Plan awaits official approval, but logistical questions remain
PLANS are in place to launch Cambodia’s first methadone programme for heroin users, officials said, a move some observers pointed to as evidence that the government is serious about developing alternatives to controversial drug rehabilitation centres.
Approval of the implementation plan could come this month and possibly as early as this week, officials said. That would mean the long-delayed pilot programme, which would provide heroin addicts with the only government-run alternative to the rehabilitation centres, could begin in late April.
If approved, the programme would constitute “a major step forward” for the government’s approach to drug users and a potential shift from the existing network of “labour camps”, said Graham Shaw, technical adviser on drug use with the World Health Organisation.
“It does indicate that the government is looking far more seriously at evidence-based approaches to treatment,” said Shaw, who drafted the proposal. “They are willing to look more seriously at what really does work, as opposed to the punitive approach” of the rehabilitation centres.
The government has come under fire over allegations – denied by authorities – that drug users sent to the rehabilitation centres are subject to abuse and forced confinement while being given ineffective treatment.
Methadone maintenance therapy (MMT) replaces heroin with controlled doses of methadone, a synthetic opioid that has similar effects. Advocates say MMT allows drug users to stabilise their lives.
The one-year pilot programme would be run by the Ministry of Health, with funding and support from donors and NGOs.
The implementation plan is now awaiting formal approval from the Ministry of Health and the National Authority for Combating Drugs (NACD).
Meas Virith, deputy secretary general of the NACD, said the anti-drugs bureau is preparing to sign off on the methadone project sometime this month.
“Heroin users face health problems and have no time to work because they use drugs many times a day,” he said. “If they use methadone only once a day, they can go to work.”
If the programme proves successful, authorities envision expanding it to other provinces where heroin use is prevalent, he said.
However, questions remain over the logistics of starting a methadone programme from scratch.
A late April start date would demand extensive preparation in a short amount of time. Though some of the work is nearly complete – the
renovation of a clinic at Phnom Penh’s Cambodian-Russian Friendship Hospital and the importation of methadone, for example – other crucial measures are not yet in place.
Uncertainty lingers over the availability of job training and housing for programme participants. Both are viewed as key resources that help drug users reintegrate and cope with addiction triggers.
“There are very few organisations that can provide services like accommodation and vocational skills training. This is the one major area that needs to be developed,” said David Harding, coordinator for drugs programmes at Friends International, which has been involved in planning the programme.
The pilot calls for a staff of more than 20 doctors, pharmacists, nurses, case managers and counsellors. Shaw said that employees have been “identified” within the Ministry of Health, but that extensive training is required to educate them to minimum standards.
The persistent questions surrounding salary supplements for civil servants also pose a challenge. The government told donors last year that it would reform a system that had seen donors topping up the salaries of some civil servants.
Both the WHO and AusAID, the development arm of the Australian government, which is contributing some funding to the US$350,000 pilot, have halted supplement payments, affecting plans for how staff members at the methadone clinic will be paid, Shaw said.
“Methadone is a restricted medication, and we don’t want it to be sold on the black market by anybody. You also have to be very careful with the dosing, otherwise you could in theory kill somebody,” Shaw said.
“It’s very important for these people to focus on their jobs. So if that means we cannot pay a salary supplement, we need to find other ways of ensuring these staff are supported.”
The pilot programme will be designed to reach 100 of an estimated total of at least 2,000 injection drug users in its first year, Shaw said.
Drug users currently have no government-led alternatives to rehabiliation centres. UN agencies are still in the process of drafting a proposal for a community-based treatment model. A local NGO’s licence to distribute clean needles has gone unrenewed since January, alarming advocates who fear a rise in HIV transmission rates among injection users.