China

China, Beset By Drugs, Enlists Help

NEW YORK (AP): Faced with a flourishing drug trade and an increasing number of addicts, the People's Republic of China has been forced to look for new methods to battle drug abuse.

And in a twist in its warming relations with the United States, the communist nation's search led it to the so-called capital of capitalism, New York City, and the offices of Daytop Village, which has gained praise for its international network of residential drug and alcohol rehabilitation centres.

The addiction problem has forced the normally ideological Chinese government to become more pragmatic.

China's health officials `were overwhelmed but honest enough to say, "We don't know what to do",' said Monsignor William B. O'Brien, a Roman Catholic priest who founded Daytop in Staten Island in 1963.

Since the days of the Communist takeover in 1949─when parts of China were swamped with opium addicts─the formula for tackling the drug problem has been much the same: Lock up addicts in military-style camps to break their habit. But what little statistics are available showed the old ways didn't work.

Chinese authorities report the number of known addicts down by 23 percent since 1991. But that still left 596,000 registered addicts in 1998, the latest year for which statistics are available, and independent researchers say the number of addicts is likely much higher.

China's southernmost province of Yunnan lies along the route from Southeast Asia's Golden Triangle, a major source of illegal drugs. Yunnan has been stung by wrenching economic reforms, all of which have contributed to a major drug problem.

After travelling within the province, `We realised that the kids we met there were just like the kids we had met in the United States and were faced with similar problems. People don't realise that China is not so different from here,' said O'Brien who performs Sunday Mass at St Brendan's Parish in the Bronx.

China first consulted Daytop in 1989 and has since adapted its programs on a widespread basis.

`Daytop helped give us direction and a good plan,' said Yuan Xiaobo, Executive Director of the Yunnan Institute for Drug Abuse, a centre that opened in January under the tutelage of Daytop.

The centre, based in Yunnan's capital of Kunming, is the first of its kind in China, and health officials hope that it may become the model for other centres around the country, Yuan said during a recent announcement at Daytop headquarters in Manhattan.

Daytop Village, a private, non-profit, non-sectarian organisation, operates 25 centres in the United States alone. It has been instrumental in the development of substance abuse centres around the world and in training counsellors in new approaches to treatment.

Unlike the boot-camp method previously used, Daytop stresses that addicts who voluntarily enter its doors take responsibility and confront their feelings. Run by a staff of mostly Daytop graduates, the program slowly reintroduces recovering addicts to the outside world after treatment that can range from 1 month to 6 months. Long-term adolescent treatment can last from 6 months to a year.

The program has treated more than 100,000 people worldwide. In this country, in-house treatment averages $50 a day and focuses on a family-style atmosphere with a hierarchical structure.

A newcomer starts as a worker in food service, business or maintenance. Good behaviour earns a step up to the position of `ramrod', where clients continue to labor menially but oversee the workers. Continued good behaviour moves clients into supervisory roles. Workers can skip the chain of command to discuss the job, but all non-work matters─requests for home passes or telephone privileges─must go up the hierarchy and back down.

`By focusing on the structures of the family, the program helps those afflicted get the confidence to lead drug free lives,' O'Brien said.

Daytop has helped train over 500 counsellors in China as well as 11 more in the United States on new approaches to treatment and prevention of drug abuse. With the addition of the centre in Kunming, Daytop's method has been used to train counsellors in 59 centres around the world.

Clearly the need is there. Many of those in training at the Manhattan headquarters are from countries not thought of as having major drug problems, such as the Maldives, Indonesia and Malaysia. But these countries are hit with the problem because they serve as transit points for narcotics smuggling networks.

Faisal N. Afdhal, who operates a drug treatment centre in the Indonesian capital, Jakarta, said he was particularly attracted to the Daytop method because `the program is not just about stopping using drugs, but to improve the quality of life.'

Others said resources in their own countries are often used to stop smuggling but money for treatment and training is limited.

`This will really be helpful for us,' Abdullah Faseeh of the Maldives said of the Daytop training. `As a small country, we don't have the great universities and many trained people, so getting a chance like this is a real help.'

