Promoting harm reduction and community-based treatment to ensure a health-based response to drug use in Cambodia

By Sreang Chheat

Speaking on the UN International Day against Drug Abuse and Illicit Traffickingon June 26 in 2016, Cambodia’s Prime Minister Hun Sen emphasised the role of local communities and authorities in responding to drug-related issues, and strongly encouraged the promotion and strengthening of quality community-based treatment and rehabilitation services. His apparent support for a shift towards drug dependence treatment services that do not involve coercion and detention, seemed to align with the government’s approval of Cambodia’s first five-year National Strategic Plan for Harm Reduction 2016-2020(NSPHR) in 2016.

However significantly increasing rates of arrest for drug-related offences, and subsequent detention or imprisonment, in recent years indicate the use of punitive measures that pose barriers to implementation of voluntary treatment and harm reduction services. Annual rates of arrests for drug-related offences (including of people who use drugs) in Cambodia have increased three-fold over three years: from 3,142 in 2014, to 7,008 (including 853 women) in 2015, to 9,933 (including 964 women) in 2016. During the first six months of 2017, more than 9,600 people were arrested for drug-related offences—almost the same number of people arrested in the previous year—of whom more than 50% were reportedly people who use drugs. Furthermore, in 2016, the government declared that 2,599 people who use drugs were detained in public and private rehabilitation centers despite the government’s rhetoric of strong support for quality community-based treatment programmes.

A 2012 estimate of the numbers of people who use drugs in Cambodia amounted to 13,000 people (with a range of 12,000 and 28,000 people), including approximately 1,300 people who inject drugs, who mainly reside in the capital city Phnom Penh. Government data show a 24% rise in the number of people who use drugs, from 16,575 people in 2015 to 20,621 people in 2016, with the majority (71%) using crystal methamphetamine and increasing rates of use in some rural areas. People who use drugs are at high risk of health and other harms associated with their criminalisation and punitive policy measures, as indicated by the following:

In 2012, the HIV prevalence rate among people who use drugs was 4% and 25% among people who inject drugs, far higher than the 0.6% HIV prevalence rate among the general population in 2015

61% of people who inject drugs are aware of HIV testing, and 32.7% took the test at least once. But only two out of 51 people who inject drugs are aware of the availability of needle and syringe programmes (NSPs)—a critical HIV prevention measure for people who inject drugs—and 52% of people who inject drugs have shared needle/syringes with their friends, which significantly increases the risk of HIV transmission, and

Almost half of those who are believed by Cambodia’s national drug control agency, known as the National Authority for Combating Drugs, to be drug dependent (estimated at 8,822 for 2015, and 9,020 for 2016) are not accessing treatment services.

It is in this context that this paper seeks to contribute to understanding of existing policies related to harm reduction in Cambodia, as well as the challenges to and opportunities for improvement in order to reduce the health and socio-economic harms associated with drug use. Following analysis of relevant policies and their implementation this paper identifies a clear need to harmonise policies on drug use and harm reduction so that health and socio-economic benefits can be maximised for both individuals and society at large.