Introduction and Aims. Southeast and East Asia has become a global hub for methamphetamine production and trafficking over the past decade. This paper describes the rise of methamphetamine supply and to what extent use of the drug is occurring in the region. Method and Design. The current review uses data collected through the Drug Abuse Information Network for Asia and the Pacific (DAINAP) and other available sources to analyse retrospectively methamphetamine trends within Southeast and East Asia. Results. Southeast and East Asia has experienced a methamphetamine epidemic in the past decade which began around 1997 and peaked in 2000‐2001. While the situation has since stabilised in many countries, methamphetamine trafficking and use are still increasing in parts of the Mekong region and there is evidence of large-scale manufacture in Cambodia, Indonesia, Malaysia and the Philippines. Methamphetamine is typically smoked or ingested, but injection of the drug is apparent. Conclusion. While the peak of the methamphetamine epidemic has passed in parts of Southeast and East Asia, attention is needed to minimise the potential consequences of spreading methamphetamine production, trafficking and use in the Mekong region and in the peninsular and archipelago of Southeast Asia. [McKetin R, Kozel N, Douglas J, Ali R, Vicknasingam B, Lund J, Li J-H. The rise of methamphetamine in Southeast and East Asia. Drug Alcohol Rev 2008;27:220–228]

The rise of methamphetamine in Southeast and East Asia

Background Historically, China has had extraordinarily high rates of opiate dependence. These rates declined drastically following the 1949 revolution; however, opiate abuse has re-emerged in the late 1980's and has spread quickly since then.

Aims  To describe the current situation of opiate addiction and treatments in China and make some suggestions.

Design  A descriptive study based on literature searched from Medline and the China National Knowledge Infrastructure database (1996 to 2004) and hand-picked references.

Findings  The number of registered addicts in 2004 was 1.14 million (more than 75% of them heroin addicts), but the actual number is probably far higher. Opiate abuse contributes substantially to the spread of HIV/AIDS in China, with intravenous drug use the most prevalent route of transmission (51.2%). Currently, the main treatments for opiate dependence in China include short-term detoxification with opiate agonists or non-opiate agents, such as clonidine or lofexidine; Chinese herbal medicine and traditional non-medication treatments are also used. Methadone maintenance treatment (MMT) has not been officially approved by the Chinese government for widespread implementation, but some pilot studies are currently underway.

Conclusion  China faces substantial drug abuse problems that appear to be worsening with time. Opiate dependence is a major threat to the public health and social security of China because of its devastating medical effects, its impact on risk for HIV/AIDS and criminal behaviors, low rates of recovery and high rates of relapse. There is an urgent need to implement MMT and other modern treatments for opiate dependence more widely in China.

Opiate addiction in China: current situation and treatments.

Drug abuse has spread quickly since reemerging as a national problem in China in the late 1980s. The number of registered drug abusers increased from 70,000 in 1990 to more than one million by the end of 2004. In addition to opioids, abuse of 'new' types of drugs including 3,4-methylenedioxymethamphetamine (MDMA) and ketamine has spread since 1997. Illicit drug trafficking and production have swept most of southern China, and throughout the country drug abuse has caused many problems for both abusers and the community. One major drug-related problem is the spread of HIV, which has caused major social and economic damage in China. In response, the Chinese government has begun an anti-drug campaign, including legislative measures to control drug abuse. However, changing the public's attitudes toward drug abusers and breaking the link between drug use and HIV spread are equally important.

/pdf/recent-trends-in-drug-abuse-in-china-4h5w67up50.pdf

Recent trends in drug abuse in China

HIV-1 seroconversion and subtype were evaluated, and factors associated with cohort retention were analyzed for subjects' baseline sociodemographic and behavioral characteristics in a 12-month follow-up study of injection drug users (IDUs). In November 2002, a community-based baseline survey was conducted to recruit 333 HIV-seronegative IDUs for a prospective cohort study in Xichang County of Sichuan Province, China. During the 12-month follow-up period, HIV incidence was 3.17 per 100 person-years (95% confidence interval [CI]: 0.98, 5.37), and all subtypes of 8 HIV-1 seroconversions were CRF_07BC. The retention rate at the 12-month follow-up visit was 70.3% (234 of 333 subjects). In a multiple logistic regression model, ethnicity (OR = 0.60, 95% CI: 0.34, 1.04) and appearing at the 6-month follow-up visit (OR = 9.03, 95% CI: 5.14, 15.89) were independently associated with retention. No drug-using or sexual behaviors were found to be associated with retention. This study confirmed one of drug-trafficking routes in mainland China, from Yunnan to Sichuan and then to Xinjiang. This study also suggested that HIV is spreading rapidly to more geographic areas along drug-trafficking routes in China, and a short-term follow-up rate may predict a long-term retention rate in this IDU cohort.

