Treating drug addicts: what Macau can teach Hong Kong
A free needle programme in Macau’s Iao Hon Neighbourhood helps prevent the spread of HIV among addicts by providing sterile paraphernalia and using a treatment-based and flexible approach to drug addiction
A few minutes’ drive from Macau’s grand casinos, a group of haggard men slump around plastic tables drinking tea, playing on mobile phones or gawking at a television drama portraying perfect lives far removed from their own.
“When I was a young man, I knew some guys who took drugs, so I took them as well because I was curious,” says Hung Chia-wai, 63, who has been using heroin for more than three decades.
“I once managed to stop using for about four years, but as soon as I felt in a bad mood or something bad happened in my life, I started using again.”
Hung is a regular at the Iao Hon neighbourhood needle syringe programme, the only of its kind in China (excluding Taiwan), where he and other addicts get free clean needles for injecting heroin. Ice (methamphetamine) users can get clean foil and straws, used to smoke the drug.
The Association of Rehabilitation of Drug Abusers of Macau opened the centre in 2008, and hands out 4,000 to 6,000 needles a month.
Established in 1994, the association has 322 registered heroin and Ice users on its books.
In 2016, about 80 per cent of its 12 million pataca (HK$11.6 million) budget came from the government; the rest was raised through its annual charity dinner and sponsorship. The aim of the centre is to help prevent the spread of HIV via infected needles, and it has reported no new infections among those on its register in 2016 or the first quarter of 2017, says Augusto Nogueira, the association’s executive director. At least 10 registered users are HIV-positive.
A former user himself, during Portugal’s 1980s heroin epidemic, Nogueira quit in his mid-20s on October 2, 1993 – a date he reels off without hesitation. He then volunteered for a now-defunct drug rehabilitation organisation and came to Macau in June 1994, when it was still a Portuguese colony.
Nogueira believes a treatment-based and flexible approach to drug addiction is the best way of curbing the problem.
“People need to continue to be given opportunities to rehabilitate, and it’s important to understand that sometimes not all the treatment therapy is adequate for all kinds of users. Sometimes people do not adapt themselves, for example, to religion-based therapies, because they themselves are not religious.”
On December 15, 2016, however, Macau’s Legislative Assembly passed an amendment to toughen the city’s anti-drug laws. The bill raised the minimum jail term for consumption from one to three months, to three months to a year. The minimum penalty for drug trafficking rose from three years imprisonment to between five and 15 years.
“We don’t do campaigning to legalise or decriminalise drugs, but I’m completely against sending people to prison for drug use or even small trafficking for personal use,” Nogueira argues. “There are other ways: these people could be referred to treatment instead of being sent to prison.”
Many heroin users in Macau also use midazolam, a versatile prescription drug used to treat insomnia but also among a cocktail of drugs used for lethal injections in parts of the US. Users crush the pills and either mix the powder with heroin or inject it alone. The association provides a small plastic dish so they can crush the tablets somewhere sanitary.
“I would not say it is their drug of choice, but it’s mainly about achieving intoxication. They try to get it from the doctors, who may prescribe it in goodwill for a medical purpose and not with the intention of them to go and use it in an illegal way,” Nogueira says.
Despite distributing drug paraphernalia, Nogueira says drugs are not allowed on the centre’s premises. Users will be punished if they try to sell drugs there, or if they try to sleep on the tables.
A 58-year-old male addict in the centre says he started using drugs in prison and has been on them for 30 years. “Everybody uses in prison, though I just used them two or three times, but after I got out I remembered the feeling from the drugs and wanted to do it again,” he says.
Not everyone’s situation is so dire, though. At the association’s Aftercare Department, a few minutes’ walk from the centre, is 52-year-old Wah Dee, who has used heroin on and off for a decade.
Now stabilised on methadone – used to treat heroin addiction – he is thinking positively about the future. He used to be married and worked as a delivery driver, but lost it all through his addiction.
“In those 10 years, I didn’t know a place to go to help me stop using drugs,” he says. “Once my body becomes healthy, I want to find a job again as a delivery driver.”
The road to recovery leads south to the lush countryside of Coloane. The association’s treatment centre is situated at the base of the former Ka Ho leper colony.
It’s home to 15 men and six women who stay for free, and typically spend one year in the spacious facility. They have access to computers, televisions, a canteen, a gym, an arts and crafts room, a cookery room and snooker room. Outside, they can sit and relax or play sports on the purpose-built pitch.
In the crafts room, eight men sit carving objects out of wood, under the supervision of a staff member. The youngest is Ah-Sing, 26, who has been in the centre since the end of May. He first tried drugs at age 15, starting with ketamine and then Ice.
“From my experience, I think there are quite a number of people around my age who take drugs. My friend gave me some ‘K’ to try at a karaoke party, and I mixed it with alcohol. It made me feel dizzy, but later I went out with friends again and the same situation happened, and the second time I took it I felt less dizzy,” he says.
It was fun for a while, getting high in discos and karaoke clubs, in Macau and the neighbouring mainland city of Zhuhai, where, he says, drugs were easy to get. But by the time he turned 18 he found himself in prison for possession, then in rehab at 21, and in jail again at 24 for a drug-driving conviction. The drugs also damaged his kidneys, and Ah-Sing decided he wanted to start a new life.
“I’m nearly 30 and have a better relationship with my family. I see the other clients in the centre and don’t want to end up like them – in their 50s or older and still using drugs,” he says.
He plans to spend a year at the centre and then build a new social circle of non-drug-taking friends. “My father’s friend opened a Japanese restaurant and I would like to learn to cook and work there,” he says.
A May 2017 report from Macau’s Social Welfare Bureau puts the total numbers of users in the city in 2016 at 548, of which 6.2 per cent were minors, representing a 55.3 per cent year-on-year drop.
Nogueira reminds us that these numbers merely represent people who have approached the bureau or NGOs for help, or have been caught by police.
“Many people are still using drugs for a longer period of time without any authorities knowing about it. There are also different kinds of users: regular users, people who need to use daily; then the recreational users who just take drugs once in a while. If someone gets caught and they have only used drugs, say, for the first time, it will still be officially registered – but in the end they are not a daily user.”
Despite Nogueira’s conviction that Macau’s treatment-based approach is the best way of dealing with the drug problem, he is realistic about the political realities of drug reform in Greater China. While some countries, such as Nogueira’s homeland of Portugal, have made significant inroads in the decriminalisation of drugs, he believes the Chinese government isn’t likely to budge on the issue.
“I think decriminalisation is a lost battle here because China will not change its perception of drug consumption. It’s useless that we fight for something different in Hong Kong and Macau.”
However, he believes Macau could be a pioneer in establishing a commission that treats drug users on a case-by-case basis, and refers people to treatment based on their personal needs.
“That doesn’t mean that we can necessarily decriminalise drugs, but we can emphasise the need for treatment and people’s individual cases.”
He also thinks Hong Kong could follow the example of setting up a Needle Syringe Programme, because the city already has a good track record in treating heroin addicts with methadone.
“Everything that we can do to avoid and minimise the propagation of HIV among intravenous drug users should be very welcome,” he says.