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.