Harm reduction in Cambodia: a disconnect between policy and practice

Cambodia is a country of about 14 million people, sharing land borders with Lao PDR, Thailand and Vietnam [1]. Despite recent economic growth, Cambodia remains one of the poorest countries in the region: the country’s GDP per capita stood at $830 in 2010, and the proportion of people living under the poverty line was about 30% of the population in 2007 [2,3]. Cambodia’s geographical location, poverty, high level of illiteracy and the loose legal system resulting from decades of internal conflicts have made Cambodia especially vulnerable to drug trafficking, drug use and its consequences [4].Estimations of the availability, patterns of use and trends of illicit drug use in Cambodia vary. In 2004, an expert consensus group estimated there to be 20,000 Amphetamine-Type-Stimulant (ATS) users and 2,500 heroin users, of who about 1,750 inject. In 2007 the National Authority for Combating Drugs (NACD) reported that there were 5,797 drug users who had come into contact with local authorities, during the same time period UNAIDS estimated that there were 46,300 drug users in the country of whom 23,150 (50%) were using ATS and some 2,900 (6.3%) heroin, including 2,025 (range: 1,250-7,500) who injected [5]. The UNODC has reportedly estimated that 4% of Cambodia’s population have ever used drugs which would mean a potential estimation of the total number of drug users of around 500,000 [4] although the non-injecting use of ATS would account for the majority of this figure as ATS continues to be the predominately used illicit drug in Cambodia [6].While it is difficult to estimate the proportion of drug users who inject, it is believed to be growing. One study estimated that the injection of drugs had increased from 0.6% of all drug use in 2000 to 10% in 2004 [7]. In 2007, of an estimated 46,300 illicit drug users in Phnom Penh, the vast majority were aged 18–25, most were male; half were regularly using ATS, with only 6.3% reporting regular heroin use while it was estimated that