Abstract
BackgroundIn Vietnam, like many countries in Southeast Asia, the commonly used approach of center-based compulsory drug treatment (CCT) has been criticized on human rights ground. Meanwhile, community-based voluntary methadone maintenance treatment (MMT) has been implemented for nearly a decade with promising results. Reform-minded leaders have been seeking empirical evidence of the costs and effectiveness associated with these two main treatment modalities. Conducting evaluations of these treatments, especially where randomization is not ethical, presents challenges. The aim of this paper is to discuss political challenges and methodological issues when conducting cost-effectiveness studies within the context of a non-democratic Southeast Asian country.MethodsA retrospective analysis of the political and scientific challenges that were experienced in the study design, sample size determination, government approval and ethics approvals, participant recruitment, data collection, and determination of sources, and quantification of cost and effectiveness data was undertaken. As a consequence of the non-randomized design, analysis of patient characteristics for both treatment types was undertaken to identify the magnitude of baseline group differences. Concordance between self-reported heroin use and urine drug testing was undertaken to determine the reliability of self-report data in a politically challenging environment.ResultsWe demonstrate that conducting research around compulsory treatment in a non-democratic society is feasible, yet it is politically challenging and requires navigation between science and politics. We also demonstrate that engagement with the government decision makers in the research conception, implementation, and dissemination of the results increases the likelihood of research evidence being considered for change in a contentious drug policy area.ConclusionsLocal empirical evidence on the comparative cost-effectiveness of CCT and MMT in a Southeast Asian setting is critical to consideration of more holistic, humane, and effective drug-dependence treatment approaches, but the garnering of such evidence is very challenging.
Highlights
In Vietnam, like many countries in Southeast Asia, the commonly used approach of center-based compulsory drug treatment (CCT) has been criticized on human rights ground
Compulsory rehabilitation centers have been criticized by the UN and human rights organizations for a variety of human rights abuses including involuntary indefinite detention, physical abuse, torture, and denial of or inadequate medical care [9, 12]
It would not have been practical to randomize participants inasmuch as those randomized to CCT would most likely withdraw from the study
Summary
In Vietnam, like many countries in Southeast Asia, the commonly used approach of center-based compulsory drug treatment (CCT) has been criticized on human rights ground. Like many countries in Asia (11 countries), centerbased compulsory treatment (CCT) is a common approach for resolving illicit drug use problems in Vietnam [4,5,6,7]. These countries (including Cambodia, China, Vuong et al Harm Reduction Journal (2017) 14:2. Based on a philosophy of “social reeducation”, compulsory rehabilitation gained momentum during the 1990s with the construction of large-scale centers in Malaysia, China, and Vietnam [9, 10] This approach was imported by neighboring countries with an estimated 2 million people placed in compulsory centers in China and South East Asia in 2006 [11]. These centers are not part of the criminal justice system and their detainees have not necessarily been convicted of any crime [16]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
