The political and scientific challenges in evaluating compulsory drug treatment centers in Southeast Asia

Abstract

BackgroundIn Vietnam, like many countries in Southeast Asia, the commonly used approach of center-based compulsory drug treatment (CCT) has been criticized on human rights ground. Meanwhile, community-based voluntary methadone maintenance treatment (MMT) has been implemented for nearly a decade with promising results. Reform-minded leaders have been seeking empirical evidence of the costs and effectiveness associated with these two main treatment modalities. Conducting evaluations of these treatments, especially where randomization is not ethical, presents challenges. The aim of this paper is to discuss political challenges and methodological issues when conducting cost-effectiveness studies within the context of a non-democratic Southeast Asian country.MethodsA retrospective analysis of the political and scientific challenges that were experienced in the study design, sample size determination, government approval and ethics approvals, participant recruitment, data collection, and determination of sources, and quantification of cost and effectiveness data was undertaken. As a consequence of the non-randomized design, analysis of patient characteristics for both treatment types was undertaken to identify the magnitude of baseline group differences. Concordance between self-reported heroin use and urine drug testing was undertaken to determine the reliability of self-report data in a politically challenging environment.ResultsWe demonstrate that conducting research around compulsory treatment in a non-democratic society is feasible, yet it is politically challenging and requires navigation between science and politics. We also demonstrate that engagement with the government decision makers in the research conception, implementation, and dissemination of the results increases the likelihood of research evidence being considered for change in a contentious drug policy area.ConclusionsLocal empirical evidence on the comparative cost-effectiveness of CCT and MMT in a Southeast Asian setting is critical to consideration of more holistic, humane, and effective drug-dependence treatment approaches, but the garnering of such evidence is very challenging.

The Development of a Community-Based Drug Intervention for Filipino Drug Users

“…The Philippine government's approach in criminalising illicit drug use and using fear as a means to get people to stop is also not unique. Asian countries such as Vietnam, China, Cambodia, Indonesia, Malaysia, and Thailand likewise adhere to the philosophy of social reeducation and force people who use illicit drugs into compulsory rehabilitation (Vuong et al, 2017). However, the rise in extra-judicial killings and reports that police receive cash rewards for executing drug suspects (Mogato & Baldwin, 2017) is a critical factor that may affect the success of community-based programs.…”

“…The Dangerous Drugs Board (2016) of the Philippines reported that 90% of those who have voluntarily surrendered could be treated in the community (Cepeda, 2016). However, like most countries in Asia, the Philippines has primarily employed compulsory residential treatment in resolving illicit drug use problems (Vuong et al, 2017). Given the overwhelming number of clients, communities have created their own programs consisting of community service (e.g., cleaning, beautification, tree planting, gardening), recreational activities (e.g., sports activities, Zumba, yoga), counselling, and spiritual formation (e.g., bible study, prayer groups).…”

Development of Community-Based Mental Health Interventions in The Philippines: An Ecological Perspective

“…Unfortunately, the Philippines did not have a history of community-based drug rehabilitation (CBDR). Like many countries in Asia, illicit drug use was treated primarily using incarceration or through residential treatment (Vuong et al, 2017). With over a million potential clients for CBDR, communities were hard-pressed to develop programs.…”

Quality of life as a predictor of time to heroin relapse among male residents following release from compulsory rehabilitation centres in Vietnam

“…The concordance between self‐reported heroin use and urine drug screens was high (80–86% across four time‐points, see Vuong et al . [31]) indicating that CCT participants reported their heroin use reasonably accurately.…”