DRUG ABUSE IN ASIA AND THE PACIFIC 1993
CONTENTS
I. INTRODUCTION
II. DEMAND FOR ILLICIT DRUGS IN SELECTED ASIAN COUNTRIES
A. Australia
B. Brunei Darussalam
C. China
D. Hong Kong
E. India
F. Indonesia
G. Japan
H. Malaysia
I. Myanmar
J. Nepal
K. New Zealand
L. Pakistan
M. Philippines
N. Republic of Korea
O. Singapore
P. Sri Lanka
Q. Thailand
III. DRUG ABUSE, HIV INFECTION AND AIDS
IV. SOME SUMMARY OBSERVATIONS
I. INTRODUCTION
1. This document reviews the current demand for illicit drugs in selected countries and territories in the ESCAP region. It is an update of reviews previously undertaken in the Asian and Pacific region. Although the pattern of drug and substance abuse has not changed substantially, some new information is available which will have important implications for drug demand reduction policy makers and programme planners.
2. No country today is immune from the pernicious effects of drug abuse. Within the countries of Asia and the Pacific, drug abuse has become a serious social problem, with the production, distribution and consumption of dangerous drugs continuing to grow in the region. It is a problem which transcends age, geographical, political, cultural and religious boundaries. Organized groups dealing with illicit drugs continue to operate at both the regional and the international level. Drug production, trafficking and consumption have raised levels of violence, crime and corruption in many countries in the region. Additionally, drug use has contributed to the introduction of AIDS to the region, with potentially disastrous consequences in several countries.
3. It has been recognized that drug abuse, in combination with associated factors such as AIDS, can cause social problems which can hinder the socio-economic development of a country. The human and economic costs associated with drug consumption are staggering. Its cost must be counted in terms of wasted human lives, decreased economic productivity, reduced human resources, and resources expended by governments and non-government organizations for demand and supply reduction programmes which might otherwise be used in other problem areas.
4. Today, countries in the region face an increasing number of HIV/AIDS cases, many of which are linked with the abuse of drugs. Although the spread of HIV in the region began only in the mid-1980s, its pace has been rapid, especially in population groups practicing behaviours which place them at risk for acquiring or transmitting HIV infection. It should be noted also, though, that AIDS has spread rapidly to population groups which do not practice high-risk behaviours. Married women infected by their husbands and children infected before birth are among these groups. Non-drug using women have become a major infected group all over the world and will soon be the largest groups.
5. In South-East Asia HIV transmission apparently began among injecting drug users (IDU), with HIV prevalence rates reaching about 50 per cent in Bangkok, Thailand and 30 per cent in Yangon, Myanmar. HIV prevalence rates of over 50 per cent have been found in IDUs in Manipur, in northeastern India. Yunnan Province, China, is geographically contiguous with South-East Asia and the epidemic of HIV infection among IDUs in that province may be considered part of the epidemic in South-East Asia. Prevalence rates of at least 10 per cent have also been noted in a few studies in neighbouring regions.
II. DEMAND FOR ILLICIT DRUGS IN SELECTED ESCAP COUNTRIES AND AREAS
6. The information presented in this document was taken for the most current sources available. However, the data available, because of the nature of the drug abuse problem and current information gathering parctices, may not represent the true dimensions of the problem. Indeed, it is a premise of the regional network that more effective approaches to the demand for abused drugs in the region requires improved information on these scope and nature of that demand.
A. Australia
The drug abuse situation
7. National household surveys conducted by the National Drug Abuse Information Centre (NDAIC) in 1985, 1988 and 1991 on drug use by people aged 14 years and above showed no significant change in the proportion of people who had ever used heroin. There were, however, small declines in the proportions of people who have ever used cocaine and hallucinogens. Cannabis continues to be the illicit drug which has been tried by the largest proportion of the population (32 per cent in 1991).
8. Drug use among street children, which was covered for the first time in the 1991 survey, revealed that 96 per cent reported having ever used cannabis, 84 per cent solvents, and 82 per cent amphetamines. For cocaine and barbiturates, the proportions reporting having ever used were 59 per and 52 per cent respectively. Heroin had been used by 45 per cent of street children while 62 per cent reported ever having self-injected illicit drugs.
