A Slow March from Social Evil to Harm Reduction: Drugs and Drug Policy in Vietnam

The suppression of drug consumption and trade is high on the Government of Vietnam’s agenda. To accomplish this goal, Vietnam employs repressive policies that often contravene international human rights law. Among the most detrimental and problematic policies are the incarceration of drug users in compulsory treatment centers, and the stigmatization and abuse of consumers by the police. That said, Vietnamese drug policy is slowly changing in the face of one of Asia’s worst ongoing HIV epidemics. While the Communist Government of the early-1990s designated illicit drugs as a “social evil” to be eradicated through punitive and often repressive means, the recent implementation of harm reduction approaches have reduced the level of needle sharing, and thus HIV transmission. This briefing will explore the current trends in drug consumption, production, and trafficking before looking at the key harms and threats associated with drugs in Vietnam. This will be followed by a summary of Vietnam’s drug policies, including the country’s approach to drug treatment, harm reduction, and illicit opium suppression—Vietnam is one of a small number of states to have suppressed illicit opium production, an intervention that centred upon coercive negotiations with limited alternative development. The briefing will conclude with some tentative recommendations for reform and thoughts on what could be expected from Vietnam during the Special Session of the United Nations General Assembly on the World Drug Problem (UNGASS 2016).

Are mental health services getting better at responding to abuse, assault and neglect?

Objective To determine whether staff responses to abuse disclosures had improved since the introduction of a trauma policy and training programme. Method The files of 250 clients attending four New Zealand mental health centres were audited. Results There was a significant improvement, compared to an audit prior to the introduction of the policy and training, in the proportion of abuse cases included in formulations, and, to a lesser extent, in treatment plans. There was no significant improvement in the proportion referred for relevant treatment, which remained at less than 25% across abuse categories. The proportion of neglect disclosures responded to was significantly lower than for abuse cases. Fifty percent of the files in which abuse/neglect was recorded noted whether the client had been asked about previous disclosure, and 22% noted whether the client thought there was any connection between the abuse/neglect and their current problems. Less than 1% of cases were reported to legal authorities. People diagnosed with a psychotic disorder were significantly less likely to be responded to appropriately. Conclusion Future training may need to focus on responding well to neglect and people diagnosed with psychosis, on making treatment referrals, and on initiating discussions about reporting to authorities.

Assessing and Reporting the Adverse Effects of Antipsychotic Medication: A Systematic Review of Clinical Studies, and Prospective, Retrospective, and Cross-Sectional Research

Objective: Adverse effects (AEs) of antipsychotic medication have important implications for patients and prescribers in terms of wellbeing, treatment adherence and quality of life. This review summarises strategies for collecting and reporting AE data across a representative literature sample to ascertain their rigour and comprehensiveness. Methods: A PsycINFO search, following PRISMA Statement guidelines, was conducted in English-language journals (1980–July 2014) using the following search string: (antipsychotic* OR neuroleptic*) AND (subjective effect OR subjective experience OR subjective response OR subjective mental alterations OR subjective tolerability OR subjective wellbeing OR patient perspective OR self-rated effects OR adverse effects OR side-effects). Of 7,825 articles, 384 were retained that reported quantified results for AEs of typical or atypical antipsychotics amongst transdiagnostic adult, adolescent, and child populations. Information extracted included: types of AEs reported; how AEs were assessed; assessment duration; assessment of the global impact of antipsychotic consumption on wellbeing; and conflict of interest due to industry sponsorship. Results: Neurological, metabolic, and sedation-related cognitive effects were reported most systematically relative to affective, anticholinergic, autonomic, cutaneous, hormonal, miscellaneous, and non-sedative cognitive effects. The impact of AEs on patient wellbeing was poorly assessed. Cross-sectional and prospective research designs yielded more comprehensive data about AE severity and prevalence than clinical or observational retrospective studies. 3 Conclusions: AE detection and classification can be improved through the use of standardised assessment instruments and consideration of subjective patient impact. Observational research can supplement information from clinical trials to improve the ecological validity of AE data.