Drug situation in Lashio is difficult: UNODC

Censored by the Ministry of Information, 2008.
By Becky Palmstrom

LARSHIO, Shan State, Myanmar:

Dr Aung Myint is going through the habits of his typical Monday morning. He walks through the compound of the small suburban office, greets the staff and asks about people’s weekends. He unlocks the door to a small cupboard in the courtyard and pulls out a large blue bucket. He shakes the bucket gently, listening to the noise of glass and metal against plastics.

“Daytime is a favourite time for injecting,” the doctor says, “although addicts require at least two hits a day.”

The bucket is filled with hundreds of used needles collected over the weekend. He seems glad that these hits atleast didn’t expose people to HIV.

Two young outreach workers climb onto a motorbike. They are off to visit the outskirts of town where addicts trade and inject heroin – the areas are known as “shooting galleries”. They will try and encourage people to use the clean needles they carry in the bags strapped around their shoulders – and they will also try and avoid the police, who could make life difficult for them if they were found to be carrying needles. The workers shout goodbye as they drive into a bright sunny morning. Men sitting in the courtyard smoking look up and wave at the workers. They are trying to overcome their addiction or just seeking a place to sit. Some of them have already contracted HIV/Adis.

Mya Myint is a mother of three, whose family used to grow opium before the government clamped down on production in the area. She brings her 67-year-old father-in-law to the drop-in centre every week. “I wish I had enough money to send my kids to Yangon where they would be away from the drugs, but I can’t afford it,” she says. Those who are not dealing must find the money for their fix by other means. According to the UNODC, a large number of addicts are dependent on their parents, which has massive implications for family life.

One outreach worker says she has a client who poured boiling water over his mother until she gave him money. Another young addict made multiple cuts running horizontally along his arm with a knife in order to force his parents to pay for his next hit of heroin, Dr Htet Aung said. It costs just K50 (0.05 US cents) to buy a clean needle, but fear of arrest, inconvenience and ignorance all play a part in the high numbers of drug users relying on dirty needles in Shan State and across the country.

“Before we began collecting needles, children used to find them in the street and play with them,” says Dr Aung Myint, who has worked at the drop-in centre run by the United Nations Office on Drugs and Crime (UNODC) in Lashio since it opened in 2004.

“In the last couple of years it’s cleaned up. It’s better,” he says. But children cutting themselves accidentally is by no means the most
dangerous aspect of a city and region with one of the highest numbers of injecting drug users in the country.

The UN estimates that in 2004 there were between 90,000 and 300,000 injecting drug users in Myanmar. Out of these, between 30 and 90 percent are infected with HIV/AIDS – one of the highest rates in the world, even compared with neighbouring China with a rate of 12.3pc. In Shan State, where much of the opium used to produce heroin is grown, the large number of disenfranchised youth, high unemployment rate, lack of educational opportunities and ready availability drugs have created what the UNODC calls an “epidemic” of HIV/AIDS cases.

Research in Southeast Asia has shown drug users are also more likely to engage in unsafe sexual practices, increasing the likelihood of passing HIV/AIDS to others in their community. The UNODC, in partnership with other INGOs, community-based organisations and the government, are battling to turn the epidemic around. Yet the health risks are often not the main concern of addicts. “I have met hundreds of people in my time here,” says Daw Moe Thu Zar, who has worked with HIV-positive sex workers and drug users as a nurse and professional counsellor for five years.

“In all of that time there have been 20 people I know who have gotten off the drugs. But those 20, either their wives told them that they would leave them if they started taking heroin again, or their boss at work said they would fire them.”

“To be honest, when a drug addict doesn’t have drugs, he can’t think of anything else,” she continues. “He becomes obsessed with getting his next fix. He often just doesn’t want to talk or come see a councillor. They don’t care about health; they are just focused on their next fix.”

Sixty percent of incarcerated people in Myanmar are charged with drug offences, and with failure to register as a drug user carrying a
three-year sentence under Myanmar law, even the UNODC outreach workers are sometimes worried about the risks of being found carrying needles – they are also subject to arrest. It discourages clean needle use, particularly for first-time drug users.

“The chances of sharing [needles] the first time you try is very high – about 50 percent of those we ask say they shared the first time they injected,” says Dr Htet Aung, who has also been working with addicts for nearly five years through the UNODC. One of the most important aspects of his work is training prisoners about the increased risk of HIV/AIDS in jail, with many inmates thought to be practising man-to-man sex and a high number of prisoners using drugs inside prisons.

There are other health risks too. “The problem is you don’t know what else people are mixing into [the heroin], and so a lot of people die because everyone along the supply line is mixing it with other stuff,” says Dr Htet Aung. “Chalk powder, milk powder, crushed paracetamol, soap powder – all of this is deadly when you start injecting it into your veins.”

Most “overdoses” are caused not by too much heroin, but by too much mixing. Although Dr Htet Aung describes these overdoses as perhaps the most dangerous aspect of heroin use, knowing the mortality rate of heroin addicts is nearly impossible. “The families will very rarely put ‘death by drugs’ on the death certificate,” he said.

Overcoming heroin addiction is rare. Despite registering some 5000 injecting drug users since 2004, Dr Htet Aung says he can think of just a handful of people who had made a complete recovery. “We have even had problems with some of our outreach workers relapsing and dying of an overdose,” he said, with the resigned tone that seemed common to those working with addicts in Shan State. Myanmar is not alone; heroin addicts become so physically dependent on the drug that even the most successful detox centres in the world register a relapse rate of 75 percent, according to a report in the UK newspaper The Independent.

“The easiest way of coming off the drug is leaving Lashio,” says Dr Htet Aung. “The dealers rely on the custom of their users to pay for
their own fix, so drug dealers parade outside of the homes of people trying to come clean, or come visit with offers of cheap fixes – K500 or K1500K – just enough to get you hooked again.”

“Crime is the other method for funding the heroin,” says a pensioner from the Department of Social Welfare, who thought the issue of drugs in Shan State was so important that upon retiring he helped start a branch of the Voluntary Social Workers Association (VSWA) in Lashio. He coordinates some 20 volunteers to visit recovering drug addicts to offer support and assistance.

Most addicts become dealers to fund their habit, he says. At a cost of K10,000 to K15,000 a day, many turn to criminal behaviour, as one young man told me. “I would sell anything – other people’s furniture, clothes, anything I could get my hands on. Even my motorbike,” he said.

He is now a member of another community-based organisation in Lashio called the Youth Empowerment Team, which was started by a recovered drug addict in the hope of building awareness in the community about the dangers of heroin.

But for the 15 young men who volunteer there, it also serves another function – to offer an alternative peer group and a set of role models for young people, who are particularly susceptible to becoming involved in drugs. This happens to teenagers as young as 12 or 13, and Dr Aung Htet said these teenagers are often involved in dealing as well. Indeed, so high is the likelihood for young males to become involved in drugs in Shan State that some families send their teenage sons to Yangon to escape temptation.

Back at the UNODC centre, the anonymous box of clean needles at the gate is being restocked for the night.

“Everywhere, every case the new ones are the best,” says the packaging on the sleeve of the clean needles. Everyday 50 needles are picked up from here, but it is difficult to assess the impact of the program on drug users in Lashio.

Although HIV/AIDS rates have dropped among the centre’s clients, one outreach worker admitted that addicts are often more worried about getting arrested or finding their next fix than they are about the dangers of a disease like HIV/AIDS that can seem a less tangible and immediate concern.

This mindset worries Dr Aung Htet. “Although right now overdosing is the biggest danger, in a while HIV/AIDS may take over as the main reason drug addicts are dying,” he says.