Reducing the harm

The harm reduction approach to heroin addiction is having a positive impact on the lives of users in Kachin State, but is meeting some resistance from faith-based treatment centers.

Residents of Jinghpaw Wunpawng Hkalup live in a fortified enclosure for fifteen days after quitting heroin. (Brennan O’Connor)

Residents of Jinghpaw Wunpawng Hkalup live in a fortified enclosure for fifteen days after quitting heroin. (Brennan O’Connor)

Illicit drug abuse has long plagued Myanmar’s northernmost Kachin State, where addiction rates have steadily increased because of an expansion of poppy cultivation. In the state capital, Myitkyina, the evidence of addiction is everywhere. It ranges from piles of bloody needles littering railway tracks and the banks of the Ayeyarwady River, to a big sign outside a high school warning pupils against bringing drugs on the premises.

In response, neighbourhood watch teams have been formed to chase away dealers. The addicts, mainly young men, are often pressured into joining one of the city’s twelve faith-based drug rehabilitation centres.

The centres, most of which opened after the change of government in 2011, are often basic, bleak institutions lacking the resources and expertise to properly treat those struggling with drug addiction.

Participants sleep in overcrowded bamboo dormitories. Special huts reinforced with steel plates and barbed wire keep them from escaping during the agonising withdrawal period.

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By international standards the centres’ methods are primitive, but few other options exist in the state to combat a drug scourge so widespread that it is said to affect at least one member of every Kachin household.

In its Southeast Asia Opium Survey for 2014, the United Nations Office on Drugs and Crime found that opium use more than doubled and the use of heroin and amphetamine-type stimulants more than tripled in poppy-growing areas of northern Myanmar from 2012 to 2014.

“The government is to blame by doing nothing,” said Nding La Ja, director of the Youth for Christ Centre, one of the first faith-based drug rehabilitation centres to open in Myitkyina. The Kachin State government has not “committed to taking any action”, Nding La Ja said.

“We have to solve this problem on our own with help from the church,” he said.

Nding La Ja (also known as Ahja) is a popular Kachin folk singer. He was a heroin addict until he embraced Christianity during a nine-year prison sentence for drug possession.

Both of Nding La Ja’s older brothers were heroin addicts. One died from an overdose and the other from unrelated health problems.

Youth inject heroin at a popular spot on the banks of the Ayeyarwady River. (Brennan O’Connor)

Youth inject heroin at a popular spot on the banks of the Ayeyarwady River. (Brennan O’Connor)

Since starting YCC in 2008, the year he was released from prison, Nding La Ja has helped about 800 drug addicts. He’s the first to admit that fewer than 10 percent manage to stay off drugs after they finish their treatment.

“After the camp it’s easy for them to use drugs again,” he said. “They have no positive role models in the community. When they see their friends, it just increases their desire. Everywhere, in every possible situation, they see drugs again.”

Dealers pay off corrupt township officials in their communities to sell drugs with impunity, Nding La Ja said

Dr Tun Tun, the Myitkyina area co-coordinator for the Substance Abuse Research Association, one of three non-government organisations in the state capital offering harm reduction programs, says quitting drugs is not easy.

“Most people think that drug addiction and relapse is from weak morals or will power, and they see drug users as weak guys,” Dr Tun Tun said. “In reality, drug addiction is a chronic brain disease like other diseases such as diabetes,” he said.

Researchers have found that drug addiction changes the way brain operates in the same way as other mental illnesses, he said.

Dr Tun Tun said that although faith-based drug rehabilitation centres have a high success rate, the rate of recidivism is also high.

Although he doesn’t agree with their methods, he respects what they are doing.

“I really appreciate that a lot of rehabilitation centres have opened within the last two to four years. Before that, there was very little involvement from the community,” he said.

