Compulsory detention for drug use undermines treatment in Laos

Laos - located between thriving opium and methamphetamine producers in Myanmar and a reported consumer base of more than two million drug users in China - has sought to limit the impact of drug transit, use and production on its population. But the government's policies, which harshly penalize drug use, are hampering efforts to treat addiction, say health researchers.

"People who use drugs are treated first and primarily as criminals, with their health needs often not properly addressed with evidence-based interventions," said Robert Gray, a technical expert on harm reduction for Population Services International (PSI), a nonprofit global health organization headquartered in Washington, DC.

Other countries in the region have begun moving away from compulsory detention for drug users, following advocacy from rights groups and reports of abuses committed in drug detention centres.

But Lao's eight treatment-and-detention centres still operate based on a 2008 drug law that authorizes involuntary detention for drug users, who are effectively treated as criminals. As required by law, all the country's drug treatment centres are government-run.

"Drug addicts cause trouble, discord, and loss of family and lineage reputation, destruction of health, lives and property in the family," says Article 13 of the law, which stipulates that members of society - especially family members - have a responsibility to identify and report drug-related activity and to "provide cooperation" in the treatment of drug users.

While only two percent of an estimated 60,000 people using drugs are in these facilities, according to 2013 government data cited in state-run media, such centres are the only places users can receive treatment. Activists and health workers are calling for more transparency into government efforts to treat users, science-based therapies that recognizes drug addiction as a disease and harm reduction initiatives to prevent the spread of HIV/AIDs among drug users.

Closed doors

According to the UN Office on Drugs and Crime (UNODC), Laos's detention centres for drug users have improved since 2011, when human rights abuses such as beatings and rape were documented by Human Rights Watch (HRW) and by the Open Society Foundations (OSF), a New York-based research network.

But it remains difficult to obtain detailed, accurate information about the estimated 1,200 people in detention nationwide for suspected drug use.

"There was always a narrative of reform around Somsanga, [where the government said] it had improved. But it is a narrative of reform without evidence behind it," said Joe Amon, HRW director of health and human rights and co-author of the 2011 report on Somsanga centre, the government's largest programme for suspected drug users.

The Lao National Commission for Drug Control and Supervision (LCDC) did not respond to requests for comment, and two security officers at the Somsanga centre blocked IRIN's approach with shouting and gestures to leave the premise.

From 100m outside the facility, which is comprised of five buildings, hundreds of patients could be seen crowded together in closed cells, enclosed by chain-link fences.

When asked to comment on updates to the country's drug treatment programmes, Vanphanom Sychareun of the University of Health Sciences in Vientiane, who has studied the country's treatment efforts, told IRIN it was "difficult to answer as these questions are too sensitive in Laos".

While according to the government's drug law, "drug addicts are considered as victims who need to be treated" the detention centres are not operated by health authorities but by LCDC, under the Ministry of Defence, and users are still regarded as criminals.

Penalties

Those suspected of drug use are subject to detention for three months; any relapse after release can mean up to one year of detention and fines of up to US$38 - more than half of the minimum monthly wage of $72, according to the World Bank.

From 2003 to 2010, anywhere from 1,100 to 2,600 people were detained annually on drug charges, according to HRW. OSF estimated 70 percent of them continued to use after completing the government's rehabilitation programme.

"In my village, there were two opium users. The police took them away," said Soulivong Laujtub, 24, from a small town in northern Luang Prabang Province, who was reluctant to share additional information.

Although the government's National Drug Control Master Plan, which is effective through 2013, pledges "improving treatment quality and building the capacity of medical and mental health services to respond to drug problems," Sychareun's 2012 research detailed a lack of harm-reduction programming in the country. UNODC has noted the nationwide absence of pharmacological therapies for drug addiction.

"We need to help local and national-level authorities - especially law enforcement agencies - to develop a more accurate understanding of what drug dependence really is and how it is linked to things like the risk of contracting HIV/AIDS," said Juana Tomás-Rosselló, a medical doctor and project coordinator with UNODC in the Asia-Pacific, who is based in Bangkok.

Sticking to science

Laos has a low HIV prevalence nationwide - 0.2 percent among people aged 15-49 - but the threat of infection is significantly higher among drug users, and it is growing.

"The countries that have been the most successful at controlling the HIV epidemic [among drug users] are those that treat users humanely, offering them evidence-based harm reduction and treatment services," said PSI's Gray.

In neighbouring Vietnam, harm reduction initiatives have successfully reduced the rate of new HIV/AIDs infections among key populations, according to the International HIV/AIDs Alliance, an international partnership of 41 organizations working on AIDS issues worldwide.

According to Vietnam's government, HIV rates have dropped among drug users mainly due to harm reduction programmes. In 2011, HIV prevalence among people who inject drugs was 13 percent, down from 30 percent a decade before.

Penalizing addicts , as the current law does in Laos, "creates a huge challenge for those interested in improving health outcomes among this already highly stigmatized group," said Gray.

"It is a simplistic and dangerous mode of thinking about drug dependence," said Amon.

"We need to remember that drug dependence is a chronic relapsing health condition. It needs to be treated just like any other disease - such as hypertension or diabetes," added Tomás-Rosselló.