9. A study to examine deaths and illnesses attributed to drug use in 1989 yielded the following results:
26,685 deaths were caused, i.e. one in every five deaths from all causes;
Tobacco-caused deaths (19,180) accounted for 72 per cent of all drug caused deaths;
Alcohol-caused deaths (6,800) accounted for 25 per cent of all drug caused deaths;
Opiate-caused deaths (397) accounted for 1 per cent of all drug caused deaths;
Barbiturate-caused deaths (52) accounted for less than 0.2 per cent of all drug-caused deaths.
10. The number of hospital episodes and bed days caused by illicit drugs amounted to 9,299 episodes and 57,283 bed days or 5 per cent and 3 per cent of all drug-caused episodes and bed days respectively. Of the hospital episodes caused by illicit drugs, 13 per cent were ascribed to narcotics; for bed days, the proportion due to narcotics was 11 per cent. These proportions are believed to have changed little since 1986.
11. It is estimated that in Australia there are:
30,000 to 50,000 dependent heroin users;
60,000 to 90,000 irregular, "recreational", non-dependent heroin users.
9,700 persons in methadone programmes.
AIDS and HIV infection
12. The first case of AIDS in Australia was identified in 1982. By january 1990, 1,707 cases were reported with 934 deaths. Of these, 0.7 per cent were in the adolescent group of 10 to 19 years, and 20.2 per cent of the cases int he next age group, with the possibility that many of these people may have been infected in their adolescence.
13. Data from the National Centre of HIV Epidemiology and Clinical Research show that as of 31 March 1991, of all AIDS cases reported, 1.5 per cent were categorized as heterosexual IDUs and 2.5 per cent as homosexual/bisexual IDUs. Of persons who had died from AIDS in Australia, the equivalent proportions were 1.1 per cent and 2.5 per cent respectively.
B. Brunei Darussalam
The drug abuse situation
14. Brunei Darussalam is primarily a consumer country. Problems exist with codeine, which is usually taken in the form of cough mixture, and psychotropic substances such as minor tranquilizers. Problems with the consumption of cannabis exit, too, while heroin and opium consumption are a minor problem. The rate of illegal drugs consumption has shown a steady increase each year. Compared to the period of July 1990 to June 1991, for the same period of 1991-92 there was a 20 per cent increase in the total number of drug-related arrests, most of which were arrests for illegal consumption of drugs.
15. Arrest figures show that 8.4 per cent are females, 33.8 per cent are unemployed, 17.1 per cent students, and 35.3 per cent 19 years old and less.
C. China
Drug abuse situation
16. The abuse of opiod drugs is increasing throughout China. This is in part because drugs are being channelled through China from the Golden Triangle to other parts of the world. These drugs h ave become available in both border and inland areas of China. A 1989 survey indicated that there are more than 70,000 drug addicts in China. They were located mainly in the provinces and autonomous regions of Yunnan, Guizhou, Sichuan, Shaanxi, Guansu and Inner-Mongolia. Countries in the border regions of Yunnan Province were found to have the most serious problem.
17. Some trends have been identified. The age of new addicts is de creasing; of the 260 addicts detained in Xi'an in 1988, 81.5 per cent were under 28 and the youngest was 15. The kind of drugs abused has been shifting from opium to heroin and synthetic drugs. In 1989, about 1,000 heroin addicts were discovered in Yunnan Province. Drug abuse is increasingly associated with crime. In Lanzhou City in 1989, 53.1 per cent of the addicts detained had criminal records, and in Xi'an this was the case for 82.7 per cent of the addicts detained.
18. Recent data indicate that domestic illicit drug abuse is increasing. In 1991, the Chinese Police and Customs seized 1,959 kg of heroin, 2,026 kg of opium, 454 kg of methamphetamine, and 49.8 tons of acetic anhydride and other essential precursor chemicals. Data from the first half of 1992 indicate an increasing trend. Reports indicate also a wide-spread abuse of gateway substances such as alcohol and nicotine.
