Rethinking regional drug policy as the market changes

Synthetic drugs seem to be everywhere in Asia Pacific these days. A typical week has reports of yet another 5 or 10 million ‘yaba’ methamphetamine tablets seized, another ton of crystal meth the story is never-ending and region-wide. The most recent UN Transnational Organised Crime Threat Assessment has also found that the methamphetamine market of East and Southeast Asia and neighbouring Australia and New Zealand are inter-connected and now estimated to be worth up to US$ 61.4 billion annually, a remarkable four-fold increase in 6 years. At the same time the heroin market has declined significantly over the same period, reflecting a dramatic and unprecedented shift away from what was once the dominant drug. We know criminals are making a lot of money as the drug market evolves and goes synthetic, but we need to ask a fundamental question: what is the impact of this change on the people, communities and public health of the region? 

There is an incorrect and often persistent perception that taking a drug directly leads to addiction. And many simply wonder why users can’t just stop. The reality is that frequent drug use can affect the brain, resulting in compulsive drug use behaviour. Stopping requires a high level of motivation, and a change in behaviour may not be possible without adequate psychosocial support and medical assistance. And an under-appreciated fact is that relapse is common in people who try to quit – addiction is similar to other diseases in that respect.

Unfortunately, services to help improve the health and well-being of people who use drugs have been severely limited in the region for many years, and the surge of synthetic drugs has dramatically exposed these limitations. Some services that help people who use drugs are even criminalized, further driving them to the margins of society. And this is after medical evidence clearly shows that these programmes effectively prevent a range of deadly illnesses.

Positively, during the last meeting of the United Nations central drug policy forum – the Commission on Narcotic Drugs – countries agreed on a strategy to promote measures to prevent and treat additional diseases resulting from drug use.  Achieving this consensus was an important signal that countries around the world see that additional priority needs to be placed on addressing drug demand and social and health related harms, including through support programmes and needle and syringe distribution.

Worryingly, people who use methamphetamine and other synthetic drugs have been known to engage in high risk behaviours, and data clearly show sexually transmitted diseases, including HIV, are much higher than in the general population.  Many services are not tailored to address the health and social consequences of drug use for people who use synthetic drugs. Ministries and government departments like those of health, public security and social welfare need to place importance on this service gap to prevent and reduce harm to individuals and spread of diseases.

Taking a health-first approach to reducing harmful drug use is cost effective. Incarceration is expensive and has proven ineffective in curbing drug use, and prison populations across Southeast Asia have been rising as the levels of methamphetamine production, trafficking and use have been rising – in some countries 80 percent of prisoners are there for related offences.  And unfortunately, one of the most common responses to drug use and dependence in the region remains compulsory treatment in centers which are similar to prisons but without access to sufficient due process and judicial review. Alarmingly, more than 455,000 people who use drugs are known to have been held in compulsory detention centers in Southeast Asia in recent years.

The UN offers guidance to countries centered on human rights, promoting drug treatment approaches that combine social and medical support. Taking this advice into practical application, UNODC began the rollout of a training package on Community-based Services for People Who Use Drugs in Southeast Asia in 2016, and it is now available in Laotian, Khmer, Thai, Chinese, Myanmar, Bahasa Indonesian and Vietnamese languages.  At the same time, UNODC, UNAIDS and WHO have been supporting drug policy dialogues with, and within, key countries in the region to also ensure market demand and harms are addressed.

Importantly, the Sustainable Development Goals include new targets to achieve universal health coverage, to end the epidemic of HIV and combat hepatitis, and to strengthen the prevention and treatment of drug dependence by 2030. Asia Pacific region can only achieve this by acknowledging and addressing the changes that have happened in the regional drug market, moving towards a model that supports access to health services as an alternative to incarceration, and through scaling-up of services for people who use drugs. 

This region is one of the world’s most vibrant in terms of economic growth.  We are confident that with leadership, and partnerships between, communities, civil society, academia, government, and international and regional organizations, it can re-balance drug-policy to ensure that the health and social implications of the changing drug market receive the focus they deserve.

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(Jeremy Douglas is the UNODC Regional Representative for Southeast Asia and the Pacific; Eamonn Murphy is UNAIDS Regional Director for Asia and the Pacific)