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Drug Abuse

Taiwan Reaps a Whirlwind


Drug addiction is quietly engulfing Taiwanese society – from university students to blue-collar workers to the bourgeoisie. How can Taiwan win this contemporary Opium War redux?



Taiwan Reaps a Whirlwind

By Ming-ling Hsieh
From CommonWealth Magazine (vol. 405 )

Clad in uniforms of white T-shirts, blue pants and white-and-blue rubber flip-flops, some 30 inmates at the Taipei Prison attentively bend their heads over worktables. The men, all participants in a vocational training class, learn how to cut fabric for a dress shirt. From the adjoining pastry-making classroom, the delicious smell of freshly baked walnut cake wafts through the building. The inmates are eager to be the first to hand the visitors some of their still piping-hot pineapple shortcakes.

Almost forty percent of the inmates here are drug convicts, and among these, as many as 80 percent are repeat offenders. Taiwan's prisons are overcrowded because they need to house more than 60,000 prisoners convicted for drug-related crimes. Due to the high number of drug offenders, as many as 255 people per 100,000 of the population are imprisoned in Taiwan, many more than in Japan and South Korea, where the figure stands at 45 and 135, respectively. Only in the United States is the ratio of people serving jail time – 700 per 100,000 – higher than in Taiwan.

It is estimated that more than 70 percent of prison inmates in Taiwan are serving time for drug abuse and crimes committed in connection with drug trafficking such as murder, robbery, or burglary.

"In all crimes, narcotics play a catalytic role," notes Hou Yu-ih, former head of the National Police Administration and current president of Central Police University.

Drug use lies at the root of deteriorating public order.

A Chronic Disease of Society

Criminologists often call drugs the root of all evil. Driven by drug cravings or suffering from withdrawal symptoms, addicts who don't have the money to buy drugs often resort to violence and crime. A heroin addict, for instance, needs NT$6,000 per day to finance his or her dependency, so that monthly expenses of NT$200,000 are not out of the ordinary.

Since taking over as head of the Yunlin Branch of National Taiwan University Hospital (NTUH), Professor Shier-Chieh Huang has met many drug addicts who did whatever it took to get their hands on money to buy drugs, be it stealing electric cables or metal sewer covers, breaking into cars, or threatening or harming family members.

A released drug offender's fatal attack on National Taiwan University assistant professor Hsieh Huan-ju last year served as a wake-up call for many. Under the influence of drugs, Yang Chen-tang assaulted Hsieh, who was riding his bicycle in downtown Taipei, and beat him to death. Yang had been released from prison only a few days earlier under a special pardon. The incident drummed home the message that the problem of drugs is not limited to the dark corners of society, but can affect everybody's life at anytime.

The money Taiwan needs to wage its war on drugs is genuinely startling. Correctional and treatment measures for drug offenders alone cost NT$5.1 billon per year, accounting for nearly one fifth of the Ministry of Justice's annual budget. These measures include incarceration in drug abstention centers, where drug offenders are evaluated during a two-month drug-free period; drug abstention and treatment centers, where compulsory detox programs are carried out; and prisons. Not included in that sum are narcotics investigations by the Bureau of Investigation, costs to society from drug-related violence and crime, or medical expenses.

Losing Ground in the War on Drugs

In 1993 when Ma Ying-jeou had just assumed his post as minister of justice, he boldly declared war on illegal drugs. Being the first justice minister to take the drug problem seriously, Ma pooled the forces of prosecutors, detectives, police and customs agents to crack down on the narcotics trade. Back then, the population of drug users stood at just 100,000 islandwide.

"We must win this war against drugs. It will be a long battle before we know whether we've won," Ma said at the time in an interview with CommonWealth Magazine.

Yet Taiwan has kept losing ground in this prolonged war.

Fifteen years later, Justice Minister Ma has become president, and Taiwan's population of recreational drug users has swollen to anywhere between 200,000 and 400,000. This means that one out of 60 to 120 people in Taiwan takes illegal drugs.

Exactly how many Taiwanese are drug users? Since various government agencies deal with drug-related issues, information is scattered, and reliable hard figures are hard to come by. After trying to get data from within the government, new Minister of Justice Wang Ching-feng came up empty-handed, admitting that the true extent of the problem remains unclear. "That is an unknown," she concedes. "What we do know is that the problem is severe."

For fifteen years Taiwan failed to squarely face the drug problem and comprehend its full scope. But if we piece together the bits and pieces of available information like an ever growing puzzle, we are able to sense that the situation is deteriorating dramatically, and swift action is needed.

Two years ago, a total of 209 kilos of heroin were found in drug raids in Taiwan, an amount that would suffice to provide 90 percent of the island's 23 million people with a one-time dose of 10 milligrams.

In 2001 Taiwanese narcotics investigators seized the drug ketamine for the first time. Five years later in 2006, the frequency of ketamine seizures had increased by 117 percent.

