A comment from a reader in response to the article on drug use in the Irrawaddy yesterday and posted as [him] 2743. I agree with these points.
Jamie
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A welcome piece in the Myanmar Irrawaddy news-outlet, though with a striking stigma issue and ignoring established evidence.
The well written article concludes with "Drug addiction is a chronic disease and addict should be considered as patients"
On all levels this oversimplifies drug dependency and contributing to deepening stigma and ignores the overwhelming evidence that dependency is a multi-layered medical and psycho-social phenomena, also it is important to realize that the fast majority of drug users (90%) do not develop problematic drug use.
The term 'addict' symbolizes for many harsh stigma and is a curse for many individuals being spit on, despised, incarcerated and killed by societies. Many hold the notion that drug dependency is just a medical issue or a brain disease in which neural circuits are the predominant factors.
In response the American Psychiatric Association (APA) and WHO argued that the term addiction did need to be superseded by a more clinically sound term. The APA updated DSM-5 (the standard classification of mental disorders) with a single category: substance use disorder, widely regarded as less ambiguous and clinically sound.
An important nuance however is that there is overwhelming evidence that criminalisation is the root cause and factor of perpetuated problematic drug use and are actively deepening stigma of drug users. It is established that criminalisation and mass imprisonment of drug users is the critical cause of distortions in a person’s connections with loved ones, families, communities.
In the case of Myanmar it is important to recognize massive injecting drug use as a social phenomena, the incidence of HIV and other bloodborn infections remains unacceptably high for persons who use drugs.
Coverage of HIV prevention services for people who inject drugs is too low to have an impact on the HIV epidemic. A worrisome conclusion, people who inject drugs living with HIV have been found to be more than twice more likely to contract tuberculosis than people from other key populations living with HIV.
Myanmar is confronted with an unprecedented concentrated epidemic among people who inject drugs, the fast majority of infection occur in hard-to-reach rural conflict areas, where there is little to no preventive health or treatment available, this opposed to an urban reality in most other parts in the worlds. A wide range of complex social, economic, risk-taking and access factors drive the HIV epidemic in the conflict areas and war zones in Myanmar.
Currently not only coverage is low, but scaling down of Harm Reduction interventions might actually take effect in most critically affected areas in Myanmar.
Under-investment in HIV prevention for people who inject drugs is often not a question of a lack of resources; rather a matter of priority setting (treatment over prevention, urban over rural) or allocation (criminal justice over public health systems).
Summarizing, Science need to drive evidence-based decision-making. Drug dependency is a multi-layered medical and psycho-social phenomena, that as matter of principle and policy this issue needs to be looked at from a rights-based angle. It is important to acknowledge that any (public health) response will fail without destigmatization and respect and decriminalisation of drug use.
Especially in Myanmar increased investments in harm reduction in rural areas need to take effect, additionally efforts alternative drug treatment options and ample public and educational campaigns are critical steps in mitigating this under-reported national crisis.
