An independent researcher said he found “palpable resistance” among health officials to a drug-treatment program the UN hopes will convince the government to pursue a voluntary approach to treating drug addiction.
“There is palpable resistance within the [Ministry of Health] to the project,” wrote Axel Klein, an addictive behavior expert and evaluator at England’s University of Kent, who was hired by the UN Office on Drugs and Crime to evaluate its $1.1 million, one-year pilot drug-treatment program.
Mr Klein’s report noted that an unnamed Health Ministry official believed that “drug users are dangerous and…are the proper preserve of the police,” according to a copy of the report, which was posted to the UNODC’s website.
As part of the UNODC voluntary program, selected communities each set up a team of counselors, relatives and former addicts that tried to talk drug users out of their habit. And rather than immediately arresting users, local police agreed to let program staff address the problem.
The government currently sends addicts to drug-treatment centers, which have been widely rebuked by human rights groups for detaining people arbitrarily, holding them against their will and offering little in the way of genuine treatment.
Hoping to convince the government that there is a better way to treat drug addicts, the UNODC launched the pilot voluntary program for drug users in 10 communes around Cambodia in February 2009. And though the pilot program came to its natural end in March, the UNODC is using it as a model for a similar effort it plans to launch this month in partnership with the government.
In his report, Mr Klein found that some of those health officials who did recognize drug abuse as a health issue believed hospital-based treatment could not work without medication, even though, the report states, “it is widely recognized in treatment circles that there is no strict need for medication at any stage of treatment” for dependence on amphetamine-type drugs.
Mr Klein wrote in an e-mail on Sunday that he found officials understanding of the country’s drug problem to be limited.
“Most of the people in positions of authority that I met, in the NACD [National Authority for Combating Drugs] and the ministries, did not seem to have a good understanding of drug use, what motivates people, what the drug experience is like, what the potential problems are,” Mr Klein wrote.
He also attributed resistance to the voluntary program to a lack or resources.
“One of the problems for health practitioners is that drug treatment eats into their budget and that no clear therapeutic [models] are available,” he wrote. “So some would like not to go there at all [addiction treatment] and leave drug users to their own devices…or leave it to other agencies.”
Graham Shaw, a technical officer on drug use for the World Health Organization in Cambodia, said he found that Mr Klein’s report gave an incomplete account of what UNODC’s pilot program had achieved. Nor did it explain exactly how the $1.1 million was spent, he said.
Mr Shaw also said the Health Ministry was learning to take its share of responsibility for addressing the country’s drug problem.
“Over the last year or more, there’s been a rapid awareness at the [ministry], from the bottom levels to the top levels, that this is a health issue,” he said.
Chhum Sovanarith, director of Banteay Meanchey province’s health department, said the Health Ministry was even pulling together a working group to deal specifically with drug addiction.
“The ministry will train health officials to work on those cases,” he said. “We are not reluctant to do such jobs, but we need training on these cases.”
Since his report, Mr Klein said by e-mail that he had also heard from Health Ministry secretary of state Eng Huot, who insisted that drug addiction was indeed a health issue.
As for the UNODC program itself, Mr Klein praised it for setting up a system for collecting drug-use data. But he also found that the program’s counselors were ill trained to offer treatment and had nowhere to refer serious addiction cases, and that an 11th-hour change in direction—away from centers in favor of community-based counseling teams—alienated other UN agencies.
“Whatever shortcoming,” Mr Klein’s report concludes, “they are all compensated for by the vibrant activity of grassroots teams engaging clients in a constructive and humane process.”
In partnership with the government, the UNODC’s new program will build on the pilot by operating out of existing government health centers and training staff to better treat more severe cases of drug addiction.
The program plans to start with two centers this month, one in Phnom Penh and the other in Banteay Meanchey province.