Irwin Loy
PHNOM PENH, Sep 16 2010 (IPS) – Twenty-nine-year-old Ramy shuddered as he described the years he has spent addicted to heroin. Lying to his family, stealing from friends to scrape together the money to feed his addiction until a few months ago, that was the life he led.
A drug user comes for his methadone dose, hopefully on the way out of the drug habit. Credit: Irwin Loy/IPS
But after joining Cambodia s first methadone maintenance treatment (MMT) programme in July, Ramy said his life has already turned around.
The first week when I started, I would inject four or five times in a day, said Ramy, who asked that his full name not be used. And after that, I injected just once in a day. After a week, I stopped injecting.
Now, Ramy said, he is able to work full-time at his family s business. My family trusts me now, he said.
Every morning, Ramy and 60 other drug users come to a small clinic at a hospital in Phnom Penh, the Cambodian capital. He speaks to a counsellor who asks him questions about his health. Then he picks up his dose of methadone from staff stationed behind a glassed-in dispensary, heads to a private room and ingests his medicine .
While methadone programmes have been operational around the world for decades, the one Ramy goes to a year-long pilot project officially launched this week is the first of its kind in Cambodia.
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Advocates say that prescribing methadone a synthetic opioid as a substitute for heroin allows participants to stabilise their lives by eliminating the need to find money for drugs. They add that coupled with supports like transitional housing and job training, MMT can enable drug users to reform their lives.
The methadone programme is also the first government-run drug treatment scheme part of a plan that experts hope will be a turning point for drug policy in this South-east Asian country, where there are an estimated tens of thousands of metamphetamine users.
Rights advocates claim drug users are routinely rounded up, detained and abused in a series of detention centres around the country. A January report from Human Rights Watch reported that many drug users were subject to rampant and at times sadistic violence in many of the centres; authorities have rejected all claims of abuse.
The methadone programme, then, represents a small step away from the detention centre model, according to one of the scheme s architects.
The compulsory drug detention centres do not provide any evidence-based or health rehabilitation activities, said Graham Shaw, technical adviser on drug use with the World Health Organisation (WHO), who designed the MMT programme.
And so this methadone clinic is completely the opposite. It s based on 40 plus years of evidence as to what does work, he added.
Chhit Sophal, who is in charge of the programme as head of the Ministry of Health s Centre for Mental Health and Drug Dependence, said the country has long lacked professional treatment options to counter addiction.
I think the options for drug treatment are very limited in Cambodia, he said. We have some NGOs providing drug interventions for them. But we don t have any professional skills yet. But now, it seems the Ministry of Health is starting to take a firm position and to lead in this area and to build up the capacity among our medical staff.
Cambodian society as a whole also needs to overcome its traditionally harsh views of drug users, he said.
For Cambodian people, we don t like people using drugs. This is the tradition. So they consider them to be like bad children, like outcasts. This is what (drug users) face, Chhit said.
But even though some advocates here say they are optimistic about progress in developing treatment, the more than 100 people expected to take part in the methadone pilot over the next year are a tiny drop compared to the scale of the problem.
For heroin use, we estimate there are probably 3,000 (drug users) nationally, said the WHO s Shaw. But for methamphetamine use, we re probably looking at 30,000 to 40,000 at least; probably even more than that. So it s a much more significant problem.
The government and the WHO have pledged to work together to roll out what is hoped will be a nationwide treatment programme to address the larger problem. But in the meantime, the majority of the detention centres singled out by the Human Rights Watch report remains open.
