June 26 is the International Day Against Drug Abuse and Illicit Trafficking. In recognition of the brave and challenging work of people who use drugs in China, Asia Catalyst spoke with Xinghong (pseudonym), one of our partners there whose work supports people who use drugs. We discussed her personal history, the government approach, and her efforts to promote evidence-based approaches, and the opportunities and challenges she faces.
Q. Please tell us about yourself. How did you get involved in the harm reduction field?
A. I began using heroin when I was 17, for about eight years. This experience almost destroyed my life, and put my parents into desperation. I was detained for using drugs and sent to a re-education camp in 2003, and then to the Sunflower Community Center, which is a trial project to provide rehabilitation and psychological support to people who use drugs. It was the first attempt by the Beijing police to explore a new model of rehabilitation besides compulsory detoxification. Sunflower’s approach mainly involved psychosocial group work and other psychological support. I greatly benefited from this project, which uses the Therapeutic Community model developed by Daytop, a drug treatment organization in the United States. I successfully got off drugs in 2004. I didn’t leave the Center immediately. I stayed and worked as a volunteer, using my own experiences to support my peers.
During these years, my parents didn’t give up on me. They did whatever they could to support me to seek help to get off drugs, and encouraged me to continue to study and develop myself. In order to provide better support to my community, I studied psychology and addiction theory in my spare time. Before I used drugs, I had studied in nursing school, so the theory part was not difficult for me. Together with my own experiences, I found it very useful when handling my peers’ cases in practice. After years of effort, I have now obtained a second-level government-issued Psychological Counseling Teacher Certificate.
I worked at Sunflower Community Center for a few years, and then joined a leading AIDS nongovernmental organization (NGO), working in their harm reduction program. In 2008, I started my own organization in Beijing, to provide support to people who use drugs and their families.
Q. What does your organization do for people who use drugs?
A. We started by running a hotline to provide information and psychological support for people who use drugs and their families. We found that they have limited information and knowledge about drugs, how addiction affects your brain and your body, and what kind of support is out there, besides government-run compulsory rehab and detention centers. We refer them to treatment, legal services, and other counseling services.
Now we are running several programs, including a Drug Education Program, in which we work with universities, local community government, and other organizations and institutions to provide information and knowledge regarding drugs and how to reduce related harms, through lectures and educational activities. The target population is young people and the general public; and Technical Support to Professionals, which offers trainings, workshops, and coaching. We equip social workers, volunteers, counselors, lawyers, and other professionals with knowledge and skills on harm reduction and addiction, so that they can better serve people with addiction. We also have a Testing Program to provide free and voluntary HIV and drug testing and counseling, and a Rehabilitation Center Program, in which we work with public security to go inside the compulsory rehab centers to provide support to the detainees. This includes information on drugs, addiction, harm reduction, psychological support, and legal counseling, and we help them prepare for their release and return to society.
We are also developing a program to support people who are released from rehab centers. After release, they return home, where a lot of obstacles will come up. They need to know how to handle discrimination, how to find a job, how to maintain good health and access to government benefits, etc. Our program works with the local community government to help them better reintegrate into society.
Q. What is the situation/trend of drug use in China today? How is it changed since you began using drugs? What do you think is the main cause of those changes?
A. I think the problem of drug use in China is more concerning these days. In 2016, China reported 2.505 million registered people who use drugs (only people who are arrested or detained for drug related problems are in the system, so the number is probably underestimated), which is a 6.8% increase from the previous year. Among these, 38% use opiates, more than 60% use synthetic drugs, and 1.4% used cocaine and marijuana. Synthetic drugs are the main drugs that people use today, and it has become a major health concern.
When I started using drugs, people who used drugs were mostly unemployed, less educated, and poor. But today, people who use synthetic drugs come from all walks of life; I’ve seen students, bankers, civil servants and so on. On average, their age is younger, with a higher level of education and income.
The cause of these changes is very complex. China is growing richer and people have more leisure time and money.. The public has been bombarded with information on the harms of heroin for generations, and the message conveyed is that that heroin is illegal and bad, and as long as they do not use heroin, they are “okay.” The legal status of synthetic drugs is more vague; only some drugs are banned. Dealers can just change some of the substances and continue to sell them.
Public security currently leads drug education work. I think the health department should play a bigger role, and the community should be more actively involved in providing harm reduction services and campaigns, too. With health department and community engagement, we can improve our harm reduction services, which may be accessible but not very user-friendly. For example, take-home methadone is not available and people have to go to the clinic every day, which makes it difficult to work and travel.