In concerted efforts the Bureau of Investigation, the Coast Guard Administration, and the National Police Administration last year jointly busted a total of 36 illegal drug factories, the highest number ever for one year.

A saying has become common in the Taiwanese drug scene: "Take drugs for a day, take a lifetime to quit." While old drug users still struggle to kick the habit, new drug users join their ranks. As a result, drug addiction has become a constantly enlarging whirlwind, mercilessly engulfing all walks of society.

The Drug-related HIV/AIDS Crisis

Another reason for grave concern is that Taiwan has a high prevalence of infection with the AIDS-causing HIV virus from intravenous drug use. Three years ago intravenous heroin injection became the primary mode of HIV transmission. In that year the number of newly reported HIV infections tripled over the previous year, 70 percent of which were caused by contaminated injection equipment such as needles and syringes. As a result, the drug problem has spun into a nationwide public health issue.

The pervasive drug culture also easily draws in impressionable and naive youngsters.

Among young people the use of Schedule 3 and Schedule 4 drugs, which include club drugs used at raves and dance parties such as flunitrazepam, ketamine, and methylephedrine, have been on the rise over the past years. Ketamine, for instance, surfaced in Taiwan for the first time in 2001. But within five years illegal trade in the controlled drug had exceeded all other conventional narcotics. In 2007 ketamine was the No. 1 seized controlled drug in Taiwan in terms of volume.

Drug users are getting younger. And thanks to electronic commerce, youngsters only need a computer to log on to websites that deal in controlled substances or their precursor chemicals. On the Internet they can readily find do-it-yourself instructions for making ketamine.

Wang Fu-lin, head of the Education Ministry's Department of Military Training Education, says if a student claims that his Ecstasy pills are cold medication, most teachers won't be able to tell the difference.

It is claimed that youngsters mostly start out with soft drugs that are of low addictive potential but often, unaware of the risks, quickly progress to expensive and highly addictive Schedule 1 and Schedule 2 drugs such as heroin and amphetamines. Criminologists call this progression from soft to hard drugs the "Gateway Theory."

But in Taiwan the consumption of ketamine and other Schedule 3 and Schedule 4 controlled drugs receives no criminal punishment.

"Today's young drug users will virtually all be drug users as adults," predicts Chang Po-hong, a PhD in criminology and superintendent of the Sindian Drug Abuser Treatment Center.

Drug careers that started during adolescence are likely to hurt people in the prime of their lives. Lien-wen Su, head of the Department of Addiction Science at Taipei City Hospital, has found that in Taiwan first-time drug use mostly occurs between 20 and 29 years of age. Most drug-related deaths in males are around age 37, while that figure stands at around 33 years for women.

The Unexpected Faces of Drug Abuse

Drug abuse and drug trafficking used to take place in dark corners, involving the stories of people on the fringes of society. But today drug addiction has gone mainstream, a tragedy staged in the open, right next door.

White-collar workers, simple farmers or fishermen, even naive young girls are equally likely to take up the drug habit.

Drug abuse has become far from uncommon among ordinary office workers. When the National Bureau of Controlled Drugs under the Department of Health conducted its first large-scale islandwide survey on drug abuse in 2005, it was surprised to find that people with monthly salaries of NT$40,000 or more were 1.8 times more likely to use illegal drugs than people with monthly salaries under NT$15,000.

Ah-Yang was a supervisor in a foreign high-tech company. He was sent to a detention center for heroin abuse and underwent two months of observatory rehabilitation. Because he was found to be an addict, his sentence was extended to one year of compulsory treatment. Ah-Yang had not yet started his compulsory rehabilitation when he developed jaundice all over his body and was sent to National Taiwan University Hospital for emergency treatment. The 37-year-old died there from acute hepatitis.

Drug abuse has also invaded rural villages.

Psychiatrist Chien Yi Ling had an eye-opening experience when she was transferred to the Yunlin Branch of National Taiwan University Hospital about a year ago to treat drug addicts with methadone replacement therapy. Having originally focused her research on schizophrenia and depression, Chien had never come into contact with drug addicts.

At the Yunlin branch heroin addicts are administered a daily oral dose of methadone in an outpatient program. Methadone helps to prevent withdrawal symptoms and decrease craving.

A quiet, thin person with gold-rimmed glasses, Chien was very frightened in the beginning, believing that she would have to deal with hardboiled criminals or gangsters with tattooed bodies. But when she started to see her patients, she was surprised to find herself face-to-face with local food-stall owners and sugarcane farmers.

"I think this issue is very important. I would really like to know how I could help them," says Chien. Perplexed and saddened, she even eagerly offered to accompany the reporter to visit individual drug addicts, to give them an opportunity to tell their story.

Even young girls may get into drugs for the most casual of reasons.