AIDS and HIV infection
19. Seven cases of AIDS have been reported in China since the first case was diagnosed in 1985. All were men. According to the Ministry of Health, since 1985 about 550,000 Chinese have been tested for HIV antibody and 419 of this number have been found to be seropositive. Of the 419,401 were injecting drug users, 403 of who were residents of Yunnan province.
D. Hong Kong
The drug abuse situation
20. Major aspects of the situation are as follows:
From September 1976 to the end of December 1991, the CRDA has recorded a total of 67,334 persons, of whom 89.7 per cent were males and 10.3 per cent females;
As of 31 December 1991, the number of assumed active drug abusers (people who had been reported at least once to the CRDA during the last five years) was 39,642 (35,666 males and 3,976 females), constituting 0.8 per cent of Hong Kong's population aged 11 and above;
There was an increase of 13.6 per cent (from 2,355 to 2,676) in the number of newly reported persons in 1991 compared with 1990. For those newly reported young persons aged under 21, an increase of 14.8 per cent was recorded (from 879 to 1,009) in the corresponding period;
Heroin continued to be the most popular drug of abuse. In 1991, 69.4 per cent of the newly reported persons and 93.6 per cent of the reported individuals with known information on the types of drugs abused had abused heroin;
The proportion of newly reported cannabis abusers fell slightly from 18.1 per cent in 1990 to 15.6 per cent in 1991. Similarly, the number of cannabis abusers as a
The proportion of newly reported cough medicine abusers increased from 6.5 per cent of all newly reported persons in 1990 to 9.5 per cent in 1991. The corresponding figures for those aged under 21 were 15.4 per cent and 22.7 per cent. The number of organic solvents has also been increasing from 0.2 per cent to 1.0 per cent in 1991;
The sharp increase in the abuse of brotizolam in the previous two years reversed in 1991. The proportion of newly reported brotizolam abusers dropped from 5.3 per cent of all newly reported persons in 1990 to 1.4 per cent in 1991. The corresponding figures for those aged under 21 were 14.6 per cent and 3.5 per cent respectively. Decreases have also been recorded in the abuse of flunitrazepam and triazolam;
11.8 per cent of the newly reported persons and 7.8 per cent of all individuals reported to CRDA in 1991, for who there was information on the types of drugs abused, were found to have abused more than one type of drug. For newly reported persons aged under 21,16.9 per cent abused more than one type of drug;
The most common age group for initial drug abuse continued to be 15-24; 59.1 per cent of the newly reported persons were in this age group;
93.9 per cent of all reported individuals in 1991 had received some form of schooling. However, only 45.6 per cent had received at least 7 years of schooling. In general the education standard of newly reported persons was much higher; 75.3 per cent of the newly reported persons had received at least seven years of schooling;
In 1991, 58.6 per cent of all heroins abusers who provided information preferred injection to fume inhalation or smoking. Compared with 1990, there was a decrease of 1.5 per cent.
21. CRDA figures show that a persons is most likely to be reported as a drug abuser to the authorities again within three months of a previous report. Thirty-one per cent are reported again within this period. Within 72 months, 86 per cent will have been reported again. Persons reported by a law enforcement agency at three and six months. Within twelve months, 64 per cent will have been reported again by either type of agency. Thereafter, those who had been first reported by a treatment agency are more likely to be reported again; at 72 months, 91 per cent and 81 per cent respectively, of those reported by treatment and law enforcement agencies will have been reported again.
E. India
The drug abuse situation
22. Data on the national drug abuse situation in India are not available, however some research has been done in Bombay.
23. The drug abuse situation in Bombay can be described in only general terms because of the paucity of data. Abuse of drugs such as LSD, mandrax, morphine and heroin apparently began to rise in the 1960's. A 1974 drug abuse survey of Bombay University students showed a prevalence rate of ever users of 19.7 per cent, with alcohol and tobacco excluded. A 1976/78 study, sponsored by the Ministry of Social Welfare, showed a rising trend in the abuse of alcohol, tobacco and analgesics. In the late 1960's and early 1970's there was also an increase in legal sales of morphine capsules. The Government reacted by banning sales of capsules. Unofficial sources claim that many morphine users subsequently turned to other drugs. Media reports and hospital records also suggest that abuse of readily available barbiturates, amphetamines and benzodiazepines was widespread and rising though the 1970's.
