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Cambodia opens first methadone clinic for heroin users

  1. Terrapinzflyer
    Cambodia has launched the country's first methadone-treatment programme, in a new approach to help heroin users.

    The World Health Organization (WHO) told the BBC that addiction was widely viewed in Cambodia as a social problem, rather than a health issue.

    Until now the government has favoured treatment centres which emphasise hard work and exercise.

    But health workers and human rights groups have criticised the facilities, describing them as "labour camps".

    The opening of the methadone clinic is the culmination of years of gentle persuasion by organisations which work with drug users.

    Ongoing concerns

    The methadone programme will be strictly voluntary. Methadone is a heroin substitute used to treat withdrawal symptoms.

    Two organisations which run outreach programmes for drug users will identify candidates for treatment.

    If they're willing, they will be taken to the clinic for an assessment based on international standards. While the facility is supported by the WHO, it is run by the Ministry of Health inside a public hospital.

    But while international health workers are delighted with the new approach, they are still concerned about the existing drug treatment facilities.

    The government has no plans to close the centres which it says are voluntary, but which the UN has described as compulsory.

    Some residents have complained of being held against their will - and forced to take experimental herbal remedies.

    By Guy De Launey
    BBC News,
    Phnom Penh
    15 September 2010



  1. Balzafire
    Cambodia Opens First Methadone Clinic

    [imgl=white]http://www.drugs-forum.com/forum/attachment.php?attachmentid=16848&stc=1&d=1284921170[/imgl]The Cambodian Ministry of Health has opened a clinic where people addicted to opiates, primarily heroin, can be administered methadone. The move is a significant departure in a country in which "drug treatment" has typically meant imprisonment, forced labor, and unproven herbal treatments.

    The opening of the clinic is the culmination of years of quiet effort by harm reduction organizations, the BBC reported. Two of those groups, which run outreach programs for drug users, will identify candidates for treatment.

    The program is strictly voluntary. Participants will be taken to the clinic for a needs assessment in line with international standards. The clinic is inside a public hospital and run by the Ministry of Health with support from the UN's World Health Organization.

    While harm reductionists and public health workers are pleased with the government's new approach, they said more steps need to be taken to shut down the existing, punitive drug treatment centers. But the government says it has no plans to do so.

    by Phillip Smith
    September 19, 2010

  2. Balzafire
    Re: Cambodia Opens First Methadone Clinic

    Cambodia's Drug Treatment Centers: Abusive, Illegal, Ineffective

    [imgr=white]http://www.drugs-forum.com/forum/attachment.php?attachmentid=16849&stc=1&d=1284921922[/imgr]They had been beaten, whipped, shocked with electric batons and even raped. Food was scarce and forced labor common. Cambodians who have spent time in the country's drug detention centers described these outrageous abuses and horrible conditions, and more.

    People in these detention centres - including adults, children and individuals with mental illness - were detained without ever seeing a lawyer, a judge or a courtroom. Some had been picked up in "street sweeps", others yanked out of bed at night. Their families had paid the police to come and "arrest" them and put them in, what they hoped were, treatment facilities.

    But "treatment" in these facilities consists of military drills, hard labor and forced exercise. Detainees are forced to work and exercise to the point of collapse, even when they are sick and malnourished. These centres offer no medically appropriate treatment such as cognitive behavioral therapy, psycho-social support (counseling, for example) or opiate substitution therapy. As one former detainee explained, his centeR was "not a rehab center but a torture center."

    In September 2009, Human Rights Watch wrote a six-page letter to the chairman of the National Authority for Combating Drugs, asking for background and statistical information about the centers, the legal and policy framework under which they operate, and the government's approach to drug treatment. In January 2010, we requested official meetings to discuss the findings of our nearly year-long investigation.

    We got no response.

    The government has responded to the press though.

    The government has sometimes declined comment, sometimes evaded direct response, or attacked the organization instead of addressing the facts. But the government also acknowledged certain abuses and revealed a perspective on drug dependence deeply out of touch with scientific evidence.

    Khieu Sopheak, a spokesman in the Ministry of the Interior, said the government was looking into the report, but emphasized that Human Rights Watch was often critical of the Cambodian authorities. They are "seeing only one tree - they do not see the jungle," he said.

    Huot Sokhom, the deputy chief of the police-run rehab center in Siem Reap, denied allegations that people are forced into drug treatment, explaining, "Those vagrant people we collect from the streets volunteer to come with us". Meanwhile, in the neighboring province of Banteay Meanchay, the commander of the military police detention center described to the press how detainees at his center were forced to stand in the sun or "walk like monkeys" as punishment for attempting to escape.

    Not one government official contacted by the press suggested that our reports of the lack of counseling, peer support, or opiate substitution therapy - international norms of drug treatment - were untrue. In fact, the Interior Ministry spokesperson, Khieu Sopheak, insisted that those in detention "need to do labor and hard work and sweating - that is one of the main ways to make drug-addicted people become normal people".

    Drug dependency can be a chronic condition, with abusers prone to relapses. I'm not sure whether that is a tree or jungle, but sweating is no treatment for drug addiction.

    The World Health Organization concurs: Its officials have said that close to 100 percent of those in Cambodian detention centers relapse, and that it does not support the centers. UNAIDS and its country representative say that the centers are clearly illegal and should be shut down.

    Abusive conditions in drug detention centers have also raised international concerns. Manfred Nowak, the United Nations special rapporteur on torture, has said that withholding adequate health or medical treatment may constitute or contribute to "inhuman or degrading treatment." The UN high commissioner for human rights, Navi Pillay, has said that drug users are "all too often ... forced to accept treatment, marginalized and often harmed by approaches that over-emphasize criminalization and punishment while under-emphasizing harm reduction and respect for human rights".

    With the Cambodian government denying most of the abuses, and the international community increasingly speaking out against them, where do we go from here?

    Under international law, the Cambodian government must investigate credible allegations of torture and ill treatment. The government should begin these investigations immediately. Surya Subedi, the UN special rapporteur on human rights in Cambodia, should clearly communicate to the government that these centers violate international human rights law, and press for their permanent closure. United Nations agencies in Cambodia should do likewise.

    Voluntary, community-based drug treatment urgently needs to be expanded within Cambodia, but the release of individuals from abusive, ineffective and illegal detention centres should not be delayed. Individuals who use drugs do not forfeit their human rights, and the Cambodian government should not create detention centers that are exempt from the protections afforded to all.

    by Joseph Amon
    January 27, 2010
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