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Drug dependence isn’t a moral issue

Drug dependence isn’t a moral issue

The glossy brochure from Cambodia’s national drugs authority is reassuring. Drug use causes social instability and blocks national development, it explains, but the ultimate solution is to encourage people who use drugs to seek support. Friends and family must “avoid discrimination, intolerance and violence” toward people who use drugs and help them “find the necessary services for people to stop using drugs”.

If only they could. The brochure does not mention that the Cambodian government’s principal strategy to address drug dependence is not treatment, but detention. Each year, more than 2,000 people pass through the 11 drug detention centres around the country, usually detained for three to six months. The “treatment” and “rehabilitation” these centres provide? Military drills, hard labor and forced exercise. Beatings are common. These centres offer no medically appropriate treatment, such as cognitive behavioral therapy, psychosocial support (counseling, for example) or opiate substitution therapy. As one former detainee explained, his centre was “not a rehab centre but a torture centre”.

His appraisal was borne out by Human Rights Watch’s own research, published in a new report, Skin on the Cable. Former detainees reported that they were shocked with electric batons, whipped with twisted electrical wire, regularly beaten and chained standing in the sun. Some told us of being raped by centre staff or coerced into donating their blood. Many reported swelling and numbness in their limbs – symptoms of nutritional deficiencies.

Given its stated commitment to helping people stop using drugs, why hasn’t Cambodia invested in effective drug treatment rather than detention?

One reason may be that the centres are a convenient means to hold people when police and municipal authorities “clean” the streets before national festivities or visits by high-ranking foreign officials. Drug detention centres are frequently used not just to hold those dependent upon drugs, but also street children, people with apparent mental illnesses or casual drug users.

Another explanation lies in the money these centres can generate. Although Cambodian law requires the government to offer free treatment to drug users, drug detention centres often accept fees from families to take in their relatives. It is unlikely that the family members are aware that the approach in these centres is “spare the electric baton and spoil the child”.

Ultimately, the driving factor behind Cambodia’s drug detention centres is a dangerously simplistic understanding of drug dependence: It’s considered a matter of having drugs in the body as a consequence of an individual’s moral weakness. Hence “treatment” requires locking people up, forcing them to sweat to remove drugs from their systems and beating them to strengthen their resolve to stay off drugs. As one former detainee explained, “The big boss [of the centre] said, ‘Doing exercise will make you sweat, and the addictive substance will come out through sweat.’ [Each morning] we had to do 50 to 100 push-ups. If you couldn’t do this, you were beaten.”

Cambodia is not the only country in the region to consider detention an appropriate form of drug treatment. In Thailand, since 2003, people who use drugs have been considered “patients, not criminals”. But in practice each year thousands of people needing drug treatment are held in prison for “assessment” for extended periods. Then they are put into “drug treatment” centres, often run by the Thai armed forces, where military drills are a key component of so-called “treatment”.

In China, an estimated 350,000 drug users are held for up to seven years in centres where they can be held without due process and subjected to forced labour and psychological and moral re-education. In Vietnam, between 50,000 and 60,000 people are detained in 109 detention centres for drug treatment, with sentences as long as five years.

It is easy to see drug dependence as a moral issue. But it is not. As a chronic relapsing medical condition, dependence on drugs cannot be addressed by locks and chains, push-ups or police batons. Treatment should be provided only for those who are dependent, drug dependency services should be run by healthcare professionals and not public security forces, and therapy should be tailored to the individual needs of the patient. Compulsory drug detention centres that deny effective treatment to drug users and rely upon beatings, forced labour and exercise should be closed, and voluntary, in-community treatment options should be supported. This is the only way we can guarantee the “treatment” for drug dependence is not worse than the disease.

Joe Amon is director of the Health and Human Rights Division of Human Rights Watch

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