A bible study at Jinghpaw Wunpawng Hkalup (JWH) drug rehabilitation centre in Myitkyina. (Brennan O'Connor)

A bible study at Jinghpaw Wunpawng Hkalup (JWH) drug rehabilitation centre in Myitkyina. (Brennan O’Connor)

Dr Tun Tun said SARA is trying to work with the faith-based centres but most are suspicious because it advocates harm reduction, which involves supporting needle exchange, and refuse to work with the association.

They think that “giving them needles is promoting drug use”, Dr Tun Tun said.

Access to clean needles does not determine if an addict decides to use them, he said, adding that usage is related to how much money they have and the availability of the drug. As their addiction increases so does their tolerance and to maintain the same level of effect, some begin to inject heroin.

Fluctuating opium and heroin prices also influence addicts to begin using needles. This has been widely proven in many studies of intravenous drug use, Dr Tun Tun said.

The main goal of SARA’s harm reduction program is to prevent a rise in blood-borne diseases spread by the use of shared needles.

“This is quite a serious issue for us,” said Dr Tun Tun, explaining that 28 percent to 30 percent of intravenous drug users aged between 20 and 40 have HIV, the virus that can lead to AIDS.

The infection rate should be five-percent or lower to help prevent the spread of HIV to the general population.

The situation is even bleaker for hepatitis.

SARA’s data shows that seven of every 10 intravenous drug users have hepatitis C. About 50 percent will develop tuberculosis.

To control the spread of these diseases, addicts must be tested, educated about the dangers of sharing needles and have access to clean ones, Dr Tun Tun said.

A recovering heroin addict draws a needle on his friend’s arm with a pen during bible study at Jinghpaw Wunpawng Hkalup. (Brennan O’Connor)

“Some people inject with needles that are very old; it’s very dirty,” he said. “They clean them themselves; in some areas they use their own urine.”

Dr Tun Tun hopes to avert a major health epidemic by convincing his community to accept the harm reduction philosophy advocated by SARA.

Last year SARA distributed about one million needles in the six Kachin townships where it has drop-in centres. As well needle exchanges it also provides education, including information about preventing the spread of diseases, and conducts free medical checks. If an addict wants to quit and is having trouble, SARA will refer them to a government-administered methadone program.

Despite being a widespread problem, drug addiction is heavily stigmatised in Kachin culture, and many addicts and their families prefer to remain anonymous. Counselling for drug addicts and their families can be arranged in private homes as well as being available at the drop-in centres.

In Kachin, most drug users are still living at home, making it “very important to get the whole family involved,” Dr Tun Tun said.

The Jerusalem faith-based drug rehabilitation centre allows SARA to provide health education, conduct on-site tests for HIV and other blood-borne diseases and distribute vaccines for treating hepatitis. Those who are HIV-positive receive referrals for anti-viral medicines.

“Only we deal with their health, but it’s really important for the drug user,” Dr Tun Tun said.

Tu Mai, 21, has been receiving care at the Youth for Christ Centre for about four months. He had been using drugs for five years before he was admitted.

“It started out as activity that gave me pleasure,” Tu Mai said. “Then I started to realize how many troubles it brought me.”

He began injecting heroin after he started working as a driver at the jade mines in Hpakant Township, an area rife with drugs.

In his village, Tu Mai smoked opium. He started injecting heroin at the mines when it became too expensive to maintain his high from smoking opium. When he couldn’t score a fix after a police crackdown, Tu Mai became acutely aware how seriously he was addicted.

“I didn’t know it was that bad,” he said. “I can’t describe it [withdrawal] with words, it was so painful.”

It was an awareness of how much shame he had brought his family that gave Tu Mai the push he needed to seek treatment.

Quitting heroin has been a struggle for Tu Mai, who has found it a huge challenge to give up his habit.

“I’ve tried many times to quit at home and have been to six camps,” he said.

Tu Mai has spent eight months at different treatment centres, the last four months at YCC.

“I feel like I’m the person I was before using drugs, now that I received Jesus. Sometimes I think about doing it again, but I think I will be able control myself.”

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