Mexico

Police Commissioner Calls For Dutch Approach to Drug Policy

MEXICO CITY: On Wednesday 10 May, Mexico City Police Commissioner Alejandro Gertz Manero decried the failure of his country's drug war policies and said Mexico should look to Holland for solutions to the drug problem. In `A Three-Part Solution Against Drugs,' a column published in El Universal and translated by the Narco News Bulletin, Gertz argued for a balanced approach to drugs that discourages street level drug activity, educates the public, and treats drug use as a public health rather than a criminal justice problem. The Dutch approach, Gertz wrote, is necessary for its focus on `the fundamental idea of ending the economic interest in drug trafficking, recognising that addicts are sick and that they require a controlled dose of drugs, that lessens over time, and medical assistance so they can recover.'

Narco News Bulletin editor Al Giordano told the Week Online that Gertz's column could represent a turning point in the drug policy debate. `It came from somebody so highly respected and so untarnished, in a country where almost every politician and cop is tarnished by something,' Giordano said. `And that he reached toward Holland so strongly is something that could change the direction of the drug debate not only in Mexico but also in Latin America and in all of the Americas as a whole.'

Gertz is widely respected in Mexico. Under his tenure as Mexico City's police commissioner, almost every crime index has fallen. `Not since 1993, when Gustavo de Greiff, the Attorney General of Colombia, came to Boston and said it's time to legalise drugs, has a Latin American official been so well positioned and had such an impeccably clean record himself to be able to speak out on this as what has happened this week with Alejandro Gertz,' Giordano said.

Giordano said Gertz's statements are particularly bold, in that he has made them only ten weeks before the national elections. `Already there is an intense amount of world attention on this,' he said. `I suspect he has created a space for more people to come out of hiding on this.' You can read the full text of Gertz's column in English at the Narco News Bulletin web site: http://.narconews.com

Jaap Toet

Trimbos-institute (Netherlands Institute

for Mental Health and Addiction)

Dept of Monitoring and Epidemiology

Postbus 725

3500 AS Utrecht, The Netherlands

Ireland

Seven Heroin Users Die Of Unknown Illness In Dublin

DUBLIN: The Eastern Regional Health Authority has said seven heroin users have died since the beginning of [May] due to an `unidentified severe illness'. A total of 14 heroin users were admitted to hospital during this period.

Those who died had abscesses on their legs, arms and buttocks, according to police, which may have been due to injecting heroin into muscles instead of veins. But it is still not known how this could have led to the deaths.

The health authorities have said the deaths might have been linked to contaminated heroin.

On Wednesday 24 May, the Eastern Regional Health Authority said five drug users had died among 10 admissions to hospital but last night, it said these figures had increased with new information.

The authority said the hospital admissions and deaths appeared to be similar to a recent cluster of heroin deaths in Glasgow, where 11 people died.

Mr Andrew Home, of Turning Point, the largest drugs centre in Scotland, said the people who died in Glasgow were also admitted to hospital with abscesses. Eight of the 11 who died were women and Mr Home said this may be due to the fact that long-term women drug users often lost the ability to inject into veins more quickly than men. He added that some of the women who died attended the same hostel in Glasgow and might have used the same heroin.

The Eastern Regional Health Authority said it was advising users who noticed an abscess, redness or swelling at the area of injecting to seek medical help immediately. It also advised heroin users to seek medical help if they developed any unusual or unexpected effects.

The authority has provided emergency methadone treatment vans in Blanchardstown and Ballymun, where no such treatment facilities exist. It said it was working with the Garda, the National Disease Surveillance Centre in Dublin and the Scottish authorities on a review of the situation. The authority added it was trying to identify common risk factors in the deaths of the heroin users.

Mr Tony Geoghegan of the Merchants Quay Project, the voluntary drugs service which offers a needle exchange facility, said heroin users were aware of the situation but they had continued to inject heroin. `Scared doesn't come into it when people are looking for drugs,' he said.

Mr Vincent Doherty, of the South Inner City Drugs Task Force, also said people were worried about the deaths but were continuing to take drugs.

`There is a temporary hype among users. Is it going to stop them buying heroin on O'Connell Street this evening? Is it going to stop them injecting? Not a chance.'

Fine Gael TD, Mr Gay Mitchell, said there needed to be a more serious response to the problem. He said the Government needed a coordinated response from the Departments of Health, Justice, Tourism and Sport and Foreign Affairs. `There needs to be a statement setting down what the Government are doing and what they are going to do to stop this from happening again,' said Mr Mitchell.

He added that heroin users should be contacted in a more effective way to warn them of the dangers. `They don't read newspapers or listen to the radio. We need to go where they hang out and tell them. I don't feel the response is meeting the need.'

