6/7 Southeast Asia & drugs - Vietnam

Organized crime in Vietnam remains limited and as in other countries of the region, the illicit drug market is mostly non-violent. Arguably for decades, the country drug policies have remained guided by repressive views (1) on the matter, aiming at suppressing drug consumption and illicit markets, mostly in regards to heroin use. With Thailand, Vietnam is the only country of the region who has successively suppressed opium production in the late 1990’s/early 2000’s, through forced eradication “which was possible due to strong state presence and high reach and capacity in opium production areas.” (Windle, 2015) Despite, or probably mostly because of this relative success, heroine and amphetamines use have greatly increased in the last decade. (Nguyen & Scannapieco, 2008)

Vietnam is probably the most pertinent comparative example to the current drug control policy situation in the Lao PDR, giving the profound and historical influence that the country’s political military elite has over its Laotian counterparts. But, while the Lao PDR seems still currently stuck in out-dated policy views on the matter, “Vietnam is currently at a crossroads and significant debate has endured over how to best provide drug treatment” (Baldwin, 2013) to drug abusers.

Part of the difficulty to study policy making in “socialist people’s republics” such as Vietnam or the Lao PDR is that it is “often unclear how policy has been formulated, who has been involved, what the relationships are between different actors and the effects that different policies have on each other.” (Vuong & al., 2012) In practice, the policy making process is almost exclusively handled by the communist political nomenklatura members; and their analysis, merely open to outside scrutiny. However, it could also be argued that drug policy mechanisms “in Vietnam are somewhat similar to those found in pluralistic societies, but operate through a more top-down and hidden process.” (Nguyen & al., 2010)

While the drug control policy framework remains heavily influenced by the 1992 National Constitution (Vietnam, 2010), as well as by “a broad ideological campaign against ‘social evils’” (Baldwin, 2013) - a notion that can be directly linked to the U.N. drug control conventions (Vuong &al., 2012) - the country is currently undertaking vast reforms on the matter, again due in great part to the rise of HIV transmission rate among injection drug users.

Three national ministries are involved in drug policy:

- the Minister of Public Security (MoPS), in charge of enforcing drug policies;

- the Ministry of Labour, Invalids and Social Affairs (MoLISA) responsible for “handling” (2) illicit drugs consumers;

- and finally the Minister of Health (MoH), which has seen its role increase with the current health crisis.

However, despite growing funds being allocated to harm reduction programs (3) from the international community, “government resources remain skewed toward supply and demand reduction activities with scarce national funding being made available for HIV prevention among people who use drugs.” (Baldwin, 2013; Reid & Higgs, 2010)

Current legal framework

“Strongly influenced by the Government’s signature to the UN International Drug Conventions of 1961, 1971 and 1988” (Vuong & al., 2012), the legal sanctions on illegal drug activities in the country resulted in measures that some consider as going beyond the treaties’ requirements. (The Beckley Foundation, 2008) However, in contrast to other countries of the region, such as China and the Lao PDR, the Vietnamese Communist Party only became significantly involved in drug policy around 2005.

This new-fashioned interest was notably due to growing concerns regarding public health, and “leaders of several Communist Party Commissions emerged as strong proponents of including harm reduction in the new HIV law.” (Vuong & al., 2012) As such, and contrary to the Lao PDR, “Communist Party organisations thus became forces for positive policy change in HIV prevention in Viet-nam.” (Ibid.)

The current framework remains nonetheless predominantly focused on sanctions for illicit drug consumption, production and trafficking and the responsibilities of each governmental agency involved in the process remains strictly separated. Three laws form the cornerstone of drug control policy in Vietnam:

• The 1999 Penal Code, reviewed in 2009 (4) and the 2000 Law on Drug Control, define the sanctions for illegal drugs production and commerce, including the capital punishment and mandatory sentences to “drug treatment centers”. In 2009, the Decree on Post Detoxification was added to the Law on Drug Control, mandating a series of provisions for “post-rehabilitation management for an additional period of up to two years for drug users who are at high risk of relapsing” and from which the now-decentralized management is handled by the District People’s Committees (HRW, 2011);

• The 2007 Law on HIV/AIDS Prevention and Control, include the Decree 108 (5) which “authorises health authorities and peer educators to conduct harm reduction activities such as the provision of sterile injecting equipment, protection of peer outreach workers and the provision of MMT to people dependent on opiates.” (Baldwin, 2013. In 2012, the Decree on Opioid Substitution Therapy was added to the Law. It established the operational components of the MMT by the MoH. As noted by several researchers (Hammet & al., 2008; Nguyen & al., 2010), the Law on HIV/AIDS directly refers and supports harm reduction practices but does not address the topic of compulsory centers (6) nor questions “the tough-on-drugs spirit of the Drug Law.” (Baldwin, 2013);

• Finally, both signed into law in 2001, the 'National Strategy on Drug Prevention and Control until 2020 with a Vision to 2030' and the 'National Strategy on HIV/AIDS Prevention and Control 2011-2020 with a vision until 2030' form the core of the country’s approach to drug control.