24. A crude form of heroin ("brown sugar") was introduced to Bombay in 1980-81. Initially, heroin abuse seems to have been a disproportionately upper-class phenomenon. Its price fell, though, to one-fifth of its original level and this resulted in its spread downward through the class structure. The average age of users also decreased. A 1986 study indicated that 81 per cent were 11-26 years old.
25. The age group 16-26 is the most susceptible to drug abuse. Education was found to have an inverse relationship with drug abuse; unemployed and self-employed persons are more susceptible to drug abuse than other occupational groups. Most addicts are from the lower income class and from nuclear and small families. They are unmarried, and their divorce and separation rate is relatively high. They tend to live alone or with friends. For treatment, addicts rely most on municipal hospitals. Lack of treatment and rehabilitation facilities is a severe problem.
26. The number of heroin abusers is estimated as 1.5 per cent to 2.9 per cent of the population in Bombay City, but there are no reliable figures available.
AIDS and HIV infection
27. The nationwide average HIV prevalence rate has grown from 0.2 per cent in 1986 to 1.3 per cent in 1990. This is a seven-fold increase in five years. The highest sero-positivity rates and number of AIDS cases have been reported from Maharashtra State, mainly from Bombay and Pune. Sexually transmitted disease patients and prostitutes constituted two thirds of the HIV carriers. Out of 5,841 IDUs tested in Manipur by January 1991, 1,135 were found to be seropositive. As of September 1991, 1,236 IDUs in India were found to be seropositive, 40 were females.
F. Indonesia
The drug abuse situation
28. Drug abuse is a small but growing problem. According to press reports based on jakarta police and hospital records, approximately 70 per cent of drug abusers in the capital are between the ages of 13 and 25. About 80 per cent of them come from middle and upper class families and nearly 70 per cent have at least a junior high school education. During 1988, 44 per cent of the patients of the Jakarta drug dependence hospital were poly-drug abusers, 27 per cent were abusers of psychotropics (mainly tranquilizers), 18 per cent were alcohol abusers, 8 per cent were marijuana abusers, and 2 per cent were opiate abusers. Poly-drug use has become increasingly popular among urban youth, particularly in sedative-alcohol or sedative-alcohol-marijuana combinations. Some adolescents have turned to solvent abuse (paint thinner, gasoline, glue).
29. There is no registry of drug abusers, nor are reliable indicators of abuse monitored. The Government of Indonesia estimates that 0.05 per cent of the Indonesian population, or approximately 90,000 persons, are narcotic addicts. The chief of Indonesia's police estimated in 1988 that there were at least 82,000 drug abusers countrywide, of which 50,000 were marijuana abusers. He based this estimate on information gathered from the Ministries of Health and Social Affairs and from police records.
G. Japan
Drug abuse situation
30. Several drug control laws are in effect in Japan; the drug abuse situation may be partly perceived from the information related to the enforcement of those laws. In the period 1980 to 1989, the following numbers of arrests were made under these several laws (the high and the low arrest figures, and the year for each, are given for each law):
Law |
Low |
High |
Stimulant Control |
1989: 16,866 |
1983: 24,372 |
Narcotic Control |
1983: 89 |
1989 248 |
Opium |
1989: 168 |
1983: 408 |
Cannabis Control |
1983: 1,231 |
1988: 1,570 |
Volatile Solvents |
1982: 36,796 |
1986: 27,560 |
H. Malaysia
Drug abuse situation
31. From 1970 until October 1991 the Malaysian Government had registered a total of 159,275 addicts out of which approximately 100,000 were active drug users.
32. Of the 6,492 new addicts detected in the first ten months of 1991, 68 per cent were below the age of 30. Heroin continues to be the main drug of abuse. Of all persons detected to data, 67 per cent admitted to having consumed heroin, 20.2 per cent cannabis and 5.8 per cent morphine. Ninety eight per cent of the addict population are males. Of those detected in 1991, 84.0 per cent were employed, 15.9 per cent unemployed and 2.0 per cent were students. The use of psychotropic substances to alleviate the discomfort of heroin withdrawal has been noted. These included amphetamines, barbiturates, sedatives, and tranquilizers.
