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A man uses a syringe to inject drugs into his veins in Phnom Penh this week.
A man uses a syringe to inject drugs into his veins in Phnom Penh this week. Heng Chivoan

Hidden victims of war on drugs

Cambodia's war on drugs is in full swing, routinely grabbing headlines as ever-growing numbers of suspects – more than 4,000 so far, most of them users – swell the Kingdom’s jails.

But behind the high-profile raids, the campaign is having an alarming, albeit hidden, side effect, observers say: With the crackdown multiplying risks for drug users, many are shunning health and substitution therapy services offered by NGOs and clinics, thereby increasing the likelihood they will overdose or contract and transmit HIV, AIDS, and tuberculosis.

Data collected by the Khmer HIV/AIDS NGO Alliance (KHANA), a national NGO specialising in HIV prevention, shows that during the first month of Cambodia’s drug crackdown, the organisation saw a 15 percent reduction in the number of drug users receiving “harm reduction” services across the board, from 425 people to 359.

These services include needle exchanges, condom and hygiene product distribution, counselling, access to antiretroviral treatment, and HIV education sessions. KHANA also provides transportation for recovering drug addicts to receive methadone maintenance treatment (MMT) at Phnom Penh’s Khmer-Soviet Friendship Hospital.

Individual KHANA programs have been even harder hit than a 15 percent total drop would suggest. Participation in its needle-exchange program, for instance, decreased from 138 people to 75 – a 46 percent drop.

“The reason we supply them with needles is because if we are not supplying them, they continue to share needles,” explained KHANA’s executive director Chob Sok Chamreun. “They inject every day, so to ensure they have enough, we supply them.”

KHANA supplies needles at 11 locations, three times a week. However, since the crackdown began, many drug users fear being stopped by police while carrying evidence of their drug use.

Within a month of the crackdown’s initiation in January, 21 out of 112 individuals receiving help from KHANA to access MMT stopped reporting for their treatments. Sok Chamreun believes they stopped coming “because they feared that police would follow them”.

Still, Sok Chamreun cannot be sure if the 21 people stopped MMT because they feared arrest or because they were actually arrested. “We don’t know where they are; we could not find them,” he said.

“If those people lost daily doses, it means that they go back to injection and can have very bad withdrawal.”

To deal with withdrawal symptoms, he adds, some may ultimately overdose, “and an overdose can kill them if they do not have Naloxone”, an antidote for opioid overdoses.

Sok Chamreun is particularly concerned about his organisation’s clients who suffer from tuberculosis (TB) and HIV co-infection.

“If those people have TB and stop treatment, that will lead to drug resistance” he said. “They have to take medicine for six months, but let’s say within that period, they just start with one month and they stop receiving it – this could lead to drug resistance, and it could weaken the health.”

KHANA is still collecting data on the number of its TB-affected clients who have stopped receiving treatment. “We don’t know who is lost,” Sok Chamreun said. “We still want to see if these people are arrested or if they have gone somewhere [else].”

In separate interviews this week, two drug users, speaking on condition of anonymity, confirmed Sok Chamreun’s concerns about the crackdown dissuading addicts from seeking treatment, while voicing a general sense of hopelessness about their condition.

“Now I don’t care about any treatment. I live day-to-day with this,” said one 32-year-old woman who, in addition to being addicted to heroin, suffers from HIV. “The drug campaign has not changed my life because I’m still addicted to drugs,” she said.

“I don’t want to abandon it because it is difficult to stop; every day since the campaign, I always find a quiet place to inject, to escape from the police.”

After the crackdown began, the woman spent one week in the Prey Speu detention centre after being caught in a drug raid. “Sometimes I want to die,” she said, “but I still make an effort to live with this problem.”

One 28-year-old man said that since the crackdown began in January, he has contended with two fears at once: arrest and heroin withdrawal. “Every day since the beginning of the drug campaign I am afraid of arrest,” he said, “and when I see someone new, I always escape.”

Last month, the man who is also HIV-positive was arrested and sent to the notorious Orgkas Khnom involuntary rehabilitation centre, where he remained for a week without access to heroin.

Despite fearing arrest, the man said that when it came to his addiction he “could not come back”. “I have been addicted for 10 years,” he said, “and if I don’t use each day, I get sick.”

The man said that he once underwent MMT, but is now “too lazy to take the medicine”. Instead of making a trip to the clinic, he said he continued to “buy needles or borrow someone’s to use”.

Another reason providing essential health, hygiene, and addiction recovery treatment services for drug users has become exceedingly difficult during the crackdown has to do with the sudden mobility of drug traffickers.

“What you generally have is dealers being quite static, in places where they can be reached easily,” says David Harding, an independent drug expert with a decade of experience in Cambodia. To avoid heightened police attention, however, “they move to less accessible places, they stay shorter periods of time”.

Making drug users, particularly heroin addicts, “hunt for their drugs makes life particularly difficult”, and risks causing potentially dangerous variations in dosage and quality, says Harding.

Tik Vuthy, a field officer for Korsang an NGO that provides HIV testing, needle exchange and counselling to drug users said on Wednesday that his daily experiences reflect this analysis.

“[Drug users] move around a lot more, they follow the dealers,” Vuthy said. “By the time we find out where they are, we’ve missed them.”

As they move, he continued, the drug users find themselves further away from the services they need. “We are trying to persuade them to receive methadone,” Vuthy said. “[To receive methadone] they must go to the clinic; we can’t take the methadone to them.”

For those drug users migrating to increasingly remote parts of Phnom Penh to buy drugs, going to receive methadone treatment can appear too costly.

“There’s a lot of dropping out [of treatment],” said Vuthy.

Multiple calls to the Interior Ministry and the National Police seeking comment for this story were not returned.

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