Executions, forced and arbitrary detentions, beatings, whipping, incarceration and hard labor — This is a common face of drug policy in many Asian nations, and one that is looking ever more archaic.
Half a million drug users are held annually in compulsory detention centers in China and Southeast Asia, according to estimates from the United Nations Office on Drugs and Crime (UNODC). Arduous physical exercises and military drills are often routine there, as is violence – former detainees described shocks with electric batons and whipping with electric wires to Human Rights Watch.
Roughly 50 to 70 percent of prisoners in Indonesia, Malaysia, Myanmar, the Philippines, and Thailand are in jail for drug-related crimes. In extreme cases, prisoners pay with their lives. Indonesia is currently preparing executions for drug trafficking.
The harsh, punitive approach to drug use in Asia stands in stark contrast with the health approach in many Western countries, where programs for “harm reduction” of drug use– such as access to clean needles and methadone substitution treatment– are the norm.
Since Portugal successfully decriminalized drugs in 2001, whereby getting caught with drugs may result in a small fine and a referral to treatment, other countries have followed suit.
This dichotomy of approaches was evident at the United Nations General Assembly special session on drugs (UNGASS) last month. While Indonesia defended the use of the death penalty amid jeers, Canada and Mexico declared they would go their own way to legalize cannabis.
A public letter to the UN urging reform was signed by 1,000 prominent global leaders and activists, including many former world leaders, as well as Hillary Clinton, Bernie Sanders, and Richard Branson. Leading global public health bodies also urged reform in a report, arguing prevailing policies have had “serious detrimental effects” on health and human rights.
UNGASS proved disappointing for reform advocates, yet it was still significant. “The international consensus on drug prohibition came to an end” at UNGASS, said Dr. Alex Wodak, a leading drug reform advocate from Australia, said. “It cannot be revived.”
“We are in a transition from a predominantly criminal justice approach to a more health and social approach. Most of Western Europe has made that transition. North America has started… and many countries in Central and South America are on the way.”
Wodak, President of the Australian Drug Law Reform Foundation, said the case for relying on drug supply control had simply “collapsed” in Australia. “The evidence for cost effectiveness of harm reduction is now so compelling while the… severe unintended negative consequences and cost ineffectiveness of supply control is just as clear. So it’s a very different discussion than in Asia where there is still much more acceptance of a drug-free world and punishment.”
A “drug-free world” was the 2015 goal of the Association of Southeast Asian Nations (ASEAN), a hopeless irony given the region’s flourishing drug trade. Between 2006 and 2013, opium poppy cultivation in the region’s “Golden Triangle” tripled, according to UNODC. Methamphetamine seizures in the region almost quadrupled from 2008 to 2013, to about 42 tons.
Governments have battled the rising trade by taking a hard stance on drugs, often directed at drug users, with police raids, forced urine testing and, in 11 countries, drug detention centers.
Drug users “face very serious human rights abuses” in these centers, Human Rights Watch associate director of health and human rights Diederik Lohman said, adding these centers violated international and often national law.
“Asia remains strongly invested in traditional law enforcement and justice approaches,” said Jeremy Douglas, UNODC’s Regional Representative for Southeast Asia and the Pacific. He called for a balance with these approaches and access to adequate health and social services. “I often comment that good public health equals good public security, but there is a distance to go before the balance is there [in Asia],” he said.
There is, however, “a significant move to align drug and public health policy,” he said. Skyrocketing HIV epidemics among injecting drug users – who number 3 to 5 million in Asia – have forced governments to change.
Take Malaysia. In the 1990s, drug users were all sent to prison or drug rehabilitation centers run by former army personnel, who enforced daily military drills and marching. More than 75 percent of reported HIV infections cases were among drug users.
It was a shocking situation for Dr. Adeeba Kamarulzaman who returned to Malaysia in 1997, after training and working in Melbourne, where it was rare to see injecting drug users acquiring HIV. “After seeing one patient after another with advanced HIV who was a drug user, I felt that something really needed to be done,” she said.
She put together a report with the help of Australian colleagues. “With that we went knocking on doors of agencies that had to do with either drug use or HIV… Ultimately we went to the highest political leadership who gave us the go ahead to pilot a methadone program in 2005. The nod to do a needle exchange program came as a complete surprise,” said Adeeba, now the dean of University of Malaya’s Faculty of Medicine.
The scientific evidence helped make a case for harm reduction and maintain it. “We took great pains to ensure that we had a good monitoring and evaluation system in place,” she said.
The Cure and Care clinics which provide free, confidential, voluntary treatment such as methadone, have impressive results. One study found less than 40 percent of drug users attending the clinics relapse after a year – yet for compulsory detention centers, 50 percent relapse within a month, and 100 percent by a year. The clinics have been described as a model and have drawn visitors from across the region.
A recent return on investment study, done with World Bank support, found harm reduction had averted 12,600 new HIV infections. “Hopefully this has gone some way in ensuring that the programs are continued,” Adeeba said.
Asia’s hard line on drugs is softening elsewhere too. Most countries now have some harm reduction programs, although not enough to meet needs, said Gloria Lai, senior policy officer for the International Drug Policy Consortium. Changes in Singapore and Vietnam may help limit the death penalty while public debate on drug decriminalisation has emerged in a few countries, she added.
Last year, representatives of nine Asian countries met in Manila with UNODC and other UN bodies and agreed to a transition towards voluntary, community-based services for drug users. “The discussion now needs to be taken up to the policy level with government ministers,” Douglas of the UNODC said.
He said the UN is also helping the Myanmar government prepare legislation on policy changes considered “quite progressive.”
Overall though, progress is still slow and piecemeal. In Malaysia, despite the success of harm reduction there, the country still maintains 28 drug rehabilitation centers and imprisons many drug users – 13,500 in 2014.
“Reform will be slow to come in the region because of the portrayal of drugs and any related activities as a security issue, in the minds of both government and the public, and the limited space for challenging those perspectives and policies,” said Lai.
She added some countries “will stay entrenched” in the tough, punitive approach “for a while to come,” in particular Singapore, Pakistan, Indonesia and China.
But with the international consensus on global drug prohibition in tatters, the push for reform will intensify. “The status quo countries can delay the inevitable but not prevent it. We can expect to see more Asian countries start moving to reform in the next few years,” said Wodak. But he added: “There will always be a Singapore or two or three that will champion the hard line approach for decades to come.”
Mangai Balasegaram is a regular columnist with The Star, a national, English-language daily in Malaysia. She has been writing on drug use for 25 years, and previously won the international journalist of the year award from the International Harm Reduction Association, which promotes a public health approach to drug use.