SIGNIFICANT HEROIN ADDICTION EMERGES IN LAOS FOR

UNCLAS SECTION 01 OF 03 VIENTIANE 000800 SIPDIS SIPDIS DEPT FOR INL/AAE - BOULDIN DEPT ALSO FOR INL/C/CJ - BROWNE E.O. 12958: N/A TAGS: KHIV LA SNAR SOCI UNCRIME SUBJECT: SIGNIFICANT HEROIN ADDICTION EMERGES IN LAOS FOR THE FIRST TIME ¶1. (U) Summary: Heroin abuse has not been encountered among the Laotian people in the past, but so far in 2007, the principal Lao national drug abuse treatment center at Somsanga has admitted more than 50 acknowledged heroin addicts, at least seven of whom admitted to current injecting drug use. Almost all of the newly-discovered heroin addicts came from a few villages in the same mountainous region of Houaphan Province, adjacent to the border with Vietnam, and the majority were Lao-Hmong. Addicts reported being introduced to heroin by Hmong dealers from Vietnam. Most reported having shared needles and/or using needles scavenged from medical clinic waste; most female addicts were also involved to some extent in commercial sex. UNODC and Lao authorities have begun an urgent survey to try to determine the full extent of this new aspect of illegal drug abuse. The capacity of Somsanga treatment center, already overburdened with methamphetamine and opium addicts, is stretched very thin by this new group, and the few qualified Lao drug abuse treatment professionals have no real experience in dealing with heroin addiction. This substantial increase in injecting drug abuse also greatly enhances the risk of more extensive transmission of HIV/AIDS, hepatitis, and other blood-borne and sexually transmitted diseases in this country. Action requested: Request that INL/C/CJ seek to identify a US expert with experience in heroin abuse treatment, preferably in the environment of a least-developed country, whom USG could offer for short-term expert consultation with Lao drug abuse treatment specialists. End Summary. ¶3. (U) Prior to 2007, heroin abuse was encountered very rarely among the people of Laos. Abuse of unprocessed opium was very common, especially among ethnic minorities such as Hmong, Mien, and Akha in remote highland areas, who grew opium for both sale and autoconsumption. Abuse of methamphetamines, as reported in Embassy Vientiane INCSRs in the past several years, has reached epidemic proportions. However, abuse of opiates in the refined form of heroin was very rarely seen. The few heroin addiction cases admitted to the main GOL drug abuse treatment center at Somsagna, near Vientiane, were generally Chinese or Vietnamese immigrants. There have been a number of heroin overdoses involving foreign tourists, several of which have been fatal because of the high purity of heroin available in the region. However, heroin addicts who were Lao nationals (both ethnic Lao and ethnic minority groups) had not previously been reported. ¶4. (U) During 2007, this changed dramatically, with admission of at least 56 admitted heroin addicts since the beginning of the year to the Somsagna treatment center alone. Most of this new cohort arrived at Somsagna as part of three lots of drug abusers moved there by Lao authorities by truck from Houaphan Province, on the border with Vietnam. (Note: Houaphan in the 1990's was one of the major poppy growing regions in Laos, and was the location of the first INL-funded Lao-American poppy reduction project, which operated there for ten years beginning in 1989. At that time, the province had a long history of large-scale opium abuse, but no reported incidence of heroin addiction at all.) The first such group consisted of 22 addicts who arrived in May, the second of 42 addicts arrived in August and the third, with 37 addicts, on September 20. Fifty-one of the 101 patients who arrived in these three movements were addicted to heroin; at least seven admitted to recent injecting drug use. (NAS officers observed apparently-fresh needle marks on arms or legs of several females and at least one male who participated in detailed interviews.) ¶5. (U) On October 2, NAS Director and staff accompanied UNODC Laos Country Rep and staff members, along with the Acting Deputy Chairman of Lao National Commission on Drug Control and Supervision (LCDC) to Somsanga to discuss this new group with treatment center staff, and to interview some of the newly-arrived heroin addicts. During initial discussion with Somsagna Director and staff, the Director emphasized both the extent to which these new arrivals had strained his already-overburdened treatment capacity, and the fact that the existing staff at Somsanga had no experience in dealing with the addiction syndrome exhibited by heroin abusers, which differs markedly from that of opium or methamphetamines users, with which his staff were familiar. The Director noted that before arrival of these most recent groups, he had already