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

The prevailing policy consensus in Cambodia is that drug misuse was unknown until the mid 1990s, an unintended consequence of the country opening its borders to travellers and trade in 1993 after decades of war and isolation. Since then there has been a sharp rise in drug seizures and arrests and the availability of amphetamine type stimulants, opium, cannabis and prescription medicine [1,2].By 1996 the country had been identified as a drug trafficking transit route [3] and by 2001 local drug consumption was being reported [4]. Patterns of use were changing, as they had done earlier in Vietnam, with a shift from opium to heroin, and the rising popularity of amphetamines [5,6]. In 1995, the government formed an inter-ministerial agency, the Secretariat of the National Authority for Combating Drugs (NACD) and solicited support from the international community. The UNODC quickly established itself as one of the key partner agencies, together with WHO, UNAIDS and bilateral agencies [7]. It solicited donor funding to support the NACD financially, assisted the government with the drafting of drug control legislation, and clean-up operations following the discovery of a clandestine laboratory.The need for drug treatment was recognised in early 2000, and led to the formation of an illicit drug-related HIV and AIDS working group (DHAWG) by the NACD and the National Aids Authority (NAA). Without a coherent strategy, problem users and their family were relying on the services of Buddhist monasteries, with a long tradition of taking in troubled young men including drug users, and the patchy service provision by a handful of NGOs like Friends International, the Khmer HIV/AIDS Alliance (KHANA), Khmer Youth Association and Cambodia Network of Positive People. Too often the effectiveness of these service providers was hampered by a lack of critical understanding of substance use, behaviour change or harm reduction [8,9].Many medical practitioners at the time had reservations about