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Officials endorse methadone plan

DRUG and health officials have approved a plan to begin Cambodia’s first methadone treatment programme for drug users, meaning the long-delayed pilot could begin within months.

Officials with the National Authority for Combating Drugs (NACD) and the Ministry of Health on Wednesday endorsed the pilot programme for methadone maintenance therapy (MMT). The move could be the final bureaucratic hurdle in getting the project off the ground after lengthy delays that had frustrated those who work with drug users.

“People who are dependent on drugs need access to evidence-informed health interventions in their communities,” said Eng Huot, a secretary of state at the Ministry of Health.

The pilot programme will be the first state-run alternative to compulsory drug centres, which critics say are little more than “boot camps” that subject detainees to violent abuse.

Advocates say MMT allows people who are addicted to heroin to stabilise their lives. The treatment itself is not aimed at ending addiction; rather, it replaces heroin with controlled doses of methadone, a synthetic opioid that has similar effects.

PEOPLE WILL NOT BE CURED. BUT PEOPLE WILL STABILISE THEIR LIVES.

For a country in which compulsory treatment has been the only option for drug users, the notion of maintaining addiction can be controversial, said one NACD official, who cautioned that it will take time for some to become comfortable with the idea.
“Many people think that when people take methadone, they may stop using drugs,” said Thong Sokunthea, the director of the NACD’s research and control department. “In reality, they don’t stop.… People will not be cured. But people will stabilise their lives.”

MMT is also a key tool to reduce the transmission of HIV among drug users, he said.

“If methadone is effective as other countries have shown, we expect that the methadone programme will be very beneficial to people in Cambodia.”

The one-year, US$350,000 pilot will be funded by donors and run by the Health Ministry, using a clinic based in the Cambodian-Russian Friendship Hospital. The pilot is expected to treat 100 people over the course of the year.

However, two types of resources must be available if the programme is to be a success, said Graham Shaw, the technical adviser on drug use with the World Health Organisation, who designed the pilot.

The plan calls for a staff of more than 20 doctors, pharmacists, nurses, case managers and counsellors. They will have to be trained in an intensive six-week course, Shaw said.

And the availability of follow-up supports already in short supply in the Kingdom – rehabilitation, vocational training, counselling and job placements – will be critical.

“They’re vital. Without them the medical part of it will fail,” Shaw said. “If drug users go back to environments and friends who keep on using heroin or opium, then almost certainly these people will relapse. That’s been found all over the world.”

Shaw said such supports will be available at first for roughly 50 people, necessitating a cautious start to the programme, which could begin in two months at the earliest.

Shaw said he is hopeful the introduction of MMT signifies a shift away from the government’s existing compulsory treatment model.

Methadone elsewhere
In neighbouring countries, drug experts say, methadone has been implemented with promising signs of its efficacy. In Malaysia, the number of people detained in compulsory treatment centres dropped as MMT was scaled up, said Simon Baldwin, the senior technical officer on HIV and drugs for the NGO Family Health International.

In Ho Chi Minh City, where more than 1,000 people are enrolled, MMT has allowed drug users to find jobs and live normal lives, he said.
“Methadone is a positive step simply because it works,” Baldwin said.

Authorities in Vietnam also announced a significant expansion of MMT after studies found a drop in petty crime following the introduction of methadone, said David Jacka, the medical officer for HIV and injection drug use for the WHO in Vietnam.

“Compulsory treatment and detention is always more attractive when you have no other option,” Jacka said in an email, though he noted that Vietnam continues to build compulsory drug detention centres.

“At present, the impact of methadone on detention centres is still speculative,” he said.

In the meantime, the project’s proponents acknowledge MMT will provide a response to only a small part of Cambodia’s addiction issues. The WHO estimates there are at least 2,000 injection drug users in the Kingdom, compared to more than 50,000 amphetamine users.

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