been dealing with a patient population of over six hundred, and he had only three qualified drug abuse counselors to work with them all. VIENTIANE 00000800 002 OF 003 ¶6. (U) Interviews with the 51 recently-arrived heroin addicts from Houaphan by UNODC and Somsanga staff found an age range of 26 to 55 years. All were members of the Hmong ethnic minority. (Comment: Interviews with addicts for the most part had to be translated from Hmong to Lao for the entire visiting group, and then into English. End comment.) Most claimed their primary occupation as upland subsistence farmers, in Xieng Kor, Sao Bao and Van Vieng districts of Houaphan Province. Ten of the group were female. All of those interviewed reported having used, or being addicted to, opium before having been introduced to heroin. ¶7. (U) In these interviews, addicts reported an "alarming" extent of heroin addiction, speaking of several villages in Houaphan Province in which every family has at least one heroin addict in the house. In most villages, according to those interviewed, addicts go to the houses of dealers and buy drugs freely there. Reportedly, in such villages, injecting drugs is not seen as behavior that should be concealed, although most residents are aware that the practice should not be seen by district or provincial authorities. According to those interviewed, opium was still cheap enough two years ago to be the commonest form of abuse. When heroin was found, it was typically used for smoking ("chasing the dragon", in vernacular phrase). However, when the price of unprocessed opium began to rise as its availability diminished, Vietnamese Hmong dealers encouraged opium users to switch to heroin and taught them how to inject heroin intravenously to increase its impact. (Comment: According to these addicts, the average cost in their region of heroin for a day is about 25,000 kip, or not quite three U.S. dollars. Opium, which is normally smoked two or three times per day, can now cost several times that much for each use, where one heroin injection per day is enough for most users. Those interviewed said this relative economic advantage of using heroin was emphasized by the dealers selling it. End Comment.) ¶8. (U) Addicts, including those interviewed with NAS officers attending, reported that, generally, heroin addicts in such villages used syringes or needles scavenged from waste at local health centers or hospitals or needles that had been used and discarded by other users. Most addicts made some minimal attempt to clean such needles by wiping them with alcohol before re-using them. Some addicts reported a practice of injecting water from water pipes used by other persons to smoke heroin. (Comment: As UNODC observed, these practices, along with the number of female addicts involved in commercial sex, may lead to a significant increase in HIV/AIDS, hepatitis, or other blood-borne or sexually-transmitted diseases. End Comment.) ¶9. (U) Most of the heroin addicts admitted to Somsagna this year, as noted above, have been Hmong from Houaphan Province, and most have previously used opium for lesser or greater periods. However, UNODC reported interviewing one young female heroin addict from Luang Prabang who described a group of 13 young people, none with any previous history of opium use, all of whom had taken up heroin use for recreation. Dr. Khamnoan Hsam, drug demand reduction consultant to UNODC Laos, told Acting NAS Director October 17 that UNODC and LCDC have initiated an urgent survey effort in Houaphan and nearby areas in an attempt to better define the actual extent and scope of this new problem of heroin addiction. She said, however, that even without having completed this survey, the number of Lao-Hmong heroin addicts newly admitted at Somsanga within the past six months and the reports they had provided of the extent of visible heroin addiction in the areas they came from led her to conclude that heroin abuse is already established as a significant new aspect of the overall problem of illegal drug abuse among both ethnic Lao and ethnic minorities in Laos. ¶10. (U) ACTION REQUESTED: NAS Vientiane requests that INL/C/CJ attempt to identify an expert with experience in treatment of heroin abuse, particularly in socio-economic context (and within the treatment capabilities) of a least-developed country. If the UNODC-LCDC survey confirms that heroin abuse already exists as a significant new problem in Laos, as appears at this point likely, NAS would like to be in a position to promptly offer LCDC the earliest possible opportunity to consult in Laos with a qualified expert in heroin addiction in order to begin to more effectively define and implement treatment protocols and practices appropriate VIENTIANE 00000800 003 OF 003 to this emerging heroin addition problem. HUSO