HIV Insight: A Qualitative Study of Treatment-Seeking Heroin Users in Contemporary China

Background

Heroin has emerged as the primary drug of concern in China, with as many as three million contemporary users. Once a Chinese citizen has been identified by Chinese law enforcement as a ‘drug addict’, that individual is ‘registered’ in an official government tracking system for the rest of his or her life, independent of verified rehabilitation and recovery. Most of what is known about heroin users in China is based on studies of registered heroin users participating, often involuntarily, in government-sponsored treatment.

Methods

Using Grounded Theory Methodology, we collected and analyzed in-depth interviews of heroin users voluntarily seeking treatment at a new, non-government-sponsored, for-profit, addiction treatment hospital in Beijing, China.

Results

We identified three major themes among our participants: (1) intense social stigma towards individuals with drug addiction; (2) a desire for anonymous, confidential treatment to avoid social stigma and the loss of personal freedom that accompanies participation in government-sponsored treatment; and (3) a deep mistrust of government-sponsored treatment and a search for more effective alternatives.

Conclusion

Despite a desire for treatment, our subjects were reluctant to access government-sponsored treatment facilities because of fear of a stigmatized identity, fear of loss of personal freedom, and lack of faith in the efficacy and safety of government-sponsored treatments. Their willingness to pay cash at a new, non-government-sponsored, addiction treatment facility illustrates the lengths to which they will go to remain ‘unregistered’ and to discover better alternatives. That the Chinese government allows such facilities to operate outside of government surveillance suggests a new openness to alternative options to combat China’s rising drug epidemic. The efficacy of these alternative options, however, remains in question.

Registered users chose New Hospital over government-sponsored treatments to avoid the loss of personal freedom they risked if their ongoing heroin use was detected while participating in voluntary treatment. They had each experienced China’s rehabilitation units through labor (RULs) first hand, and described these places as punitive and ultimately ineffective.

“I spent 6 months in a forced program in Inner Mongolia. It was too horrifying. I was treated like less than an animal. I had no human rights. I can’t even talk about it.” (Male, 44 years old, divorced, a registered heroin user.)

“In 9/2012 I was arrested for heroin and that was when my family found out about my addiction. I went to a forced detention center for seven months and it was basically like jail. There was no medicine, no methadone, no freedom. They taught us about detention center regulations and Chinese laws regarding drug use. They had us watch videos of people getting arrested for drugs. I talked to my family through a glass window. I made some friends. I got discharged early to care for aging parents, and because I wasn’t having any more withdrawal. The loss of freedom made everything painful. And I swore to myself that I would never do drugs again. One month later, I relapsed.” (Male, 46 years old, college graduate, never married, a registered heroin user.)

“I went to a camp in Datong. I stayed for two years and three months. They made us work sometimes, but there wasn’t much to do. Sometimes we made paper bags. There was no treatment in the camp, no methadone, no detox, no medical follow-up after I was discharged from the camp. I relapsed after 20 days.” (Male, 41 years old, middle school graduate, divorced, a registered heroin user)

“I was arrested for heroin and spent six months in a forced detention camp. It was like jail. We lived 20-30 people to a cell. If there was work, we did it, like making plastic flowers. Otherwise we would just sit there and do nothing. No medication, no treatment. I relapsed 6 months after I got out.” (Female, 46 years old, divorced and remarried, a registered heroin user.)

Full article at: http://goo.gl/JfT4Ap

By: Anna Lembke corresponding author