A new road to recovery
Private clinics are offering addicts a better chance of staying clean than harsh state-run centres, writes Jane Moir
Just over an hour's drive from the congested centre of Wuhan , a large alabaster building with a blue-tiled roof and landscaped courtyard sits amid sprawling fields. Flanked by farmhouses, it is accessible only by car or taxi.
Its inhabitants have travelled from around the mainland to enter its doors, staying for up to a week at a time. Their aim is to suppress heroin addiction.
In one room of the Kangjiu clinic, a petite 25-year-old woman with pigtails has just undergone minor surgery to place an implant of naltrexone, a drug that blocks the effect of heroin or other opiates, beneath the skin of her stomach.
One of her neighbours has just undergone similar surgery - for the second time. He wants to make sure it will still have an effect and keep his heroin habit at bay.
Upstairs, fellow patients are playing table tennis or watching TV as they recover from a three- or four-day detoxification process. A large team of medical staff is on standby should they require anything.
Their experience is in stark contrast to the detox process for most of the heroin addicts on the mainland. Placed in state-run drug enforcement centres run by the police, they must suffer the effects of sudden heroin withdrawal, or cold turkey, and the only rehabilitation is forced labour.
Patients at the Kangjiu clinic are paying their way to a cleaner bill of health. For 1,500 yuan they can undergo a detox supervised by medical professionals; a further 12,000 yuan will buy a naltrexone implant.
The clinic is one of a growing number of private drug treatment centres being set up in Wuhan as Beijing gradually relaxes its stance on addiction care from strictly punitive to progressively palliative.
The Hubei capital is taking the lead in becoming a private drug treatment hub. It is a process that has been gathering pace since the unprecedented visit in 2004 of Premier Wen Jiabao to the 1,360-bed Wuhan Drug Abstaining Centre run by the Public Security Bureau. During the visit, Mr Wen highlighted a softer shift in sentiment among policymakers when he said that although drug addicts were flouting the law, they were victims who should be offered a degree of humanity.
'The government has started to put down some practical policies to help,' said Zhang Liwei, associate general secretary of the Amity Foundation, a Chinese non-profit group which promotes health and rural development on the mainland. Chief among them, he said, was its methadone and clean needle policies.
According to a Xinhua report in June, the mainland has 300 methadone clinics, with the number expected to reach 1,000 by 2010.
The government started promoting methadone with vigour in 2003 to curb the spread of HIV/Aids and hepatitis caused by sharing needles. By the end of 2005, the country had 91 free needle exchange centres.
It came against the backdrop of a burgeoning drug problem on the mainland. Although official statistics put the number of registered drug users at about 1.2 million, some experts estimated the figure could be up to 12 million.
Beijing's zero tolerance policy meant local police stations could send users to a drug enforcement centre for between one and three months without trial or judicial process. According to Xinhua reports, there are 583 of these centres.
Mr Zhang recently visited one in Yunnan . 'If a drug addict is found by police, he or she will be sent to these detox centres, the government-run institutions,' he said.
'It is a sort of compound where several people live in one room; they do morning exercises and sometimes they will do other work in there so they can be distracted.'
People also worked on farms, growing potatoes, he said. 'As far as I know, most are young or middle-aged, between 20 and 40 years. One of the reasons they are there is poverty. The other is that drugs are so rampant, people can quite easily get them.'
Sara Davis, founder and director of Asia Catalyst, a New York-based organisation which helps grass-roots human rights, social justice and environmental protection groups, also visited some of the mainland's larger enforcement centres while working with Human Rights Watch in the country.
'Most are very much like prisons,' she said. 'People are forcibly sent to them; they have to do forced labour without pay and are forced to go cold turkey. They also have to chant slogans like 'drugs are bad, I am bad'.'
According to a report by Human Rights Watch, titled Locked Doors, these centres emphasise militarised education for addicts, such as marching in formation and repetitive drills. Conditions are basic and overcrowding is rampant.
NGO workers who contributed to the report described cramped sleeping quarters. In one facility, detainees shared their quarters with pigs. Once released, 95 per cent of the detainees will relapse.
While the conditions at the Kangjiu clinic are hardly palatial, it is a more comfortable option and one that is gaining popularity. About 50 private drug treatment centres have set up in Wuhan - no other city has as many - and most are seeking to turn a profit.
'I think where they are ahead in Hubei province is that they are allowing private treatment centres to set up for detox and putting in implants,' said Wayne Moran, a Hong Kong-based addiction expert. 'There are also treatment centres where they stay for up to a month. It will be interesting to see what happens in the next 10 years, because if this takes off and starts to spread through provinces, we should see more interesting things happening in China.'
Estimates of the number of private drug treatment centres on the mainland range from 200 to 2,000. In many cases, it is unclear where the initial outlay to set up the clinics has come from, although most are seeking to turn a profit.
In Wuhan, much of the emphasis is on the detoxification process rather than longer-term rehabilitation, in contrast to most western approaches to addiction. An exception is the Hankou Railway Clinic, which adopts a therapeutic approach. A handful of such clinics have been set up on the mainland, with an emphasis on group counselling and the reintegration of addicts into society. Doctors at the Hankou clinic are quick to emphasise: 'These are not patients; these are our family members.'
A group of recovering addicts sing around a table in the centre, the walls covered in motivational messages such as 'Drug Abuse Yield to Our Persuasion' and 'I am here because there is no refuge finally from myself until I control myself'.
On the second floor, there is a room with bright orange chairs and sofas. This is the 'psychology room'. It is a stone's throw away from the special wing which has been set up for those addicted to so-called party drugs such as ketamine and Ecstasy, as well as codeine.
Nearby, there is a factory where patients are given paid jobs as a halfway measure to help them back into the workforce.
Most of those who check in are heroin addicts, the youngest so far being 16 and the oldest 73. The centre has been open for four years and has seen more than 10,000 patients pass through. It claims a success rate of 94 per cent.
Most addicts, however, cannot afford the cost of treatment. While patients can stay up to three months, it will cost about 3,500 yuan. As the hospital's manager Ng Kim-chu said: 'After the fourth month, the treatment is free.'
Despite making inroads, Wuhan has a long way to go before it reaches the standards of clinics in the west.
At the Xu Jia Peng Recovery Centre, for example, the follow-up action for addicts who have gone through the detox process or implant surgery is limited to phone calls on their return home. Similarly, at the Wudon Clinic, rehabilitation facilities are in their infancy. The centre offers counselling to patients and detox after-care can range from two weeks to a month. The detox relapse rate at the centre is 80 per cent.
Most of the patients at the private clinic seem to be in their early 20s. There is a small courtyard with
table tennis, and the area is surrounded by trees and shrubs.
The centre is a hotchpotch of buildings, and there is no escaping the large steel bars across all the windows.
Inside, the facilities are army-like. Patients share a room with bunk beds and, in some cases, family members. There are no mission statements - just a palpable sense of longing to be out.