Harm reduction

As noted by several researchers, “the last decade has witnessed a progressive change in the mindset of political leaders in Vietnam around illicit drug use and HIV issues. This has led to adoption of evidence-based interventions and the evolution of drug policy that support the scale up of these interventions.” (Vuong & al., 2012) HIV prevalence rate remains extremely high (around 31,5% among drug users) and this is arguably “due to limited access to effective interventions and impediments caused by the compulsory treatment centre system.” (Ibid)

In 2006, the WHO (2009) reported that 65% of all the reported cases of HIV concerned people who injected illegal drugs. Conducted by the Ministry of Health, the The 2009 Integrated Biological and Behavioral Survey (IBBS) reported that in some regions of the country, more than half of illegal drug injection users were HIV positive (Vietnam, 2009). Furthermore, such users are also overwhelmingly affected by other transmittable disease such as Hepatitis B (80,9%) and C (74,1%) (Quan & al., 2009), as well as affected by premature death linked to heroine overdose which amounts to 27% of causes of death for injection users (Quan & al. 2009a).

Influenced by these dramatic developments, the change of perspective among Vietnamese political elite can be traced back to the mid-2000’s. Back then, an official edict proclaimed that “drug dependence is a chronic relapsing medical condition, not a crime" (Vietnam, 2008) and Article 199 of the Penal code was finally removed in 2009 (7) (Vietnam, 2009a) Needle and syringe exchange programs (NSPs), as-well as Methadone Maintenance Treatment (MMT) became more institutionalized and are nowadays firmly established in many regions of the country.

These changes, “emphasise that while national policy has been stuck, local authorities have moved forward in introducing evidence-based programming with technical assistance and financial support from internationally funded projects.”(Vuong & al., 2012) Nevertheless, the vast majority of these programs remain largely dependent on foreign aid and therefore poses a challenge for Vietnam as donors have reduced "their funding since Vietnam has become a middle income country in 2010." (Palmieri, 2010)

Although, Vietnam’s drug policy is “slowly changing in the face of one of Asia’s worst ongoing HIV epidemics” (Windle, 2015), and despite vast sum invested by international aid agencies, notably in MMT and NPS in the different region of the country, “structural barriers such as mandatory reporting and compulsory detoxification limit access to these services” (Baldwin, 2013) as-well as to the containment of the health crisis.

Compulsory centers

Similar to the Lao PDR, one of the most problematic topic in regard to drug policies remain the cases of compulsory drug detention centers. Several important changes were made in 2008 to the the Law on Drug Control and the Penal Code, including the downgrading of illicit substance possession from a criminal to an administrative offense.

The revised Law declares that drug consumption is to be considered as a social issue, scaling down from the moral ground on which the precedent Law was build. Providing treatment for illicit substance users has therefore become a requirement of the new drug policy strategy. First, from a still overused compulsory treatment centers process, to a current slow, but noticeable transition towards a voluntary and community based system.

In 2012, the Law on the Handling of Administrative Violations was enacted, which outlined the process (8) which send people to compulsory centers. Essentially, the Law “targets people dependent on drugs who do not have a fixed address or who have returned to drug use following community-based detoxification.” (Baldwin, 2013) There is no clear definition of what is a “drug dependence” and often, a conclusive urine test is evidence enough to send someone to a centre.

As noted by several researchers, there remain an “ongoing political commitment to compulsory treatment centres in Vietnam due to belief in the philosophy behind this approach as well as a variety of motivations and incentives for different government organisations.” (Vuong & al., 2012) Arguably influenced by the ASEAN and therefore committed to being “drug-free” (AIFOCOM, 2010), the country elites still wishs to present progress in regard to that goal.

Governmental agencies involved in the management of the centers have notably seen their budget regularly increased over the years (Vietnam, 2007). Such as financial gains made possible by the commercial contracts ratified by the compulsory centers (HRW, 2011), the government has strong “incentive for keeping the existing centres and building new ones.” (Vuong & al., 2012) For these reasons, many illegal substance users “remain reluctant to access harm reduction services fearing detection by police and detention, thus increasing their risk of HIV exposure.” (Reid & Higgs, 2011)

In 2012, the Law on Administrative Violations - which lays out the framework for compulsory detention centers operations - was revised, and the Ministry in charge, the MoLISA, developed “a model of “open” centres, known as the “Renovation” Plan (which is) based on Malaysia’s cure and care centres.” (Baldwin, 2013) In the plan, MMT operations are expanded but the core focus of the policy remains centered on 50 compulsory centers beyond the 2020 horizon. In this regard, despite growing concerns among the international community, Vietnamese authorities still run 121 facilities, retaining approximatively 35,000 inmates in 2013 (Baldwin, 2013).

