Bali Police chief supports methadone program

Bali Police chief supports methadone program

I Wayan Juniartha, The Jakarta Post, Denpasar, Bali

Bali Police chief Insp. Gen. Made Mangku Pastika expressed on
Tuesday his support for the Harm Reduction-based Methadone
Maintenance Treatment Program (MMT) in local prisons as part of
the effort to curb the spread of HIV/AIDS among convicted or
detained Injecting Drug Users (IDUs).

His support will pave the way for local prison authorities,
health workers and non-governmental organizations to put MMT into
effect in four local prisons across the province as early as next
October.

"I certainly will support this effort as long as its ultimate
goal is to help people free themselves from drug addiction," he
said.

This was the first official support publicly voiced by a
senior police officer for the Harm Reduction approach, which for
years had been accused of promoting drug use.

Pastika expressed his support during a meeting with Bali's
joint commission for HIV/AIDS prevention.

Comprised of officials from the Ministry of Health, Ministry
of Justice and Human Rights, prison authorities and the
Indonesian HIV/AIDS Prevention and Care Project (IHPCP-AUSAID)
the commission was seeking Pastika's support for the treatment
program to commence.

"In fact, I have already asked my men to treat drug users
differently from drug dealers. Drug users are just the victims
and not the criminals," Pastika said.

A synthetic opioid, methadone is widely used in detoxification
and rehabilitation facilities around the world to ease the
withdrawal symptoms generally experienced by heroin users who are
trying to free themselves from their addiction. In the longer
term, methadone is also one of the most effective and safe
medications for substitution therapy.

"Numerous studies in various countries have shown that
methadone is an effective substitute for heroin. It is safe and
does not cause any toxicity in long-term use," Ratna Mardiati of
the health ministry said.

Methadone, with its longer-lasting effect, ranging between
15 hours and 32 hours, also provides its users with more time to
manage their personal and professional life compared to heroin,
whose effects last between 3 hours and 5 hours.

"The parents of drug-users currently undergoing MMT in the
Drug Dependency Hospital (RSKO) in Jakarta say that their
children's behavior and attitudes have gotten better," Ratna
said.

The RSKO Jakarta and Sanglah Hospital in Bali were the sites
for WHO-funded MMT clinic pilot projects. Around 92 IDUs
registered for the MMT in Sanglah.

"The problem arises when an MMT participant is arrested by
police and is then sent to prison, where methadone is
unavailable. This person might start injecting heroin again and
waste all the previous effort," the IHPCP's harm reduction
advisor, Palani Narayan, said.

Injecting drug users are critical to the spread of HIV/AIDS.

The number of HIV-infected injecting drug users has been
increasing at an alarming rate all around the world. The risky
habit of sharing needles and other injecting paraphernalia has
been acknowledged as the most efficient, fastest and convincing
way of transmitting HIV/AIDS. The problem is particularly acute
in prisons, where the prisoners have no access to sterile
needles, something that makes the prison population particularly
vulnerable to the spread of HIV/AIDS.

"In 2000, out of around 60 IDUs in detention, up to 50 percent
of them tested HIV positive," Kerobokan prison medical officer AA
Ngr. Hartawan said.

Since methadone is taken orally, MMT frees the IDUs from the
necessity of acquiring injecting paraphernalia, and thus curbs
the spread of HIV/AIDS.

With the police's support, the joint commission will set up
the necessary mechanisms for ensuring that an injecting drug user
who participates in MMT will still receive methadone even if he
or she is arrested and incarcerated in a police lockup or state
prison.

"We will implement this program step by step. We don't want to
scare people," Palani told.

As of April, there were 325 people recorded as being infected
with HIV on Bali, although the actual number could reach 3,500.