HIV incidence and factors contributed to retention in a 12-month follow-up study of injection drug users in Sichuan Province, China.

Objectives
The aims of this study were to examine the prevalence of child abuse exposure among Thai people in a suburban community and to describe the association of abuse experiences with common mental disorders (CMD), alcohol use disorders and substance use.

/pdf/the-experience-of-abuse-and-mental-health-in-the-young-thai-zckil5phom.pdf

The experience of abuse and mental health in the young Thai population A preliminary survey.

Aims This is the first part of the Second National Epidemiological Survey on Illicit Drug Use in six high-prevalence areas in China in 1996. The scale of illicit drug abuse and patterns of use in the survey areas were assessed. Design, setting and participants 67 319 registered permanent residents in the community and those who were at institutions at the point of the survey (15 years old and over, males 34 755, 51.6%; females 32 564, 48.4%) in selected areas in China were screened and interviewed by trained psychiatrists. Measurements Demographics and drug-related data were assessed using the Epidemiological Inventory for Illicit Drug Use developed by the authors. Illicit drugs in this study were defined as a group of psychoactive substances controlled by international and national laws, used for non-medical purposes, including opiate, cocaine, amphetamine-type stimulants (ATS), cannabis, hallucinogens, etc. Findings The lifetime prevalence of illicit drug use was 1.60% (male, 2.58%, female 0.57%), and 1-year prevalence was 1.17% (male 1.80%, female 0.48%). There were 67 cases who used a drug initially before 1952; no new cases of illicit drug use could then be found during the period of 1952‐86. However, the number of new drug users in each year has been rising steadily since 1986. The majority of drugs used were opiates in which heroin dominated, although there was some variability among the six sites. The main routes of administration were inhalation and intravenous injection. More than half the users (59.1%) took drugs on seven occasions or less per week, and 15.8% users used drugs on 21 occasions or more per week. Conclusion Compared with the data from the 1993 survey, illicit drug use has continued to escalate across the areas, calling for priority concern in various sections of the country.

The second National Epidemiological Survey on illicit drug use at six high-prevalence areas in China: prevalence rates and use patterns.

Non-suicidal self-injury (NSSI) is a common behaviour among psychiatric patients that is easily overlooked and often brings serious consequences. The current literature is limited to certain groups and uses different diagnostic criteria. Here our aim was to investigate the prevalence of NSSI in psychiatric patients in China. Diagnostic and Statistical Manual of Mental Disorders, fifth edition diagnostic criteria were used to conduct a 2-week cross-sectional survey of all psychiatric patients presenting to 15 hospitals in 14 cities across 8 provinces in China during this period. A total of 3,298 psychiatric patients were included. The highest prevalence of NSSI behaviour was found in adolescents aged 10–19 years (14.3%). The prevalence of NSSI behaviour in females in outpatients (16.9%) and inpatients of child and adolescent psychiatric departments (19.6%), outpatients (5.9%) and inpatients adult psychiatric departments (7.7%) was significantly higher than in males. The prevalence of NSSI behaviour in patients with personality disorders was significantly higher than in any other diagnostic group (46.7%, χ2 = 195.239, P < 0.000). The prevalence of NSSI in psychiatric patients is high, especially in adolescents. Therefore, it is necessary to inform patients and medical workers to effectively treat and manage NSSI. In the broader literature and across country contexts, higher levels of non-suicidal self-injury in adolescents and young adults have been reported. These data are a rare, robust and valuable contribution in documenting differences in non-suicidal self-injury in a large, nationally representative sample in China where the participants were diagnosed with Diagnostic and Statistical Manual of Mental Disorders, fifth edition criteria. 

A cross-sectional epidemiological study of non-suicidal self-injury prevalence in Chinese psychiatric patients

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The second National Epidemiological Survey on illicit drug use at six high-prevalence areas in China: prevalence rates and use patterns.

A cross-sectional epidemiological study of non-suicidal self-injury prevalence in Chinese psychiatric patients