Civil society

Mass organizations such as the Vietnam Women’s Union, which are presented by officials as civil society organizations, are seen by many as merely an extension of the state capacities. As funding and staff of such organizations are exclusively coming from the government, civil society remains relatively new in the country. However, these organizations are rapidly growing in capacity, scope and in the number of implicated participants.

Organizations such as the Vietnam Civil Society Partnership Platform on AIDS (VCSPA), founded in 2007, “brings together formal and informal civil society organisations that share an interest in combating HIV.” (Vuong & al., 2012) As such, “while the involvement of civil society in social and political processes is still new, the government appears to be increasingly receptive to this development, particularly with respect to HIV/AIDS prevention and control.” (Khuat, 2007)

Despite the involvement of such organizations in the drafting of the 2006 HIV Law and Decree 108, political inclusiveness remains low in national drug policy making. A 2009 study by the Open Society Foundation, revealed that “few civil society respondents were aware of the content of the national drug control policy and their knowledge about drug addiction treatment was limited.” (OSF, 2009) As reported by the foundation, civil society organizations had never been formally included in the development of drug control policies (Ibid.).

While drug policy processes in the country remain opaque, in the face of the most dreadful HIV epidemic of the region, “alternative approaches to drug policy are being considered by some parts of the Government and debates about how to best help people who use drugs are becoming more open.” (Baldwin, 2013) Perhaps the most detrimental and problematic policy remains the compulsory detention of drug users in the infamous 06 Centers all around the country. Intertwined with human rights violations, the concept induces stigmatization and abuse of consumers by law enforcement forces (Windle, 2015) and greatly limits the positive evolution of the political elite in regard to harm reduction services.

As in other countries of the region, drug use and abuse are conflicted. But, “one of the lessons of the Vietnamese experience is the value of scientific evidence for policy advocacy.” (Vuong & al., 2012) This notably shows, and is particularly relevant for the Lao PDR, that countries which take a pragmatic approach to the issue can shift from blindfolded ideological views in order to develop evidence based drug policies, even in the midst of a communist type regime where by definition civil society remains weak.

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1) “in contravention of international human rights norms” (Windle, 2015a).

2) The Vietnamese term “quản lý” loosely translates into “management”. However, this can differ in meaning from “administrative monitoring” to “social control”.

3) “such as the supply of sterile injecting equipment, peer education, HIV testing and treatment as well as MMT.” (Baldwin, 2013)

4) In theory, the revised drug law is a marked divergence from the 1999 Penal Code that defined illicit drug use as a criminal activity (Vietnam, 1999). However, the Law on Administrative Sanction stipulates that people who relapse due to drug use following compulsory community based detoxification, or people found to be drug dependent and without a fixed address will be subject to detention in centers for a period of up to two years.

5) Through an participatory process which included civil society organizations and organized groups of people infected by the HIV, the Vietnamese government developed Decree 108 in 2007 as a guideline for the implementation of the HIV/AIDS Law. “Although it does not meet expectations of all the activists including people living with HIV and civil society organisations, the content of the Decree shows that some critical comments from the consultations were taken seriously.” (Vuong & al., 2012) Such, “Decree created a crucial legal corridor for the implementation of a harm reduction programme for drug users.” (Ibid.)

6) As explained by Simon Baldwin (2013), “the compulsory detention of people who use drugs remains a major policy issue in Vietnam.”

7) “The revision recognises people who are addicted to drugs as patients rather than criminals; this means illicit drug users should not be arrested and imprisoned for drug use. However, under the Ordinance on Administrative Violations, illicit drug use is still considered an administrative violation with illicit drug users subject to being sent to compulsory centres for 2 years. This means that even though illicit drug use has been decriminalised since 2009, there has been no difference in the way drug users are dealt with by the operational police and community leaders at the local level.” (Vuong & al., 2012)

8) Article 96 of the Law states that “Individuals subject to placement in compulsory drug rehabilitation facilities shall be drug addicts aged full 18 or above who have been educated at communes, wards, or district towns but are still addicted, or have not been so but do not have a permanent place of residence.”

• (AIFOCOM, 2010) ASEAN Inter-Parliamentary Assembly, Report of the seventh meeting of the AIPA fact-finding committee (AIFOCOM) to combat the drug menace, 2010.

• (Baldwin, 2013) S. Baldwin, "Drug policy advocacy in Asia: Challenges, opportunities and prospects. Cambodia - China - India - Indonesia- Lao PDR - Malaysia - Myanmar - Phillipines - Thailand - Vietnam", International Drug Policy Consortium, 2013, http://www.aidsdatahub.org/sites/default/files/publication/drug_policy_advocacy_in_asia_2013.pdf, Accessed: 12/05/15.

