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The Lao PDR - The Compulsory Drug Detention Centres (CDDCs) - 4/4 What is being done to change cour

  • Benjamin-Alexandre Jeanroy
  • Jun 13, 2016
  • 7 min read

On October 2012, a workshop on drug policy sponsored by UNODC, the U.N. Economic Social Commission for Asia and the Pacific, and UNAIDS, which was attended by Lao PDR and eight other Asian countries, presented potential reforms regarding CDDCs: “Countries agreed to decrease the numbers of compulsory detention centers and the number of people being detained in such centers” (Amon & al., 2014), but “at a rate to be determined by the country.” (UNAIDS, 2012 para. 14) Three years later, the Third Consultation on Compulsory Centres for Drug Users (CCDU), organized by UNODC, UNAIDS and U.N. Economic and Social Commission for Asia and the Pacific (ESCAP), took place in Manila, Philippines, in September 2015. Participating countries included Cambodia, China, Indonesia, Malaysia, Myanmar, Philippines, Thailand, Vietnam - all of whom have or had CDDCs at one point - and for the first time since the beginning of the conferences, Lao PDR hold an “observer” status seat. In the past, the country had been invited to the conference but had always refused to send any representative.

The reason behind this decision perhaps lied, as again and often in the region, in the words that are publicly used to describe social phenomenon. Because the Lao PDR does not officially run “compulsory centers", there is no reason for its governement to send representatives to a conference which very name clearly state otherwise (1). However in 2015, by mistake, inadvertence or political flair, the invitation to the conference was sent to the Lao PDR Minister of Health (MoH) instead of the Minister of Public Security (MoPS). The former accepting the invitation, when the latter always disregarded it. Upon learning of it, the acting Chairman of the LCDC - which is part of the MoPS - Mr. Kou Chansina, was far from being thrilled (2). To avoid embarrassing retraction, a compromise was found as the Lao PDR would officially be present at the meeting but only as an “observer”. The government additionally sending non-english speakers with orders not to make any intervention whatsoever. This anecdote remains revealing as to the length of the road that the Southeast Asian country has yet to make to leave the concept of the CDDCs behind.

However, in parallel to the centers, is being moderately developed (3) another form of “drug-treatment” under the concept of Community Based Treatment (CBT). CBT is a long-term, group-based drug-free approach, that is usually provided through residential treatment facilities. The community environment theoretically providing peer influence to foster responsibility and respect, in order to improve attitudes, social skills and overall behaviors. As defined by the U.N. Economic and Social Commission for Asia and the Pacific (ESCAP, 2015), “Community Based Treatment refers to a specific integrated model of treatment for people affected by drug use and dependence in the community which provides a continuum of care from outreach and low threshold services, through detoxification and stabilisation to aftercare and integration, including maintenance pharmacotherapy. It involves the coordination of a number of health, social and other non- specialist services needed to meet the patient’s needs. Strong support is also given to the patient’s family and the community to address the drug and alcohol problems in their complexity and to ensure efficient and long-term results.” Supported by UNODC (4) and foreign donors (5), this approach is potentially holding key, to sustainable and human rights preserving solutions for the perceived issue of drug abuse.

The “Community-based drug treatment models for people who use drugs” Harm Reduction International Report (HRI, 2015), lists the common elements of Community-based treatments found in the analysis of experiences in six Southeast Asian countries (Cambodia, China, India, Indonesia, Malaysia and Vietnam), namely:

  • Voluntary access;

  • Client-centered approach/Located in the community;

  • Meaningful involvement and empowerment of people who use drugs and civil society;

  • Comprehensive health and psychosocial care services;

  • Medical guidelines, oversight and continuity of care;

  • Drug policy reform and leadership;

  • Coordination with law enforcement.

Source: (ESCAP, 2015)

The concept as we can see with the diagram, is centered on the “patient”, and is rather different from what the CDDCs approaches to drug-related treatment are. However, the concept is still widely underused in the Lao PDR and often, the few available practitioners run in conflict with local authorities, which can significantly reduce the reach and the pertinence of such approach. Even the prohibition-lead ASEAN acknowledges that “drug user rehabilitation in a number of rehabilitation centers and communities still lacks the outreach an effectiveness.” (AIFOCOM, 2014)

In this regard, we could argue on one hand that the limited experiences in CBT approaches are permissible by the Lao PDR authorities because of the growing international community public pressure. And while it allows for the start and development of best practices, the Lao PDR government is still keeping the CDDCs open, planning to open new ones. On the other hand, analysts argue that the centers remain a necessity, in order to maintain the illusion of “desirable security” to appease a specific segment of the population, and that slowly, the flow of patients could theoretically follow there (6). But this remains to be seen.

