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Addiction Treatment in Bali (and Indonesia)

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“Indonesia asks: What is Drug Rehabilitation?”.

 

The National Narcotics Board (BNN) in 2011 estimated that there are between 3.7 million to 4.7 million drug users in Indonesia. Among these drug users, only 0.047 percent had sought treatment. However, the country can only provide treatment to 18,000 drug users per year. 16,000 of the drug users are offered treatment in a privately run rehabilitation center while 2,000 receive it in government funded programs.

4000000

The National Narcotics Board (BNN) ambitious plan is to provide treatment to four million Indonesian drug users in 10 years and eradicate drug abuse completely. 22 percent of the estimated number of drug users comprise of students while 70 percent are workers. Among those who sought treatment, majority were students.

 

The Ministry of Health in Indonesia uses the International Classification of Diseases and Health Problems (ICD-10) to gauge drug dependence in a drug user and which treatment is best suited for them.

 

According to the World Health Organization, there is no legislative provisions for treatment and rehabilitation for people with substance use disorders. Indonesia has no drug courts either or available programs which divert clients away from the criminal justice system towards treatment, and so the purpose of drug rehabilitation is vital to helping Indonesia’s society.

 

Majority of people seeking treatment in Indonesia finance their treatment. Majority of those who receive treatment for alcohol or go through the drug rehabilitation process, receive it through primary health care while people with drug use disorders choose specialized treatment centers since they are the most effective.

Drug Policy

Government legislation in Indonesia provides compulsory treatment to people who are dependent on drugs. The National Narcotics Board is responsible for implementing this drug policy. The National Narcotics Board aimed at rehabilitating 100,000 drug users in 2015 and it aims to double this number each year.

 

The Ministry of Health estimates that there are 74,000 drug injecting drug users in Indonesia. In 2015, seven government bodies which include the National Narcotics Board, the Ministry of Health, the Ministry of Social Affairs and the police signed a Memorandum of Understanding in Bali that aimed to provide a more lenient approach to drug addiction treatment. This Memorandum sought to rehabilitate drug users rather than incarcerating them. However, few drug dependents in Indonesia seek treatment and the National Narcotics Board alongside the police still detain drug addicts forcefully.

 

The country has over 400 addiction rehabilitation center found in government hospitals private clinics and narcotic centers. However, formalized practice standards for treatment are unavailable in major parts of the country and it’s only in major cities like Bali where one can go to the best rehabilitation center that applies high standards and care. Around the country, the major treatment options are medical detoxification in hospitals, the 12 step program and alternative treatment methods such as spiritual and religious centers that claim to cure drug treatment through prayers or beatings. Few rehabilitation centers evaluate their treatment options often to see how the programs are effective.

 

Relapse rates according to the United Nations Drug Report of 2010 are high in Indonesia since the compulsory treatment and rehabilitation offered is costly to the government and it’s ineffective. According to the report, HIV infections and stigma increased particularly in Bali where drug addicts who had gone through the program after being sampled were found to have relapsed. It was equally difficult for them to get jobs due to the stigma. It is through observing such failed attempts at addressing drug addiction that the United Nations in 2012 requested countries including Indonesia to adopt what they termed as “voluntary, evidence-informed and rights-based health and social services in the community”.

 

Methadone maintenance programs and needle syringe programs have long been used in drug treatment especially of opioid use in Indonesia. Starting in the late eighties when there was a surge in drug use around the country, these treatment methods were first tested in places like Bali before they spread to other cities. In a survey conducted in 2010, the survey showed that methadone maintenance therapy had helped reduce heroin use, transmission of HIV, criminal activity and risk of drug related deaths due to overdose. However, these treatment is available only in major cities like Bali where there is access to facilities and there is need to expand the program to other places around the country. The survey showed that transmission of HIV among users had reduced from 42 percent in 2011 to 36 percent in 2013. This method of treatment has also been very successful in Indonesia since it has brought many drug users closer to drug treatment and support services.

 

Some of the most successful voluntary, community based drug rehabilitation programs in Asia are based in Indonesia and they include Rumah Cemera and Rumah Singgah PEKA. The United Nations Office on Drugs and Crime (UNODC) is in the process of documenting these two treatment models as some of the most effective approaches to drug treatment. These programs are offered by non-governmental institutions which are often managed by former drug users. They offer a catalogue of treatments options based on evidence of harm reduction. These treatment approaches have been found to be a success since they lead to overall health of the drug user, productivity, reduction in risky drug use patterns and setting of personal goals by the drug users.

 

Common treatment options provided in most rehabilitation centers in Indonesia include an outpatient free program that is based on counselling and symptomatic medication, use of a tapering codeine dose and symptomatic medication combined with psychosocial services, drug substitution programs through the use of methadone and buprenorphine and therapeutic community programs such as the combined 12 step approach.

 

The new regulation referred to as Joint Regulation on Processing of Drug Addicts and Victims of Drug Abuse into Rehabilitation Centers that was proposed in August 2014 proposed that drug addicts detained by the police would undergo an assessment and depending on the results of the assessment, the prosecutor would decide whether the person would go for treatment in lieu of incarceration. However, this condition is only available to drug users who surrender to the police. The pilot program was rolled out in Bali, East Jakarta, Padang, Riau Islands and South Tangerang.

 

Some of the challenges faced in forced incarceration for drug abuse were increased spread of HIV and drug overdose. According to the Ministry of Health in Indonesia, barely one percent of the HIV infections in 1995 were related to injecting drugs. However in 2015, almost half of all new HIV infections caused can be attributed to drug injection.

 

In some areas of Indonesia like Bali, there’s still resistance to needle exchange programs and methadone clinics are always under constant surveillance. Rates of relapse from rehabilitation centers in Indonesia is high. According to the Asian Community for AIDS Treatment and Advocacy (ACATA) based in Bali, a single approach to drug treatment is only successful to 8 percent of the drug addicts and majority of rehabilitation centers don’t offer alternative treatment options or a comprehensive set of approaches.

 

Drug treatment projects that are NGO funded also face a challenge whereby they don’t have data on the treatment that has been offered – if any to former drug users. Drug treatment in Indonesia remains a big challenge due to the high levels of stigmatization and generalization of drug use.

 

Building of drug rehabilitation centers in Bali has been a challenge due to the difference in regulations between the central and regional authorities. In recent years, Bali has witnessed high profile drug cases. Majority of drug addicts in Bali are sent to government run facilities that are in West Java, Makassar, South Sulawesi and Sukabumi. According to officials in Bali, having a government run rehabilitation would benefit the resort island and Eastern Provinces like East and West Tenggara which lack drug rehabilitation centers although there is high drug use.

 

According to a 2011 study by the National Narcotics Board and the University of Indonesia’s Center for Health Research, 1.8 percent of Bali’s population, or around 50,500 people, are drug users. This figure is slightly lower than the national average of 1.9 percent, or between 3.1 million and 3.6 million people. Calls for drug users in Bali to have greater access to rehabilitation facilities have increased following revelations in 2014 that two-fifths of all Indonesians in prison were there for drug-related offenses.

 

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