Methadone maintenance treatment should be made available to injecting drug users in prisons in Cambodia. It requires daily intake and is used to wean people who are addicted to heroin off the drug. It is considered less addictive and safer than heroin because it is administered and monitored in a regulated, clinical setting.
Kimneang has been in Prey Sor prison, in Cambodia, for over a month since being arrested by the police and accused of stealing car number plates. As a result he is missing out on access to methadone maintenance treatment as there is no provision for people who inject drugs in the prison.
The treatment requires daily intake of methadone and is used to wean people who are addicted to heroin off the drug. Although methadone is itself habit-forming, it is considered less addictive and safer than heroin because it is administered and monitored in a regulated, clinical setting.
According to one doctor working in a clinic in the mental health and drug department who didn’t want to give his name: “If a patient misses just four to seven days of methadone, his or her symptoms will start to relapse. A patient can re-access methadone again if they come to the clinic and the doctor continues to provide a service for them following the clinic’s guidelines.”
HIV among drug users
The National Centre for HIV/AIDS, Dermatology and STI’s states that HIV prevalence among people who inject drugs was estimated to be 24.4% in 2007, compared to the much lower rate of 1.1% among people who use drugs.
An assessment of HIV risk behaviour found that 47% of people who inject drugs had shared injecting equipment at least once, while 32% reported sharing on the day of the assessment.
In the 2007 Drug User Integrated Biological and Behavioral Surveillance report, 74% of respondents reported always using clean or new equipment in the previous month but nobody reported disinfecting equipment with bleach as recommended. Condom use with all partners is lower among people who inject drugs than among people who use drugs.
Reducing harm when using drugs
After a few days in prison Kimneang said: “I feel very sick because I have missed methadone for a long time and this feeling is not normal, making me almost vomit.”
Kimneang was identified as vulnerable by staff of KHANA Mundol Meanchey Centre in 2011. He later went on to become an active outreach worker who spent a lot of time educating his friends about the importance of harm reduction.
To date Cambodia only has one methadone clinic, based in the Russia Referral Hospital. Patients must go there daily to take their methadone and cannot take it anywhere else without permission. There is currently much discussion in the country about whether methadone programmes should be available in prison where, according to Kimneang, there are many people who inject drugs in need of methadone.