Cablegate: Significant Heroin Addiction Emerges in Laos For

DE RUEHVN #0800/01 3021052
R 291052Z OCT 07





E.O. 12958: N/A

1. (U) Summary: Heroin abuse has not been encountered among
the Laotian people in the past, but so far in 2007, the
principal Lao national drug abuse treatment center at
Somsanga has admitted more than 50 acknowledged heroin
addicts, at least seven of whom admitted to current injecting
drug use. Almost all of the newly-discovered heroin addicts
came from a few villages in the same mountainous region of
Houaphan Province, adjacent to the border with Vietnam, and
the majority were Lao-Hmong. Addicts reported being
introduced to heroin by Hmong dealers from Vietnam. Most
reported having shared needles and/or using needles scavenged
from medical clinic waste; most female addicts were also
involved to some extent in commercial sex. UNODC and Lao
authorities have begun an urgent survey to try to determine
the full extent of this new aspect of illegal drug abuse.
The capacity of Somsanga treatment center, already
overburdened with methamphetamine and opium addicts, is
stretched very thin by this new group, and the few qualified
Lao drug abuse treatment professionals have no real
experience in dealing with heroin addiction. This
substantial increase in injecting drug abuse also greatly
enhances the risk of more extensive transmission of HIV/AIDS,
hepatitis, and other blood-borne and sexually transmitted
diseases in this country. Action requested: Request that
INL/C/CJ seek to identify a US expert with experience in
heroin abuse treatment, preferably in the environment of a
least-developed country, whom USG could offer for short-term
expert consultation with Lao drug abuse treatment
specialists. End Summary.

3. (U) Prior to 2007, heroin abuse was encountered very
rarely among the people of Laos. Abuse of unprocessed opium
was very common, especially among ethnic minorities such as
Hmong, Mien, and Akha in remote highland areas, who grew
opium for both sale and autoconsumption. Abuse of
methamphetamines, as reported in Embassy Vientiane INCSRs in
the past several years, has reached epidemic proportions.
However, abuse of opiates in the refined form of heroin was
very rarely seen. The few heroin addiction cases admitted to
the main GOL drug abuse treatment center at Somsagna, near
Vientiane, were generally Chinese or Vietnamese immigrants.
There have been a number of heroin overdoses involving
foreign tourists, several of which have been fatal because of
the high purity of heroin available in the region. However,
heroin addicts who were Lao nationals (both ethnic Lao and
ethnic minority groups) had not previously been reported.

4. (U) During 2007, this changed dramatically, with admission
of at least 56 admitted heroin addicts since the beginning of
the year to the Somsagna treatment center alone. Most of
this new cohort arrived at Somsagna as part of three lots of
drug abusers moved there by Lao authorities by truck from
Houaphan Province, on the border with Vietnam. (Note:
Houaphan in the 1990's was one of the major poppy growing
regions in Laos, and was the location of the first INL-funded
Lao-American poppy reduction project, which operated there
for ten years beginning in 1989. At that time, the province
had a long history of large-scale opium abuse, but no
reported incidence of heroin addiction at all.) The first
such group consisted of 22 addicts who arrived in May, the
second of 42 addicts arrived in August and the third, with 37
addicts, on September 20. Fifty-one of the 101 patients who
arrived in these three movements were addicted to heroin; at
least seven admitted to recent injecting drug use. (NAS
officers observed apparently-fresh needle marks on arms or
legs of several females and at least one male who
participated in detailed interviews.)

5. (U) On October 2, NAS Director and staff accompanied UNODC
Laos Country Rep and staff members, along with the Acting
Deputy Chairman of Lao National Commission on Drug Control
and Supervision (LCDC) to Somsanga to discuss this new group
with treatment center staff, and to interview some of the
newly-arrived heroin addicts. During initial discussion with
Somsagna Director and staff, the Director emphasized both the
extent to which these new arrivals had strained his
already-overburdened treatment capacity, and the fact that
the existing staff at Somsanga had no experience in dealing
with the addiction syndrome exhibited by heroin abusers,
which differs markedly from that of opium or methamphetamines
users, with which his staff were familiar. The Director
noted that before arrival of these most recent groups, he had
already been dealing with a patient population of over six
hundred, and he had only three qualified drug abuse
counselors to work with them all.