Mr Tony Gregory TD said police on the north of Dublin city were aware of an increase in availability of heroin of varying strength and purity.

United States of America

One-Size-Fits-All Approach Won't Stop Heroin Plague: Treatment options must be offered

They are 34-year-old tax consultants, 18-year-old high school students, 39-year-old housewives, 25-year-old warehouse workers.

The list of 48 heroin-related deaths in Luzerne County since 1997 presents a cross-section of our adult population. Some might have tried heroin only a few times before succumbing to an overdose. Some might have had drug habits that lasted for years.

Still, as revealed in a three-part Times Leader series, `Valley with a Habit,' the Luzerne County Heroin Task Force insists that its single-minded approach─heavy on education and enforcement but vehemently opposed to a methadone maintenance program─is the only approach.

We believe the members of the task force─a group consisting mostly of local medical, law enforcement and treatment professionals─are sincere and dedicated to the goal of saving lives.

But we also believe their insistence on opposing any local methadone clinic that offers anything other than short-term, methadone-to-abstinence treatment is ill-advised, counter to the opinions of most experts in the field and bound to fail.

Even in pursuing that flawed treatment policy, the task force has exhibited a stunning lack of urgency. After leading the charge against a proposed methadone maintenance clinic in 1998, the task force announced in November 1999 it would favour a methadone-to-abstinence clinic. But it has made little discernible progress toward that goal.

After three years on the job, the task force can't even give the public a definitive number of heroin-related deaths in the county since 1997.

`Your guess is as good as ours,' task force co-chair Michael Donahue told us. Yet our reporters were able to count 48 such deaths merely by studying government documents already in the possession of county Coroner Dr. George E. Hudock Jr, a founding member of the task force.

After three years on the job, can't co-chair Tom Cesarini come up with anything better than: `We have enough information out there to show us what we're dealing with. We have a problem. We have a serious problem.'

For all its hand-wringing over that problem, the task force seems blissfully uninterested in studying the approaches taken in other cities. No member attended a national conference in Seattle on preventing heroin deaths.

And task force co-chair Donahue went so far as to say: `I don't really care about . . . I shouldn't say it that way . . . I'm not concerned about' programs in Philadelphia and Allentown.

`Our problem is our problem. And my concern is our kids.' Donahue, who directs a local treatment centre, said long-term methadone maintenance, in which daily doses might be administered for years, would condemn young users to a life of dependency.

But he ignores the fact, illustrated by our survey of local heroin deaths, that many local addicts are in their 30s and 40s and have presumably spent years on heroin.

Those older addicts constitute a network that eases the entry of younger people into heroin addiction, either through drug sales or just by bad example. Their role in perpetuating the cycle of drug addiction among the young should not be ignored.

Long-term methadone maintenance should be available locally for those older addicts. Such treatment would allow them to live stable, productive lives without the requirement of travelling to the nearest methadone clinic in Allentown, something about two dozen local residents do daily.

But local methadone maintenance should be available for younger addicts too. There is little evidence that methadone-to-abstinence, while it is certainly an approach worth trying in many cases, will be effective in treating even the youngest drug users with short-term addictions.

A 1994 study by the New York State Office of Alcoholism and Substance Abuse concluded that 80 percent of patients in programs that demand abstinence after a limited period of ever-decreasing dosages of methadone return to heroin use within two years.

`Stubbornly clinging to the paradigm of abstinence as the only acceptable therapeutic orientation . . . condemns the vast majority of heroin addicts to continued suffering and, all too often, to death,' writes Dr. Robert Newman, president of Beth Israel Medical Centre in New York City, a pioneer in methadone treatment.

Thankfully, the heroin task force has given itself some room to manoeuvre on the abstinence issue─last year the task force was talking about a program that would wean addicts from methadone after four to six months. Donahue is now talking about a three-year program.

We hope the task force shows even more flexibility on this issue and comes to realise that any local methadone clinic must offer a range of treatment options tailored to suit each patient.

While methadone-to-abstinence is certainly a preferred approach, it won't work for all, or most, addicts.

It would be better to give those addicts a chance at a stable life through methadone maintenance than to condemn them to a life on heroin and condemn society to the attendant increases in crime, family dysfunction and health-care expense.

But if the task force continues its current approach, our local anti-heroin campaign will continue to resemble an out-of-kilter three-legged stool, with the legs of education and enforcement dwarfing the stunted leg of available treatment.

And more people will probably die.