I. Myanmar
The drug abuse situation
33. Poppy cultivation and opium smoking have a long tradition, especially in the mountain border areas of Shan and Kachin states. Increasing heroin use has been reported since 1970. The traditional opium users are the elderly from rural areas, while heroin is most often used by young city dwellers.
34. According to the Health Information Service of the Ministry of Health, the total number of registered addicts in Myanmar as of March, 1991 was 51,143, broken down as follows: 12,143 heroin users, 33,972 opium users, 364 marijuana users, 218 tranquilizer users and 4,263 users of such drugs as codeine and psychotropic pharmaceuticals. Two-thirds of the registered drug addicts are opium users, while heroin addicts comprise less than a quarter of the total number. Alcohol use is widespread. Most of the drug users are male in the 20-39 year old age group. The eastern region of the country registered the highest number of users.
AIDS and HIV infection
36. In the late 1960's there were less than 50 cases of addiction to illicit drugs in Nepal. In a span of merely 20 years, that number has swollen by more than 500 times. So far, no officially recognized data exists on socio-economic status and geographical distribution of drug addicts or abuse of different categories of drugs. It is, however, roughly estimated that there are about 25,000 Nepalese addicted to hard drugs, mainly heroin. Most of these addicts belong to the 15-30 year old age group. The majority of drug abusers live in the Kathmandu Valley, followed by the Pokhara Valley and few other urban centres where there is frequent contact with foreigners. There may be quite a number of drug addicts in rural areas as well, where the use of drugs such as marijuana has long been accepted as part of the local culture.
K. New Zealand
The drug abuse situation
37. Cannabis-related offenses accounted for 93 per cent of the total drug offenses for 1990 and this has been the case for several years now. With a limited supply of heroin available, users continue to manufacture "home-bake", a locally produced form of morphine and heroin, form codeine-based products. hallucinogens such as LSD and mescaline are still used as revealed by seizures made by authorities. Cocaine is available throughout the country, but is popular only in the business sector.
38. Young people in New Zealand tend to use prescription drugs, often accompanied by alcohol and cannabis. Most are obtained by burglary or prescription fraud. In September 1991, 40,000 tablets of Tamgesic were imported through the mail from Thailand. Morphine sulphate tablets, prescribed for terminally ill cancer patients, are popular for intravenous drug abusers. Amphetamine, methamphetamine, and crystal methamphetamine, imported from Australia, are popular with motorcycle gangs.
L. Pakistan
The drug abuse situation
39. Heroin addiction was virtually unknown in Pakistan before 1980. The 1979 order prohibiting the sale of opium and other drugs (e.g. alcohol), coupled with the increase in opium production, appear to have had the unfortunate effect of stimulating a domestic demand for heroin.
40. The early 1980s saw the rapid development of a very serious heroin problem which continues to the present. The most frequent method of administration is by "chasing the dragon". Fortunately, use by injection is still extremely rare. A survey of street heroin in 1987 found heroin to be on average 29 per cent pure. The average daily dose in 19990 was 750 mg. costing the user around 40 Pakistan rupees per day, although many serious addicts use far larger amounts.
41. A conservative estimate of 500,000 regular daily users suggests that 41 metric tons of heroin (400 tons of opium equivalent) costing 7.3 billion rupees (about 300 million US dollars) is required to satisfy the annual domestic demand. A recent trend of mixing barbiturates with heroin has increased medical problems.
42. Cannabis use also continues to be rife in Pakistan with an estimated 900,000 users (who often also use heroin). In addition, there is a well-established and increasing problem of the misuse of psychotropic drugs in Pakistan. This was revealed in the 1988 household survey on the misuse of psychoactive substances such as tranquilizers, hypnotics, anti-depressants and analgesics in the urban areas of Pakistan.
