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A Lack of Funding or Geopolitics?

Understanding drug abuse in developing Asian countries is a more complex task than you might think. Between the realities of a geopolitically divided world and the many challenges unique to Asia itself, the interrelated problems of drug abuse and the spread of communicable disease have lingered past the point of reason in developing countries such as:
  • The Republic of Korea
  • Myanmar
  • Indonesia
  • Cambodia

…and elsewhere.

However, no matter how you measure it, the situation ends up looking like a referendum on austerity. A lack of public funding is the proximate cause of these nations’ struggles with drug abuse and the risks it represents. But a lot of the blame lies with Western leaders, who for generations have preferred exporting conflict instead of practical knowledge and cooperation.

Before the rest of the world can understand the requirements, we need to take an honest look at some of the factors that contribute to this ongoing problem in the first place. Nobody should believe the proximate cause is a lack of self-control or a lapse in individual morals, as we’re often meant to think about drug users.

Rather, drug abuse is both a social and practical problem.

Drug use in developing countries is a problem with a clear solution. In fact, the problem has steps worth taking, for both Asian nations and for those looking on in interest and concern from other shores.

Understanding the Risk Factors

The developing parts of Asia are not, in the grand scheme of things, “uniquely” at risk of abusing drugs. But there are some factors here which make drug use uniquely interrelated with the spread of highly infectious and dangerous diseases such as HIV/AIDS.

One challenge health care workers and world institutions face is the sheer size and diversity of Asia’s population. Another challenge is that, in parts of the continent, a working knowledge of modern medicine has not permeated yet. The use of heroin, cannabis and hashish is common throughout Asia — and not exclusively for recreational use, either. Depending on the region, people have used some of these substances for traditional and medicinal purposes for generations unnumbered, according to the WHO.

Furthermore, injection is the preferred method for administering some of these “medicines.” In the 1990s, for example, the use of amphetamine-style drugs began to dramatically rise in popularity throughout the developed and developing parts of Asia, including the Republic of Korea, Thailand, Indonesia, China, Japan, Myanmar, the Philippines and elsewhere. And at locations where a local doctor or religious leader administers ostensibly “medicinal” drugs, it’s not uncommon for up to 50 “patients” to share a single needle.

Another condition that has shaped Asia’s relationships with illicit drugs also include the overlap between what experts call “IDUs” — injecting drug users — and sex work. In the parts of the world where sex work is most common, drug abuse seems to follow.

So, it quickly becomes apparent that risk of disease is high. Add to this the lack of authoritative, accessible health care systems and an inclusive educational system…and we can begin to understand the complexity of regional issues. Each of these factors contribute to the likelihood of drug abuse and exposure to its many risks.

Although men abuse a majority of opium and other drugs in Asia, the WHO has observed upticks in the number of female and child drug users in developing regions.

Profiles of Drug Users in Asia

Reports have disagreed for years about the rate at which women abuse drugs in Asian countries. Smoking opium, in particular, was historically a male pursuit. But authorities worry we’ve been underreporting the rate at which women use injectable drugs. They are also concerned we’ll see current numbers rise even further — perhaps to as high as 25 percent of the drug-using population — as we study these trends and better understand these “hidden” populations in Asia.

The portraits of at-risk communities in portions of Vietnam, Cambodia and even parts of China include higher-than-average percentages of homeless children and high rates of both male and female sex workers, all of which has known ties to drug abuse. Educational levels vary among Asia’s drug-using population, but unemployment and underemployment are also major drivers and sustainers of drug use in Asian communities.

What Asia Needs from the Rest of the World

In their most recent tussles over tariffs and the exportation of goods and knowledge, most wealthier nations haven’t worried themselves too much about exporting the materials and personnel necessary for up-and-coming countries to invest in their education and health care systems. Indeed, wealthy governments don’t usually concern themselves with ensuring the prosperity of other peoples of the world, especially those in developing nations.

Suffice it to say, evidence-based drug abuse and HIV prevention measures are not common in middle-income and impoverished countries in Asia. If there’s a public health budget at all, rather little of it tends to be earmarked for prevention and educational/outreach purposes.

This general lack of institutional health resources — plus the public tendency toward avoidance of topics about the relationships between promiscuous sex, the spread of STDs and the use of injectable drugs — trap developing countries in cycles of poverty that leave people lacking essential resources and a livable degree of dignity for generations at a time.

The main point is this: Living life in poverty further fuels drug use in at-risk communities in Asia and beyond.

But it’s not just care for, and education of, the drug user or patient that matters. We must also make efforts to help these countries better educate their police forces. There is a balance to be found between approaches that emphasize harm reduction and those that focus on occupational safety for police officers. There is, appropriately, concern among law enforcement that drug users might have dangerous paraphernalia on them, such as used needles. And accidents can happen.

Efforts to better educate members of the law enforcement community can yield better, and more compassionate, results. In Kyrgyzstan, officers who received education about what daily life is like for drug users came to employ more compassionate means to keep the peace in their communities, including referring patients to public health facilities, instead of confiscating their property or condemning them to criminal proceedings.

Supervised Injection Sites

In Europe, and even certain areas in the United States, one type of public health investment that’s resulted in positive returns is called a “supervised injection site.” Citing successes in Europe, cities like Seattle, Washington provide drug users with safe places where they can gradually wean themselves off chemical dependencies. Supervised injection sites are motivated by harm reduction ideologies, without the need to use on the street and risk using a contaminated syringe or needle.

The idea is not to encourage “moderate” drug use. It’s to provide community-based aid and practical, compassionate next steps for people suffering from the effects of drug dependency. Beyond that, supervised injection sites help slow the spread of infectious diseases among drug-using communities that might otherwise be sharing needles.

Still, safe injection facilities are uncommon even in the developed world due to social stigmas and a lack of funding — and that makes them even rarer in developing countries. In Kazakhstan, for example, political controversy derailed a national opioid substitution therapy program. And in Uzbekistan, a similar federal-level pilot program for weaning patients off opioids got rejected before the first trials had finished.

General Takeaways

There is now plenty of evidence linking the abuse of drugs in developing nations with incidences of HIV/AIDS and STD transmission, among other forms of social harm. But what tends to be missing is serious attention and follow-through from the countries who have the resources to do something.

The institutions whose job it is to study trends like these and draw up actionable conclusions, such as the WHO and Family Health International, agree reducing drug abuse and its many ancillary types of harm in the developing areas of Asia comes down to three major components of a long-overdue consciousness-raising campaign:

1. Syringe exchange programs are a proven success that can save lives and tens of millions of dollars. If the developing world adopts them in higher numbers, they can save lives there, too, and help prevent the spread of infection.

2. Residents of these nations need better access to biomedical and behavioral preventive medicine. Behavioral prevention might take the form of educational mission trips, which can help deliver some of the practical, and potentially life-saving, knowledge these citizens need to understand their health better.

3. Developed nations must share their resources for HIV/AIDS treatment strategies, including making testing protocols more widely available and sharing plans for education and early detection.

Still, economic austerity plays a hugely detrimental role in the health of world citizens. In Greece, following that country’s economic meltdown in 2007, some of the following years saw roughly 15-fold increases in rates of HIV infection. As a country’s tax revenue falls — or, rather, gets siphoned off to fund privately owned enterprises — that country’s investments in public health and medicine must also fall, and the health and “health literacy” of its citizens necessarily suffers.

It’s possible to measure a country’s greatness by how willing it is to help vulnerable people turn their lives around. Because of this, Asia’s struggle with drugs is everybody’s struggle.

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