The following is an excerpt from an ANCD report:
Myanmar is bordered by China in the northeast, Lao PDR in the east and Thailand in the southeast. Myanmar is a signatory to the IDADIN. Myanmar was once considered the world’s second-largest producer of opium, although sustained crop eradication activities have reduced the amount currently produced (Devaney, Reid & Baldwin, 2006). Myanmar is also considered one of the largest producers of ATS (United Nations Office on Drugs and Crime, 2010b).
Amphetamine-type stimulant use
Myanmar is a major manufacturer of ATS pills and, while much of this production is for trafficking to neighbouring countries, there has been a recent increase in domestic demand (Devaney, Reid & Baldwin, 2006). While heroin and opium rank one and two respectively in terms of drugs used, the increased use of ATS pills, especially in border areas near China, Lao PDR and Thailand, is of concern (United Nations Office on Drugs and Crime, 2010b). ATS pills in these areas are cheaper than those in major cities where their use appears to be restricted to wealthier users. ATS pills in Myanmar are typically smoked and there is no reported use of crystal methamphetamine (United Nations Office on Drugs and Crime, 2010b).
Manufacture, trafficking and seizures
As noted above, Myanmar is a major manufacturer of meth/amphetamine, much of which is destined for non-domestic markets. In 2009, 23.9 million ATS pills, 124kg of crystal methamphetamine and 339kg of ATS powder7 were seized (United Nations Office on Drugs and Crime, 2010b). The massive increase over 2008 seizures (ATS pills 1.1 million, 14kg crystal methamphetamine and 3.9kg ATS powder) is thought to be the result of pressure being exerted on ethnic ceasefire groups to come under government control. Due to political pressure, many manufacturers have moved ATS stocks into Thailand. There was also a marked increase in the seizure of precursor chemicals in 2009 (United Nations Office on Drugs and Crime, 2010b). More than 1600kg of ephedrine, 122 400 bottles of ephedrine-based nasal drops and 9.4 million ephedrine-containing tablets were seized during 2009. Increased interventions targeting precursor drugs are likely to result in alternative precursors being sought and used. Precursor drugs are trafficked into Myanmar from India, China and Thailand (United Nations Office on Drugs and Crime, 2010b).
Injecting drug use
There is no reported injecting of ATS in Myanmar, but high levels of injecting in neighbouring countries are of concern (United Nations Office on Drugs and Crime, 2010b). Injecting is the major route of administration for heroin. Meth/amphetamine powder is concentrated meth/amphetamine used in the manufacture of meth/amphetamine pills: 339kg will yield 3.7 million meth/amphetamine pills.
Of more than 3400 drug-related arrests, 26 per cent were for ATS (995 for ATS pills and six for crystal meth/amphetamine) (United Nations Office on Drugs and Crime, 2010b). One quarter of those arrested for ATS were women. Arrests for ATS have increased by 34 per cent since 2007.
Drug users are required to register or face a five-year gaol term. Myanmar has compulsory drug treatment for those found in possession of drugs and the Ministry of Health operates 69 treatment centres (United Nations Office on Drugs and Crime, 2010b). Services in these centres focus on opiate use: of more than 1000 treatment admissions in 2009 only 2 per cent (n=23) were for ATS (United Nations Office on Drugs and Crime, 2010b). Most ATS users receive treatment through private facilities (psychiatric wards, private clinics and centres run by the United Nations and non-government organisations), though data on these were not available.
HIV in the community and among injecting drug users
Myanmar has a population HIV prevalence (15–49 years) of 0.6 per cent; among PWID the prevalence may be 38 per cent (United Nations Office on Drugs and Crime, 2010b). In treatment centres prevalence is even higher, some sentinel surveillance data showing up to 80 per cent of PWID infected (United Nations Office on Drugs and Crime, 2006). Among other high-risk groups, HIV prevalence is 18.1 per cent in female sex workers and 28.8 per cent in MSM (UNAIDS, 2010a). One-third of all HIV cases in Myanmar are thought to be due to PWID. Although levels of ATS injection in Myanmar are thought to be low, injection of heroin/opium is a major concern, so ATS injection could increase.
There has been an increase in testing for high-risk groups. In 2009, almost three-quarters of sex workers and 50 per cent of MSM received testing and counselling for HIV (Devaney, Reid & Baldwin, 2006). However, the figures for testing for HIV among PWID were considerably lower, with only 7 per cent coverage (Devaney, Reid & Baldwin, 2006). During 2008, 1731 PWID were tested for HIV, a fraction of the estimated 90 000–300 000 PWID in Myanmar.
HIV anti-retroviral treatment
According to the UNAIDS Progress Report 2010, 29 825 people are receiving ART in Myanmar, while 76 000 require ART (Myanmar Ministry of Health, 2010).
Harm reduction in Myanmar is still in its infancy. By 2005 a number of international nongovernment organisations and UNAIDS-funded projects were beginning to address the lack of harm reduction services for PWID. An estimated 3.5 million sterile injecting units were distributed in 2008, two-thirds more than in 2007 (World Health Organization, 2010b). The majority were provided in four townships only. Harm reduction services that do exist are oriented towards males and female PWID are not encouraged to access these services. No details of injection of ATS were available. In 2008, 580 clients received OST (World Health Organization, 2010b).
Prevention education in schools promotes abstinence from drugs and emphasises the dangers of drug use. Prevention education targeting PWID reached 8274 PWID, 30 per cent less than the intended target (Devaney, Reid & Baldwin, 2006).
There was no information on the mixing of drug-using groups, in particular between heroin/opium users and ATS users, leading to risks of injecting initiation. Little is known about female drug users, and services need to target women.