M. Philippines
The drug abuse situation
43. Multiple drug abuse, characterized by the simultaneous intake of stimulants and depressants, as well as other drug combinations, continues to be a problem in the country. Opiate abuse is practically non-existent, while cannabis and methamphetamine are the two most commonly abused drugs. Cannabis is usually taken in combination with cough syrup preparations, tranquilizers/anxiolytics belonging to the benzodiazepine group, and/or other pharmaceuticals, while methamphetamine is being abused by itself, although the abuser may switch to cannabis when his supply runs out.
44. In 1991 and 1992 the majority of clients in treatment and rehabilitation facilities nationwide came from the Metro Manila area, representing an average of 55 per cent of total admissions. Drug abusers are predominantly male on a ration of 10:1 and are on average 24 years old.
AIDS and HIV infection
45. Based on a report by the National AIDS Prevention and Control Programme, as of August 1992, 329 HIV-infected individuals have been detected in the country. Of this number, 72 have already developed full-blown AIDS. Two of the six new cases detected this year contracted the disease through sexual contact, one is a female, the other a homosexual/bisexual. The infection routes of the four others, all male, are still unknown. So far, 49 deaths as a result of AIDS have been monitored in the country.. Previous records show that the most common infection route for both AIDS and HIV positive individuals is through sexual contact. Of the total number of cases so far, 169 heterosexuals and 60 homosexuals/bisexuals were infected through sex. Most of the cases were females (a total of 168). There have been no known cases of IDUs who were HIV positive.
N. Republic of Korea
Drug abuse situation
46. Drugs principally abused in the Republic of Korea are methamphetamine which is domestically trafficked under the names "Philipon", "Ice", "Shabu". The drug is manufactured in clandestine laboratories in the country.
47. There was a sharp increase from the mid 1980's to 1988 of nearly twofold in trafficking and abuse of methamphetamine. This trend was reversed in 1988 due to concerted efforts of law enforcement agencies. The price of methamphetamine rose to almost 20 times of that before 1988.
48. Cannabis is the second most abused drug in Republic of Korea. Recently there has been a shift from the abuse of methamphetamine to cannabis.
49. The Prosecutor's Office estimates that there are 400,000 drug-related offenders, including 130,000 drug abusers, in the Republic of Korea at present.
O. Singapore
The drug abuse situation
50. The primary drug of abuse in Singapore is heroin. Of the 4,133 drug abusers arrested in 1987, 3,819 (92.4 per cent) abused heroin, 232 (5.6 per cent) opium and 74 (1.8 per cent) cannabis. Inhalation is the primary method of heroin ingestion.
51. An intensive effort to deal with drug abuse was begun in April 1977. At the time there were an estimated 13,000 heroin abusers in the country. During the rest of 1977 an average of 858 drug abusers per month were arrested. This average fell to 575 in 1978 and 250 in 1979, and rose to 284 in 1980. The monthly averages for 1985, 1986 and 1987 were 242, 260 and 292 respectively. The estimated heroin-abusing population had been reduced to 7,000 by 1986.
52. The stabilization of arrest figures reflects the existence of a core group of recalcitrant drug abusers. The existence of such a group is also reflected in changing relapse rates among drug abusers treated in Singapore's Drug Rehabilitation Centers. In 1979 their relapse rate after two years of supervision was 70 per cent. It dropped to 44.8 per cent in 1980 and dropped further to 40.7 and 40.3 per cent in 1981 and 1982 respectively. By 1986, though, the overall relapse rate was back up to 59.2 per cent, partly because the relapse rates of those going through the Drug Rehabilitation Centers for a second and third time were 70.5 and 77.7 per cent, respectively. In addition, relapse rates of first-time Drug Rehabilitation Centre graduates increased from 37.6 per cent in 1981 to 59.2 per cent in 1987. Of the 3,909 drug abusers who were in treatment at the end of 1986, 1,124 (28.8 per cent) were classified as "hard core" because they had been in treatment four or more times.
53. Of the 4,133 local drug abusers arrested in 1987, 3,556 (86.0 per cent) were 20 to 29 years old, and 279 (6.8 per cent) were below 20 years old. Of this group, 2,586 (62.5 per cent) had no more than a primary education, 1,361 (32.9 per cent) had attended secondary school and 184 (4.5 per cent) had completed secondary education. Of those admitted to Drug Rehabilitation Centers in 1985-1987, an average of 5.9 per cent were female.
