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Reaching out and reaching up - developing a low cost drug treatment system in Cambodia

Axel Klein, Vonthanak Saphonn and Savanna Reid*

Harm Reduction Journal 2012, 9:11  doi:10.1186/1477-7517-9-11

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Perspective on current situation regarding drug treatment in Cambodia

Mark Elliot Barrett   (2012-06-20 12:04)  Research Consultant email

I should mention that I participated in the project that is the subject of this article as the research consultant who did the commune survey analysis and report write-up (referenced below).

The H-83 project did take many twists and turns from its original conception as an attempt to introduce evidence-based drug treatment services in Cambodia, which really had nothing at the time. The authors are right in that an opportunity was missed in providing a model that could have been used to provide an alternative to the "boot camp" type programs run by military and police. UNODC has recently began to introduce a TREATNET community-based model with linkages to the public health centres and hospitals. However, H-83 did not really provide much o.f a foundation for the new initiative (at least based on an assessment I led in Banteay Meanchey, the first site to begin the TREATNET approach). There was little indication of any on-going work at the time of the TREATNET assessment (Sep 2010), probably due to the cessation of any continuing project inputs or support.

The figure of 500 USD provided to each CCT member was incorrect-- that may have referred to the entire team budget for one year. Budget provisions for the provincial teams were minimal in comparison to the tota budgetl. Also, it is often the case that when funding for projects such as this ceases most or all project activity also ceases.

The problem of alcohol use was not really addressed; but alcohol and tobacco are probably the cause of many more serious health problems than illicit drug use in Cambodia. These were given an almost equal focus in the initial survey, Interesting alcohol is a problem that public health facilites are mandated to work with; whereas drug cases are usually referred to the compulsory drug treatment centres. Thus, another opportunity to get a foothold for substance abuse treatment by starting with alcohol abuse and dependent clients was missed here.

A substantial number of drug users are being helped by Harm Reduction programs (such as Mith Samlanh, as mentioned, or Korsang, Seado, and others which were not mentioned), There are also shelters and special NGO programs that cater to many at-risk populations.

While the title suggested something about a "low cost drug treatment system for Cambodia" , the authors provide only a vague reference to informal activities that may or may not have occured on any kind of regular basis. There is no description of what kind or quality of services these persons actually received (even a short case study or two would have helped here). About the only thing that we can probably agree on is that it was definitely "low cost" and may (or may not) have helped in diverting drug users away from the compulsory centers, although, there was no real evidence provided for this claim. I would also agree that this project may have been helpful in identifying a cadre of persons who gained knowledge regarding drug prevention and treatment, as well as HIV and other associated problems. However, without an ongoing mechanism these networks have probably mostly disbanded by now.

I would refer the reader to the h-83 Survey for more detiail (both quantitative and qualitative descriptions of a fairly large sample of drug and alcohol users). I thought this might have deserved mention as an accomplisment of the project, but it was only briefly mentioned in the introduction.) The reference is posted below, and I would be happy to send the PDF version to anyone upon request (at the email given :

Barrett, M.E. (2008, May). H-83 Baseline Behavioral Survey in 60 Badly Affected Communes in Cambodia. Pnom Penh: UNODC.

Competing interests

As mentioned I was hired as a research consultant by UNODC to do the commune survey analysis and report writeup for H-83 during the initial phase in 2007-2008. (The quantitative one-to-one questionnaires was developed by the Indian consortium mentioned in the paper).

I have worked on many projects and continue to work on occasion as a consultant with UNODC; currently (June 2012) I am working on a Health Curriculum for training Cambodian Correctional Officers in Prisons with UNODC and UNOHCHR.


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