Q. What are the positive changes you have seen in the field of harm reduction in the past decade in China?
A. Overall, I think drug policy in China has improved a lot. The enactment of the 2008 Anti-Drug Law emphasized a health approach over punishment, with the concept that people who use drugs should be offered medical and social support. Community-based treatment and rehabilitation were introduced into the law for the first time. Although detention is still the main strategy, the ultimate goal is for people who use drugs to go back to their community, and to be a “well-functioning citizen.” So the idea of community-based treatment and rehabilitation is to support people who use drugs in the community where they live, not in detention centers, and to provide substitution therapy and psychological and social support. In Beijing, Shanghai, and Yunnan, the government set up pilot projects to explore the community-based treatment and rehabilitation model, and some have proven very successful.
The ministries of Public Security and Justice lead on drug issues in China, and their emphasis is on detoxification and rehabilitation rather than harm reduction. However, implementation varies from region to region; I think in the South, the health departments are more engaged and harm reduction programs there are very strong. But in the North, such as in Beijing, Public Security is the dominant force working on drug policy.
Q. As a former drug user, what is the biggest barrier you encounter in your life?
A. I think the registration and monitoring system made my life more difficult. In China, we have this so-called Dynamic Control System (DCS), which is a registration system used by the Ministry of Public Security to monitor the location and movement of people who have been convicted or detained for using drugs. Because I have been detained and sent to compulsory rehab, I am in this system. Through the system, the police regularly visit and check up on you. This can lead to revealing the person’s drug use history to others, and results in discrimination and a disruption in our recovery. According to the regulation, if a person is clear of drugs for three years, he/she will no longer be subject to police checks. However, the implementation of this policy is uneven and the procedures to amend your status in the system remain unknown.
Most of the time, I have no problem traveling across the country, but sometimes, on important dates, such as a major political conference or sports event, I am checked or stopped. For example, when I passed through a tollway in a city in the South during a political event, I was stopped by the police, though later on, I had no problem staying in a hotel in the city. Even though I am never checked when taking flights and trains, I know many of my peers do have such experiences.
Discrimination is the major challenge faced by people who use drugs in China. I am lucky because I work in the NGO field. People who I work with, including colleagues, government officials, scholars, know my history and respect me, it is a very friendly working environment. However, some of my peers were fired from their work place when their status was known, or found it very difficult to find a job.
Q. As a leader of an NGO serving people who use drugs, what opportunities and challenges do you see?
A. I think the current policy environment provides us a good opportunity. The government emphasizes the role of community-based treatment and rehabilitation. It has been ten years since they first proposed the 2008 anti-drug law. Although there are some pilot projects, overall the system for community-based treatment and rehabilitation, and the working methods, have been developing quite slowly. There is a lot to do. With more and more people using synthetic drugs, the government realized that one single department can not handle the issue and working with multiple departments and organizations is therefore the strategy that the government advocating and implementing. For example, in Beijing, the government required that the district level anti-drug offices have to work with social organizations. As one of the few organizations led by people who use drugs in this area, this definitely provides a very good opportunity for us.
In terms of challenge, I think we really need professional and specialized staff, especially social workers and psychology counselors. However, we have limited funding for that. Our major funding source is from the government, and it requires that most of the money goes to programming, with only a small portion for overhead. Our salary structure is not competitive enough to hire qualified staff. I am also trying to support our peers to involve in this work. We have a group of volunteers who are former drug users to conduct outreach, and now two peers in our staff team.
Q. What do you think can be done to remove the barriers you and your organization face?
A. For the DCS, the focus should be on the implementation of the regulations. The public security should set up clear criteria and procedures for people to be removed from the system, and strictly limit the use and disclosure of information from the database.
As for funding, I hope that funders can be more flexible in supporting core costs. This is already being done in some provinces in China. For example, in Shenzhen, Guangzhou, and Shanghai, some groups can use up to 70% of their funding for overhead, so you can have enough money to run the organization and hire qualified people.
Q. What can Asia Catalyst, as a capacity builder for marginalized groups, do to support you and your community?
A. I think groups in China should form networks and support each other’s work. Because we cannot solve all the issues that our community face, if we can work with more professionalized groups, and refer people who need their services, that’s strengthening for both our work. I hope that Asia Catalyst (AC) can play that role, to bring groups together. In addition, I hope AC can help us link with relevant resources and organizations in the outside world. This field is developing rapidly, and we need to learn the current debates on drug policy on the international/regional front, to look at how groups are handling these problems in other countries, and then bring these back and adapt to the Chinese context. I think that, as an international organization supporting marginalized groups, AC has a unique role to play.