Tanguay Pascal, Kamarulzaman Adeeba, Aramrattana Apinun, Wodak Alex, Thomson Nicholas, Ali Robert, Vumbaca Gino, Lai Gloria, Chabungbam Anand
Ozone Foundation, Bangkok, Thailand.
University of Malaya, Kuala Lumpur, Malaysia.
Harm Reduct J. 2015 Oct 16;12:31. doi: 10.1186/s12954-015-0071-0.
Evidence indicates that detention of people who use drugs in compulsory centers in the name of treatment is common in Cambodia, China, Indonesia, Lao PDR, Malaysia, Myanmar, Philippines, Thailand, and Vietnam. The expansion of such practices has been costly, has not generated positive health outcomes, and has not reduced supply or demand for illicit drugs. United Nations agencies have convened several consultations with government and civil society stakeholders in order to facilitate a transition to voluntary evidence- and community-based drug dependence treatment and support services. In an effort to support such efforts, an informal group of experts proposes a three-step process to initiate and accelerate national-level transitions. Specifically, the working group recommends the establishment of a national multisectoral decision-making committee to oversee the development of national transition plans, drug policy reform to eliminate barriers to community-based drug dependence treatment and support services, and the integration of community-based drug dependence treatment in existing national health and social service systems.In parallel, the working group recommends that national-level transitions should be guided by overarching principles, including ethics, human rights, meaningful involvement of affected communities, and client safety, as well as good governance, transparency, and accountability. The transition also represents an opportunity to review the roles and responsibilities of various agencies across the public health and public security sectors in order to balance the workload and ensure positive results. The need to accelerate national-level transitions to voluntary community-based drug dependence treatment and support services is compelling--on economic, medical, sustainable community development, and ethical grounds--as extensively documented in the literature. In this context, the expert working group fully endorses initiation of a transition towards voluntary evidence- and community-based drug dependence treatment and support services across the region, as well as the steady scale-down of compulsory centers for drug users.Components of voluntary community-based drug dependence treatment and support services are being implemented in Cambodia, China, Indonesia, Malaysia, and Thailand. However, significant technical and financial support will be required to be allocated from national budgets and by international development agencies in order to complete the transition and reduce the reliance on detention of people who use drugs in Asia.
有证据表明，在柬埔寨、中国、印度尼西亚、老挝、马来西亚、缅甸、菲律宾、泰国和越南，以治疗之名在强制中心拘留吸毒人员的情况很常见。这种做法的扩大成本高昂，并未产生积极的健康成果，也未减少非法药物的供应或需求。联合国机构已与政府和民间社会利益相关方进行了多次磋商，以推动向基于证据和社区的自愿戒毒治疗及支持服务过渡。为支持这些努力，一个非正式专家小组提出了一个三步骤流程，以启动并加速国家层面的过渡。具体而言，工作组建议成立一个国家多部门决策委员会，以监督国家过渡计划的制定；进行毒品政策改革，消除基于社区的戒毒治疗及支持服务的障碍；将基于社区的戒毒治疗纳入现有的国家卫生和社会服务系统。同时，工作组建议国家层面的过渡应以总体原则为指导，包括伦理、人权、受影响社区的有意义参与、服务对象安全，以及善治、透明度和问责制。这种过渡也是一个机会，可审视公共卫生和公共安全部门各机构的角色和职责，以平衡工作量并确保取得积极成果。从经济、医疗、社区可持续发展和伦理角度来看，加速国家层面向基于社区的自愿戒毒治疗及支持服务过渡的必要性十分迫切——正如文献中广泛记载的那样。在此背景下，专家工作组完全支持在整个区域启动向基于证据和社区的自愿戒毒治疗及支持服务的过渡，并稳步缩减吸毒人员强制中心的规模。柬埔寨、中国、印度尼西亚、马来西亚和泰国正在实施基于社区的自愿戒毒治疗及支持服务的组成部分。然而，需要从国家预算和国际发展机构分配大量技术和财政支持，以完成过渡并减少亚洲对吸毒人员拘留的依赖。
