ETHNIC MINORITIES, DRUG USE & HARM IN THE HIGHLANDS OF NORTHERN VIETNAM A Contextual Analysis of the Situation in Six Communes from Son La, Lai Chau, and Lao Cai July 2003 This book was prepared in the framework of a UNODC project but the views expressed therein are those of the authors and do not necessarily reflect those of the UNODC Principal Author: Ami-Jacques Rapin, Ph.D. Coordinator and Editor: Jason Eligh, MA Field Research: Dao Huy Khue, Ph.D. Dong Ngoc Duc, MA John Eyres, Ph.D. Vi Cuong Tran Peter Higgs, MPH Nguyen Van Duan And 72 local ethnic minority peer workers Translation: Pham Huy Tien, M.D. Nguyen Tien Hung Ho Thi Xuan Hong Nicholas Stedman, MA Valérie Lesbros, MA Hoang Cong Dung, MA Nghiem Trung Kien Donor support supplied by: Acknowledgements We wish to express our thanks and gratitude to the following people and organisations whose enthusiasm and participation made this research possible. We wish to acknowledge the dedicated contribution of the researchers involved in this assessment: John Eyres, Dao Huy Khue, Dong Ngoc Duc, Vi Cuong Tran, Nguyen Van Duan, and Peter Higgs. From CEM, we would like to thank Hoang Cong Dung, Phan Van Hung, Nghiem Trung Kien, Phan Van Cuong, Nguyen Ngoc Ha, and Ho Thi Hoang Anh; and at the UNODC Vietnam Field Office: Doris Buddenberg, Nguyen Thi Ngoc Dung, Nguyen Tuong Dung, and Per Vogel. We also would like to extend our gratitude for the cooperation and assistance of the many central, provincial, district, and commune government and sector leaders, all too many to name here. Special mention should go to the 72 ethnic minority peer workers, who will remain nameless here, but without whose participation, insight and patience none of this work could have been completed. Finally, special thanks are reserved for Ami-Jacques Rapin, whose experience, diligence and attention to detail brought all of this research together. Foreword Living in some of the most remote, isolated and impoverished areas of the country, few other people are more marginalised in Vietnam than highland ethnic minority populations. Their extensive historical participation in the domestic cultivation of opium poppy, accompanied by the development of their formerly isolated environments, has led them to become increasingly vulnerable to complex and embedded drug use environments of risk and harm emerging as a by-product of rapid national economic development. Unfortunately knowledge of the risks inherent to these changing drug use behaviours, including HIV and other blood-born viruses, is largely non-existent, and little drug use and harm prevention and intervention work has been attempted with regard to the specific needs and cultural characteristics of these populations. In recognition of the unforeseeable health implications of this situation, the Vietnamese government Committee for Ethnic Minorities (CEM) and the UNODC have developed and implemented project AD/VIE/01/B85 – Drug Abuse Prevention among Ethnic Minorities in Vietnam (2002-2004). Its aim is to evaluate the drug use environments in these areas, as well as to assess the types and prevalence of risk behaviors, with a goal of devising effective and culturally-appropriate interventions to reduce both the overall demand for drug use in these remote border areas as well as drug-related harm as a result of this demand. Subsequently evidence-based research is of paramount importance in order to effectively tackle these goals. Thus the information contained in this research assessment report is one step toward trying to understand the complexities of harm in these transforming environments. Combining a revised rapid assessment methodology with experienced professional researchers, and incorporating the direct participation of local ethnic minority drug users throughout the entire research process, this document gives us a unique insight into the historical, cultural and social contexts of drug use in some of Vietnam’s most remote highland ‘risk environments’. Dispelling myths and challenging contemporary anecdotal accounts of drug use ‘tradition’ within these cultural communities, this assessment demonstrates the beginning of a quest to gain some understanding of the drug use and harm being created in these areas, and represents a first approach in the participatory process of developing culturally relevant intervention materials and activities to mitigate these harms. Doris Buddenberg UNODC Representative, Vietnam iv Table of Contents Acknowledgements.................................................................................................................................... iii Foreword ........................................................................................................................................................ iv Table of Contents........................................................................................................................................... v List of Figures................................................................................................................................................ vii List of Tables................................................................................................................................................... ix List of Acronyms.......................................................................................................................................... xii Executive Summary................................................................................................................................. xiii PART ONE: THE CONTEXTS Historical & cultural contexts of opium and its use in the highlands of Southeast Asia ........................................................................................................................................... 2 Ethnic minority myths & tales...................................................................................... 2 Origins of opium in highland ethnic minority cultures of Southeast Asia........ 11 Introduction of opium poppy cultivation into northwest Vietnam & the case of Deo Van Tri ............................................................................................ 14 The colonial administrative organisation................................................................. 24 The colonial opium monopoly & the indigenous producers................................ 26 Relationships between opium, the Hmong, & other highland ethnic groups ................................................................................. 34 The ambivalences of opium ........................................................................................ 38 1. Therapeutic use of opium............................................................................ 39 2. Recreational/hedonistic use of opium...................................................... 40 3. Excessive use of opium ................................................................................ 41 The problem of smuggling .......................................................................................... 45 From 1945 to the era of Doi Moi................................................................................. 47 PART TWO: VIETNAMESE DRUG-RELATED POLICIES Four Issues of Vietnamese drug-related policy....................................................... 56 1. Eradication of opium poppy cultivation .............................................................. 56 Opium poppy eradication in Son La ............................................................. 65 Opium poppy eradication in Lai Chau ......................................................... 67 Opium poppy eradication in Lao Cai............................................................ 67 2. Trafficking .................................................................................................................. 78 3. Consumption ............................................................................................................. 86 Number of drug addicts listed by the authorities.................................... 86 Types of substances consumed.................................................................... 90 Sociological characteristics of drug addicts .............................................. 92 v Sociological profile of highland drug users .............................................. 95 Becoming a drug addict................................................................................ 99 Public policies towards consumption ...................................................... 103 Social impact of drug consumption.......................................................... 105 4. The HIV epidemic................................................................................................... 106 PART THREE: ASSESSING THE HIGHLAND DRUG USE AND HARM ENVIRONMENTS IN SON LA, LAI CHAU & LAO CAI An assessment of the drug use and harm environments in six communes of Son La, Lai Chau and Lao Cai provinces, Vietnam.......................................... 114 Methodology................................................................................................................ 114 Situation of the research sites Thuan Chau district, Son La province......................................................... 118 Dien Bien district, Lai Chau province.......................................................... 123 Bat Xat district, Lao Cai province................................................................. 129 Results