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6. (U) Interviews with the 51 recently-arrived heroin addicts
from Houaphan by UNODC and Somsanga staff found an age range
of 26 to 55 years. All were members of the Hmong ethnic
minority. (Comment: Interviews with addicts for the most
part had to be translated from Hmong to Lao for the entire
visiting group, and then into English. End comment.) Most
claimed their primary occupation as upland subsistence
farmers, in Xieng Kor, Sao Bao and Van Vieng districts of
Houaphan Province. Ten of the group were female. All of
those interviewed reported having used, or being addicted to,
opium before having been introduced to heroin.

7. (U) In these interviews, addicts reported an "alarming"
extent of heroin addiction, speaking of several villages in
Houaphan Province in which every family has at least one
heroin addict in the house. In most villages, according to
those interviewed, addicts go to the houses of dealers and
buy drugs freely there. Reportedly, in such villages,
injecting drugs is not seen as behavior that should be
concealed, although most residents are aware that the
practice should not be seen by district or provincial
authorities. According to those interviewed, opium was still
cheap enough two years ago to be the commonest form of abuse.
When heroin was found, it was typically used for smoking
("chasing the dragon", in vernacular phrase). However, when
the price of unprocessed opium began to rise as its
availability diminished, Vietnamese Hmong dealers encouraged
opium users to switch to heroin and taught them how to inject
heroin intravenously to increase its impact. (Comment:
According to these addicts, the average cost in their region
of heroin for a day is about 25,000 kip, or not quite three
U.S. dollars. Opium, which is normally smoked two or three
times per day, can now cost several times that much for each
use, where one heroin injection per day is enough for most
users. Those interviewed said this relative economic
advantage of using heroin was emphasized by the dealers
selling it. End Comment.)

8. (U) Addicts, including those interviewed with NAS officers
attending, reported that, generally, heroin addicts in such
villages used syringes or needles scavenged from waste at
local health centers or hospitals or needles that had been
used and discarded by other users. Most addicts made some
minimal attempt to clean such needles by wiping them with
alcohol before re-using them. Some addicts reported a
practice of injecting water from water pipes used by other
persons to smoke heroin. (Comment: As UNODC observed, these
practices, along with the number of female addicts involved
in commercial sex, may lead to a significant increase in
HIV/AIDS, hepatitis, or other blood-borne or
sexually-transmitted diseases. End Comment.)

9. (U) Most of the heroin addicts admitted to Somsagna this
year, as noted above, have been Hmong from Houaphan Province,
and most have previously used opium for lesser or greater
periods. However, UNODC reported interviewing one young
female heroin addict from Luang Prabang who described a group
of 13 young people, none with any previous history of opium
use, all of whom had taken up heroin use for recreation. Dr.
Khamnoan Hsam, drug demand reduction consultant to UNODC
Laos, told Acting NAS Director October 17 that UNODC and LCDC
have initiated an urgent survey effort in Houaphan and nearby
areas in an attempt to better define the actual extent and
scope of this new problem of heroin addiction. She said,
however, that even without having completed this survey, the
number of Lao-Hmong heroin addicts newly admitted at Somsanga
within the past six months and the reports they had provided
of the extent of visible heroin addiction in the areas they
came from led her to conclude that heroin abuse is already
established as a significant new aspect of the overall
problem of illegal drug abuse among both ethnic Lao and
ethnic minorities in Laos.

10. (U) ACTION REQUESTED: NAS Vientiane requests that
INL/C/CJ attempt to identify an expert with experience in
treatment of heroin abuse, particularly in socio-economic
context (and within the treatment capabilities) of a
least-developed country. If the UNODC-LCDC survey confirms
that heroin abuse already exists as a significant new problem
in Laos, as appears at this point likely, NAS would like to
be in a position to promptly offer LCDC the earliest possible
opportunity to consult in Laos with a qualified expert in
heroin addiction in order to begin to more effectively define
and implement treatment protocols and practices appropriate

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to this emerging heroin addition problem.

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