Numerous challenges still impede the progress in transitioning from compulsory drug detention centers to community-based treatment. First, the lack of security in the funding of harm reduction services remain a key challenge for service providers and patients, as well as for local and national policy makers advocating for the transition. Furthermore, human resources, “both in terms of volume of available workers as well as in regards to the capacity and attitudes of drug treatment service providers” (HRI, 2015) remain limited. Finally, while in theory the meaningful participation of patients is required in the design and implementation of the services, in practice, many models still fail to do so.

In 2014, the AIPA counted in the Lao PDR “eleven standard and non-standard re-habilitation and vocational training centers, while two are under construction and additional three are in the pipeline.” (AIFOCOM, 2014) Without lingering on an improbable definition of a “non-standard re-habilitation and vocational training center”, the statement of the ASEAN parliamentary assembly allows us to observe the casual trend on which these centers are floating. With an ever ending supply of potentially “treatable” individuals, the demand for these new centers will be met. After all, if “after being discharged by (the) centers, a number of beneficiaries” find themselves “healthy and able to reintegrate into the society” (AIFOCOM, 2014), others will still be able to experience again the conditions of “treatment” offered by the centers. Arguably, without proper medical attention, the “rehabilitation” programs in substances users detention centers in Lao PDR remains a blend of “punishment, social control of “undesirable” populations, and profit from forced labor.” (HRW, 2012)

Additionally, in spite of a call in march 2013 from twelve U.N. agencies to cease the activity of the centre “without delay” (UNAIDS, 2012), little practical progress has been made towards ending the arbitrary detention of drug users and expanding effective, community-based, voluntary drug dependency treatment. In many ways, foreign donors are still supporting the programs by building on their capacity and reducing operating costs. The roles of UNODC and major donors still remain, potentially problematic. As Simon Baldwin remarked in a 2013 IDPC advocacy note: “while some actors have called for the closure of the centre, other organizations such as UNODC and Bureau of International Narcotics and Law Enforcement Affairs (INL) have advocated for improving the quality of services delivered within the centre.” (Baldwin, 2013) This is notably the position of the U.S. which advocates that ameliorating the conditions of treatment of the inmates should be the priority. In this regard we could question the truthfulness, willingness and dedication of the U.N agency to ultimately end these outdated practices.

As Michel Foucault famously theorized, “a dominant discourse or a « regime of truth » is held to impose critical limits upon our ability to think politically about particular problems faced.” (Foucault, 1980) In this regard, and similarly to claims of the international agency not to have known before and not to partake today in CDDCs’ activities, observations, analysis and critical point of view are necessary in regard to what the U.N. agency use to validate the current IDCR.

 

(1) The official policy of the country is to claim the centers work on a voluntary basis.

(2) Interview conducted on the 15/10/15 with UNODC Consultant.

(3) “Government drug addiction treatment facilities lack the resources to provide evidence-based treatment and post-discharge follow-up. However, the Lao government has begun to introduce community-based treatment for users and actively coordinates with the donor community on improving conditions.” (U.S. INCSR, 2015)

(4) “U.S. funding also supports a UNODC pilot project on community-based treatment for ATS users.” (U.S. INCSR, 2015)

(5) “To support demand reduction efforts, the United States supports adoption of community based treatment and the study of best practices from different treatment modules for Lao consideration. The United States provides funding to UNODC and the World Health Organization (WHO) to develop treatment services for local communities, while concurrently working to integrate these services into Laos’ public health system. In conjunction with this effort, UNODC and WHO are also working to share evidence-based practices and the latest research on treatment of substance abuse with the government and treatment professionals. The U.S. government is additionally funding vocational training for those recovering from substance use disorders to provide sustainable means of livelihood and recovery.” (U.S. INCSR, 2015)

(6) Interview conducted on the 15/10/15 with UNODC Consultant.

(7) Informal interview with U.S. Embassy personnel in Vientiane on 14/10/15.

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