Withdrawal Symptoms
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Monday, April 23, 2018


Withdrawal Symptoms


A Burmese man and woman shoot up in a backstreet in the Chinese border town of Ruili. (Photo: Nic Dunlop/Panos)

The days of the opium pipe are passing. Nowadays, more Burmese drug users are injecting heroin—while youngsters opt for methamphetamines

THERE has been a substantial reduction in opium poppy cultivation in the mountainous regions of northern Burma over the past 10 years. The prime factors for this are Chinese pressure on local ceasefire authorities and the Burmese military government’s decision to comply with Asean’s target to make the Golden Triangle region drug-free by 2015.

However, the idea that a reduction in opium production automatically leads to less drug use does not hold for Burma. Instead, the scarcity of opium and heroin has led drug users to shift back and forth between different substances.

Less cultivation has led to an increase in the price of opium and heroin, and a progressive pattern from smoking opium to smoking heroin to injecting heroin has emerged.

A man in Kachin State smoking opium in a pipe. (Photo: SKT)
So, while the numbers of opium and heroin users may be going down, a new and expanding group of drug users is becoming involved in the most problematic form of opiate consumption—intravenous drug use, with its consequent risk of HIV and other blood-borne infections.

The price of opium and heroin varies according to season and region, indicating that the market is fragmented and in disarray.

Over the past three years, opium prices in Kachin State have doubled on average. Raw opium seldom sells for less than US $1,000/kg, and for best quality dry opium prices are as high as $1,400 to $1,600/kg. In southern Shan State, where production has increased significantly in the past two years, raw opium “farm gate” prices have remained relatively stable at around $200 to $300/kg, while the price at the Thai border can reach $650.

And while the price has increased, the purity of heroin has decreased, as dealers typically mix it with cheaper substances.

“In the past, 5 yuan ($0.73) a day would be enough to support a heroin habit,” said a drug user in Ruili on the China-Burma border. “Now we have to spend at least 15 yuan ($2.19) a day.

“People have started to inject it, because they have no money and injecting is cheaper,” he said. “Many begin by smoking heroin, but quickly realize the cost-effectiveness of injecting, where they can achieve a stronger effect from a smaller amount.”

One of the main causes of the HIV/AIDS epidemic in Burma is the sharing of contaminated needles among drug users. Though some international NGOs are active in this field, most addicts do not generally receive counseling on safer consumption patterns and safe sex practices, and there exists little in the way of treatment to reduce or end their drug use.

Ensuring wide availability of condoms and sterile needles and syringes, and offering substitution therapy with methadone or buprenorphine would be the first logical and necessary step.

In Burma, the law still prohibits the provision and possession of needles and syringes without a license. In practice, though, needle exchange occurs daily. Twenty-four locations currently operate in Burma. A pilot scheme for methadone treatment started in 2006, but so far just six centers have opened.

According to the latest estimates of UNAIDS, only 3 percent of injecting drug users in Southeast Asia have access to such harm reduction services. One international NGO estimates that more than 40 percent of all intravenous drug users are HIV-positive in Burma.

In Burma, few drug users receive anti-retroviral treatment (ART) for HIV/AIDS. “Drug users are excluded from ART, apart from a few show cases—maybe 20 persons,” said an NGO representative.

Methamphetamine pills (ya ma or myin say in Burmese slang) have clearly become the drug of choice for many of the newer generation.

“Fewer and fewer people in Rangoon use heroin,” said a drug user working for a local self-help group. “It is not easy to find and the price is high. Most people use ya ma nowadays. It’s easier to get hold of. People are trying out new drugs because they cannot find heroin. Some kids even sniff glue and diesel.”

Amphetamine-type stimulants (ATS) first came into wider  use in Rangoon at the end of the 1990s, he said. “At that time, they were very cheap. Young people took the pills at nightclubs. Businessmen, high school and university students and truck drivers also took them,” he added.

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