Wearing a denim skirt and a short-sleeved sports shirt, Hsiaomei looks like an innocent, unaffected university student, yet she is addicted to heroin. Hsiaomei smoked heroin for the first time two years ago, when her boyfriend told her it would ease her menstrual pain.

"I just took one puff, one puff only, and my body didn't hurt anymore and felt light," she recalls. But she was not aware that heroin can be addictive even when smoked just once or twice.

Hsiaomei started methadone replacement therapy after trying to detox at a private rehabilitation center. Now she gets her daily methadone after noon at the Taipei City Hospital on Kunming Street. Even though Hsiaomei, now 24, has always been in treatment since getting addicted, she seems to acknowledge that she will have to battle her heroin dependency for the rest of her life.

"At first everyone says, it's all right, we can control it ourselves, we can quit for sure. But when you go this far, you realize it's not very likely," she says. But her eyes don't reveal whether she is feeling despair or just resignation to her fate.

Take Drugs for a Day, Take a Lifetime to Quit

Drug abuse resembles a chronic disease that infests society. Yet Taiwan has never learned how to deal with this debilitating disease.

"In the past we overemphasized tackling the supply side. So we earnestly conducted anti-drug operations. We kept cracking down on drug trafficking very actively and posted very good results. The more we investigated, the more drugs we seized," recalls former Justice Minister Morley Shih. The past focus on the drug trade neglected the need to also curb demand for illegal drugs by sending drug addicts to rehab and making anti-drug education more effective, to prevent youths from taking them.

The Central Police University's Hou has also noticed that police at the grassroots level are very frustrated to see that many drug offenders are apprehended for new offenses as soon as they have gotten out of jail or other correctional institutions.

And while many addicts want to kick their habit, they do not know how to go about it, or where to go for help.

The present compulsory detox treatment at drug abuser treatment centers has not proven very efficient.

In Taiwan the recidivism rate for drug convicts following compulsory treatment has steadily risen from 23 percent in 1993 to 75 percent last year. This means that three out of four drug convicts who are released after compulsory treatment will end up back in correctional facilities.

"To be honest, Taiwan has had no success with its efforts to keep addicts off drugs," Justice Minister Wang frankly told a symposium on heroin prevention last July.

In the three months since taking office, Wang, an expert on domestic violence and sexual assault, has made great efforts to read up on the drug problem, an issue rather unfamiliar to the minister, as she modestly admits. She has meanwhile discovered that Taiwan's system of drug addiction treatment is hampered by the lack of a full-service package encompassing the addict's family, employment and other aspects of resocialization. Many addicts are estranged from their families and therefore do not have a support network to fall back on once they have left prison. Under such circumstances, staying off drugs is even more difficult.

If an addicted individual goes to the hospital for detox treatment on his own initiative, he will have to pay around NT$30,000 for a 7-10 day program, an amount that many already impoverished addicts cannot afford. Another problem is that merely physical detox does not end emotional dependency on drugs, which is why many turn to their dealers as soon as they leave the hospital.

Broadening the Support Network

After methadone outpatient treatment was launched, civic groups also began to realize that drug addicts, once stigmatized and relegated to the dark corners of society, need to be given opportunities to return to normal lives. "What we need to do next is to build a support system within society," declares Professor Yi-ming Arthur Chen, founder and coordinator of the Living With Hope Organization, an AIDS support group. "After immense effort, we've finally managed to build up some momentum, and a lot of complementary measures need to be carried out."

The Living With Hope Organization dispatches social workers to methadone outpatient programs for group counseling, to identify those addicts that are willing to change their lives and want to find work. The social workers help them to register for a special employment program under the Council of Labor Affairs to ease them back into society. A number of religious organizations also assist with or have begun to run detox programs.

Over the past few years, government agencies have also begun to take a vastly different approach. Instead of one-sidedly focusing on seizing illegal drugs, they are now trying to strike a balance between fighting drug trafficking, running anti-drug campaigns and helping addicts to quit drugs.

Highlighting the new approach, the Legislative Yuan in early April amended Article 24 of the Statute for Narcotics Hazard Control, formally legalizing methadone therapy. Under the new law indictment can be deferred for heroin offenders as long as they are under methadone treatment.

In Taiwan drug abusers are seen as people afflicted with an illness, whose brains have suffered damage. The only problem is that the number of drug abusers keeps rising, causing widening damage to society, as is evidenced by daily front-page news about drug-related crime.

"We know the problem is serious," Justice Minister Wang Ching-feng says. "But it's useless to cover the problem up. We have to bring it out into the sunlight, to make it transparent, to face it and solve it together."

The whirlwind of illegal drugs engulfs us all. After a delay of 15 years, we must now unleash a new war on drugs for the long run.

Translated from the Chinese by Susanne Ganz

Chinese Version: 新鴉片戰爭