54. Heroin abuse is still the main drug problem in the country. Inhaling is the usual method of consumption. Intravenous drug abuse is uncommon. Cannabis and opium are also abused.
55. Drug addicts are detected by urine tests. In 1991, 4,225 local drug dependent persons wee arrested. Of these 83.2 per cent were in the 20 to 39 years age group, 94.3 per cent of whom abused heroin.
56. In the first quarter of 1992, 1,048 drug dependent persons were admitted to the Drug Rehabilitation Centre for treatment and rehabilitation. Of this, 18.9 per cent were newcomers.
P. Sri Lanka
The drug abuse situation
57. In 1988 drug offenders constituted the largest single category of all convicted prisoners, 27.3 per cent as compared to 13.6 per cent in 1984. An estimated 2,000 persons per year with problems relating to heroin abuse seek medical help from government and private hospitals and doctors.
58. Southeast Asian heroin (Heroin No.3) is most commonly used in Sri Lanka. The preferred mode of administration is by inhalation. The average daily consumption of a dependent person is about 500mg., usually taken in three were predominantly IDU, and 82 claimed to have injected heroin at least once during their career.
59. Another study indicates that heroin abusers are unmarried, male, 15-35 years old, from lower social classes, engaged in unskilled manual labour or pretty trade, and from large urban families where family organization and parental care is minimal.
Q. Thailand
The drug abuse situation
60. It is estimated that there are approximately 300,000-500,000 drug abusers in Thailand, about 0.5 per cent of the total population.
61. Heroin continues to be the main drug of abuse, followed by opium and marijuana. Opium smoking is mainly used in the northeastern regions. Moreover, amphetamines and volatile substances have become a problem. Heroin abuse has escalated among the hilltribes for various reasons. Also heroin abuse has spread to rural areas and to fishermen.
62. The abuse of amphetamines is common among the blue collar workers, especially drivers. many road accidents have been caused by drivers using amphetamines. Ephedrine hydrochloride is the main ingredient used in amphetamine production.
63. The yearly voluntary treatment intake was 57,000 cases in 1987, 61,000 in 1988, 60,000 in 1989, 54,408 in 1990 and 68,593 in 1991.
AIDS and HIV infection
64. The first case of AIDS in an injecting drug user was reported in 1987. An explosive outbreak of infection among IDUs occurred in Bangkok in early to mid-1988. This was documented by surveillance done on heroin (and other opiate) users (predominantly IDU) attending methadone treatment at the Thanyarak Hospital and the Bangkok Metropolitan Administration (BMA) Health Department. HIV rates climbed from about 1 per cent at the start of 1988 to 32-43 per cent by August-September of the same year. In June, 1989 the first national sentinel serosurvey in 14 provincial capitals revealed that rates were comparable to those in Bangkok, even among IDUs from remote hilltribe populations. From mid-1990 to mid 1991, prevalence rates in Bangkok have stabilized in the 30 per cent range.
III. DRUG ABUSE, HIV INFECTION AND AIDS
65. The personal and social costs of HIV/AIDS are rising to very high levels all over the world. Men and women who are in the most productive years and who family responsibilities are at their peak are the most commonly affected. In the hardest-hit areas whole families and villages are dying out.
66. The World Health Organization (WHO) estimates that more than 10 million people have been infected with HIV since the start of the pandemic in the late 1970s or early 1980s; over 5,000 persons are infected everyday. Among them, some two million have gone on to develop AIDS, the late stage of HIV infection, which occurs 10 years on average after initial infection with the HIV. By the year 2000, the WHO estimates that 30-40 million adults and children will have been infected by HIV. Nearly 90 per cent of the projected HIV/AIDS cases in this decade will occur in the developing countries.
67. One of the most common modes of HIV infection is the exposure of IDUs to HIV-infected blood through shared needles, as well as through unprotected sex practices. The latter tend to be associated with all kinds of drug abuse including alcohol.
