabilitation center in the central city of Da Nang.

One of the escapees told Dan Viet that he just wanted to be free.


The United Nations has called for alternatives to compulsory rehabilitation centers for people who use drugs in Vietnam, saying these centers "do not provide either effective treatment or rehabilitation."

In a statement released on Tuesday (September 6), the UN Country Team (UNCT) in Vietnam said it has specific concerns about the compulsory detention of sex workers and/or people who use drugs.

"There is a lack of evidence globally to demonstrate the effectiveness of compulsory detention in reducing relapse rates amongst detained people who use drugs following their release. On the contrary relapse rates in Vietnam amongst former 06 Center [for drug users] detainees are repeatedly reported to be very high with a majority of detainees having been detained at least once before," the statement said.

The UN said there are viable alternatives to compulsory detention for people who use drugs which are far more cost effective in their prevention, treatment and rehabilitation goals and which also facilitate access to other relevant HIV and drug treatment services.

"The UNCT emphasizes that, as in the case with any other medical procedure, drug dependence treatment, be it psychosocial or pharmacological, should not be forced onto patients. Moreover, in the case of minors, therapeutic and rehabilitative services should be specifically tailored for children and young people as a child welfare and protection measure," it said.

In the statement, the UN pledged to continue to support the Vietnamese government in developing and expanding voluntary community-based drug dependence treatment services.

"The success of the pilot methadone maintenance treatment (MMT) clinics in Vietnam is recognized globally and the [UN] applauds the [Vietnamese] government for its commitment to scale-up MMT service provision in the community," it said.

Vietnam aims to reduce the number of drug addicts nationwide by around a third by 2020 and improve rehabilitation services, the government said in a statement in June.

Vietnamese Foreign Ministry spokeswoman Nguyen Phuong Nga said compulsory drug rehabilitation in Vietnam is humane, effective and beneficial for drug users, their communities and society, AP reported on August 7.

 "Vietnam's drug rehabilitation centers comply with Vietnamese law and are in line with drug-treatment principles set by the US, the UN and the World Health Organization," Nga added.

On the same day, AFP quoted Nga as saying that "compulsory detoxification is a humane measure that supports and helps the addicts."

By late 2010, the country had a total of more than 170,000 drug users of which 70 percent were young people, according to statistics compiled by the National Committee for HIV/AIDS, Drug and Prostitution Prevention and Control. The official number of drug users as of late 2009 was 146,730.

A conference held by the committee early this year reported that drug users were to be found in all 63 provinces and cities. Ninety percent of districts and 56.5 percent of communes nationwide were home to drug addicts, according to media reports.

The new strategy aims to detect all drug users and provide 90 percent of them with access to rehabilitation services and vocational training centers. It also aims to reduce the percentage of relapsed drug users by 10-15 percent.

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