• (Hammet & al., 2008) Z. Wu, TT. Duc, D. Stephens, S. Sullivan, W. Liu, Y. Chen, D. Ngu, & DC. Des Jartais, ‘’Social evils’ and harm reduction: The evolving policy environment for human immunodeficiency virus prevention among injection drug users in China and Vietnam’, Addiction, 103 (1): 137-145, 2008.

• (HRW, 2011) Human Rights Watch, "The Rehab Archipelago: Forced labor and other abuses in detention centers in Southern Vietnam", New York, Human Rights Watch, 2011.

• (Khuat, 2007) T. H. O. Khuat, "HIV/AIDS policy in Vietnam. A civil society perspective", New York, Open Society Institute, 2007.

• (Nguyen & al., 2010) H. Nguyen, A. Pharris, T. Nguyen, N.T.K. Huong, B.R. Chuc, & A. Thorson, ‘The evolution of HIV policy in Vietnam: From punitive control measures to a more rights-based approach’, Global Health Action, 3: 1-10, 2010.

• (Nguyen & Scannapieco, 2008) T. V. Nguyen, & M. Scannapieco, “Drug abuse in Vietnam: A critical review of the literature and implications for future research”, Addiction, 103(4), 535–543, 2008.

• (OSF, 2009) Open Society Foundations, "At what cost? HIV and human rights consequences of the global “war on drugs”", International Harm Reduction Development Program, Public Health Program, 2009.

• (Palmieri, 2010) S. Palmieri, “Representation from the top: Ethnic minorities in the National Assembly of Viet Nam”, 2010.

• (Quan & al., 2009) V. M. Quan, V. F. Go, L. V. Nam, A. Bergenstrom, N. P. Thuoc, J. Zenilman, “Risks for HIV, HBV, and HCV infections among male injection drug users in northern Vietnam: A case–control study”, AIDS Care, 21(1), 7–16, 2009.

• (Quan & al. 2009a) V. M. Quan, N. L. Minh, T. V. Ha, N. P. Ngoc, P. T. Vu, D. D. Celentano, “Mortality and HIV transmission among male Vietnamese injection drug users”, Addiction, 106(3), 583–589, 2009.

• (Reid & Higgs, 2010) G. Reid, & P. Higgs, ‘Vietnam moves forward with harm reduction: An assessment of progress’, Global Public Health: An International Journal for Research, Policy and Practice, 6 (2): 168-180, 2010.

• (The Beckley Foundation, 2008) D. Barrett, R. Lines, R. Schleifer, D. Elliott & D. Bewley-Taylor, "Recalibrating the regime: The need for a human rights- based approach to international drug policy", The Beckley Foundation Drug Policy Programme, 2008.

• (Vietnam, 1999) National Assembly of Vietnam, The Penal Code of Vietnam, 1999.

• (Vietnam, 2007) Economic and public health analysis of institutional and community responses to injecting drug use and HIV/AIDS in Vietnam, DSEP/MOLISA (Department of Social Evils Prevention of Ministry of Labour, Invalid and Social Affairs), Hanoi, 2007.

• (Vietnam, 2008) National Assembly of Vietnam, Report no. 599 of 7 May 2008 on the appraisal of the Amended Drug Law. Hanoi: Committee of Social Affairs, 2008.

• (Vietnam, 2009) Preliminary results from the second round of the HIV/STI Integrated Bio- logical and Behavioral Surveillance (IBBS) in Viet Nam 2009. Viet Nam Ministry of Health, 2009.

• (Vietnam, 2009a) National Assembly of Vietnam, The amended penal code of Vietnam, 2009

• (Vietnam, 2010) Overview of the impact of policies on drug rehabilitation treatment on its implementation in Vietnam. Ministry of Labor Invalid and Social Affairs of Vietnam, 2010.

• (Vuong & al., 2012) T. Vuong, R. Ali, S. Baldwin, & S. Mills, ‘Drug policy in Vietnam: A decade of change?’, International Journal of Drug Policy, 23, 319–326, 2012.

• (WHO, 2009) Assessment of compulsory treatment of people who use drugs in Cambodia, China, Malaysia and Viet Nam: An application of selected human rights principles, Manila, (2009), http://www.wpro.who.int/publications/docs/FINALforWeb_Mar17_Compulsory_Treatment.pdf, Accessed 03/11/15.

• (Windle, 2015) J. Windle, Drugs and Drug Policy in Thailand, Foreign Policy at Brookings, Improving Global Drug Policy: Comparative Perspectives and UNGASS 2016, http://www.brookings.edu/~/media/Research/Files/Papers/2015/04/global-drug-policy/WindleThailand-final.pdf?la=en, Accessed: 30/10/15.