68. The past decade has seen a marked increase in the number of people injecting drugs for non-medical purposes. In the United States of America, 1.2 million persons are estimated to inject drugs on either a regular or an intermittent basic. In Europe, the number of people injecting drugs is estimated at between 750,000 and one million. The significance of this problem for HIV/AIDS is highlighted by the fact that of the over 50,000 AIDS cases reported in the United States by the end of 1987, approximately 25 per cent were directly associated with drug injecting (homosexuality was related risk factor in 8 per cent of these cases). In the European region drug injecting currently accounts for up to 21 per cent of the approximately 8,500 AIDS cases thus far reported to WHO (homosexuality was a related risk factor in 3 per cent of these cases).
69. As the problem of drug abuse increase in the region, the pandemic of HIV/AIDS also continues to grow. The contribution of illegal drug use, particularly through injection,appears to be reaching alarming levels in some countries in the region.
IV. SOME SUMMARY OBSERVATIONS
70. Available information permits only superficial and partial descriptions of the drug abuse situation prevailing in Asia and the Pacific today. Data were available from only 17 countries out of a total of 58 ESCAP members and associate members, less than a third of the total. Data were not collected with a standard format, a fact which makes comparisons between countries and the identification of common patterns difficult. For the same reason, estimation of trends over time and predictions are difficult.
71. Demand for drugs is mostly defined in a very narrow way: only data on dependent abusers of illicit drugs are collected. Data on nicotine, alcohol and other "gateway" drugs as well as information on attitudes and intention to use drugs are missing. This is true also for drug-related behaviour such as delinquency and sexual behaviour. Information of this kind, however, is necessary to identify groups at risk and to design effective preventive interventions.
72. It is possible, however, to conclude with a few summary statement sand identify the major trends.
Drug abusers in different countries appear to have certain common characteristics throughout much of the ESCAP region. Ninety-five percent or more are male. They are young; the majority are commonly less than 30 years old. They tend to come from deprived population groups. They tend to be under-educated relative to the averages in their home countries. Relative to the circumstances of their home countries their employment tends to be of low quality; they tend to be unemployed or underemployed, or employed in menial occupations.
The wide variety of drugs which are abused - licit and illicit, natural and designer, singly and in combination - as well as the correlation which exists between drug abuse and socio-economic development being experienced throughout the ESCAP region.
The age of abusers appears to be decreasing in some countries of the region. This would likely be observed more widely if volatile substances, and probably alcohol, were included in such information. Age decreases in drug abuse have been noted, for instance, in China, India, and the Philippines. It is not clear whether apparent age decreases reflect actual changes in drug abuse, or whether they are the result of information systems which are sensing drug abusers earlier in their careers.
The abuse of drugs is not only an urban phenomena. Pakistan has a large number of rural heroin abusers. In China, India and Thailand, for instance, there have been reports of increasing rural heroin abuse. The problem may be particularly acute among tribal groups in remote areas in all three countries.
Modes of drug consumption vary widely. There appears to be little intravenous use in, for example, India and Singapore, but a lot in China, Hong Kong, Myanmar and Thailand. myanmar reports that most heroin abusers begin intravenous use within a year of beginning abuse. High intravenous use in China has seen associated with high HIV infection rates. In Thailand, with high HIV rates, 80-95 per cent of heroin abusers use needles.
Illicit drugs such as heroin and marijuana, which receive the most attention, are just the core of a tenacious problem. Where the supply of heroin has been effectively halted, as in the Philippines, or where control measures have raised its price, as in Myanmar, other drugs have quickly come into use. These drugs, in turn, appear to have acted partly to keep people poised for a return to harder drugs when their supply increases. This has happened with smokeable methamphetamine in the Philippines and heroin in Myanmar. Evidence from other countries suggests that this is a general phenomenon.
The available information highlights the needs for better drug abuse information systems in Asia and the Pacific. Enhanced information can be used in many ways. For example, it would be very useful to be able to make comparative evaluations of rehabilitation approaches in different countries. To identify vulnerable groups and to design primary prevention programmes data on attitudes towards drugs and the intention to use them are necessary. AIDS prevention programmes, too, would benefit from better information about the modes of drug ingestion and the effect of drug on the risk-taking behavior of users.