Dr Nang Pann Ei Kham, coordinator of the Drug Policy Advocacy Group, speaks to Al Jazeera about the deadly addiction.
Beijing, China – She appeared out of the black of an early spring night, wearing a biker jacket and a slicked-back ponytail. One of Beijing’s biggest commercial areas was only a block away, but instead she turned down a narrow alleyway and into a small restaurant.
She strode past the diners, the cash register too, and pushed open a plywood door. Inside was a small circular table surrounded by low orange stools, sandwiched in a room containing a row of industrial kitchen sinks and a drying rack for dishes.
She sat down, opened her laptop and waited. It was 7:30pm on a Monday. The Narcotics Anonymous (NA) meeting would start once more people showed up. Only two others did, ultimately. Much of China was busy celebrating the yearly Tomb-Sweeping holiday.
But the meeting went ahead as usual. They passed around plastic cups of Coke and laminated reading material, then bowed their heads to pray, as they did at the start of every meeting.
What they were about to share was personal, achingly so, and anonymity was crucial, as the group’s name suggests.
Shirley, who asked to be identified only by her English alias, is one of the Beijing branch’s founding members. She knows NA’s dictates well – particularly, that members conceal their identities “at the level of press”.
Addiction has been part of Shirley’s life since she was a teenager, but finding the right treatment took years. Drugs weren’t the only problem. She also had to contend with the weight of Chinese history, and the acute stigma it has placed on drug use.
China is believed to have more narcotics regulations than any other country in the world, with more than 500 laws and guidelines implemented at various levels of government over different periods of time.
These “relentless and draconian countermeasures” have done little to lessen China’s drug problem, according to a report released last year by the Brookings Institute, a Washington, DC-based think-tank.
In 2012, the NGO Human Rights Watch included China in its report, Torture in the Name of Treatment. It condemned China, along with several Southeast Asian countries, for “cruel, inhuman and degrading treatment” of drug addicts.
Before Shirley had ever even touched drugs, she knew the stigma that addiction carried.
The Opium War brought great shame to China ... I think the whole nation has been frightened by drugs since then.
Even as a young girl, the mere possibility that she might develop a drug habit was a constant source of anxiety for her parents. Her mother had once given her a gold-plated clock, and Shirley remembers coming home from middle school one day to find her parents eyeing the polishing powder she used to buff it.
“My parents were terrified. They thought it was drugs,” she recalls. They were relieved to hear that it wasn’t.
“But what they didn’t expect is that I became a drug addict in the end anyway.”
The story of how she first encountered drugs rings all too common. She says she wanted to hang out with the cool, rich kids in her neighbourhood, so she started binge drinking when she was about 16.
That escalated to heroin, China’s most popular drug at the time, followed by ecstasy, weed and other banned substances.
It was the 1990s, and a heroin craze was taking off, fuelled by China’s burgeoning economy.
But Shirley says that part of the blame for her generation’s addiction problems also lies with the Chinese media.
Fear tactics and intimidation were the tools used to scare young people away from drugs, she says. At school, she was subject to dire warnings: Take drugs, and your family will fall apart. On TV, documentaries like The Chinese Sword (1995) depicted explicit, drug-related violence.
When she first tried heroin, Shirley expected to become addicted instantly, to be sucked into a wormhole of vice and decay. That was what she had learned from the media, but when that didn’t happen, she began to wonder: What if I’m an outlier? What if I’m special somehow?
Her understanding had been distorted by the media, which in turn had been skewed by China’s traumatic history with drugs.
“The Opium War brought great shame to China,” Shirley says. “I think the whole nation has been frightened by drugs since then. The reason why drug education is exaggerated stems from this fear.”
Opium, in particular, is blamed for launching a “century of national humiliation” in China.
It arrived through traders as early as the 7th century, under the Tang dynasty, but it was only in the 18th and 19th centuries that it was identified as a scourge against the Chinese people.
It wasn’t as if opium’s “poisonous” qualities were previously unknown. They were. But for several centuries, opium enjoyed a reputation as a pastime for the elite. Its value rivalled gold, and its uses were myriad; it was a medicine, an aphrodisiac and a means of socialising.
Traders from Portugal, Britain and elsewhere saw profit in China’s opium demand. The ruling Qing dynasty, however, saw a threat. As its power started to collapse, opium’s influence expanded, reaching across China’s social strata.
A succession of emperors, some opium users themselves, would grapple with how best to control China’s drug use. Under the Qing dynasty, China became one of the first nations to institute opium regulations. Early on, it debated treatment methods and deterrents – a debate that still finds resonance today. Governments continue to weigh the merits of drug prohibition and legalisation, just as China did so long ago.
One 1729 edict, recorded by the British social reformer Joshua Rowntree, proposed a whole series of punishments – banishment, beatings and strangulation among them – for participants in the opium trade, but not the opium smokers themselves.
A letter to Britain’s Queen Victoria in 1839 shows a shift in this policy, just over a century later. Lin Zexu, an official in China’s imperial court, explained: “He who sells opium shall receive the death penalty and he who smokes it also the death penalty.”
By the dawn of the 20th century, yet another system was put in place. Proven addicts could purchase opium legally with a licence, on the condition that they commit to a detoxification schedule. Government officials, for instance, had only six months to get clean.
As the Communist Party rose to power in 1949, it zeroed in on the remaining vestiges of China's 'shame' - the country's ever-growing addict population.
The opium trade hit its peak in 1906, with 35,000 tonnes grown domestically and an extra 4,000 tonnes brought in from abroad. By that time, China had lost two wars over opium to “barbarians” from Europe, and its “celestial court” was fatally weakened. A whopping 13.5 million Chinese, out of an estimated population of 400 million, were hooked on opium, including 27 percent of the country’s male population.
Only after World War II did the “century of humiliation” come to a close.
As the Communist Party rose to power in 1949, it zeroed in on the remaining vestiges of China’s “shame” – the country’s ever-growing addict population. Estimates suggested there were as many as 20 million, or five percent of the population.
“Because of the Opium Wars, China was still in a crisis mode, in terms of its political, economic and cultural identity,” says Hong Lu, co-author of the book China’s Drug Practices and Policies. Contemporary drug laws were an opportunity for the new government “to reflect upon the shame, the degrading past”.
Under the Communist Party, opium fields were razed. As with previous governments, addicts had to subscribe to a detoxification schedule, or else suffer punishment. More than 800 traffickers were put to death, and many more were successfully prosecuted.
A nationwide campaign spread an anti-drug message, and systems of neighbourhood surveillance were implemented to report local drug users.
In 1953, barely five years into the new regime, the Communist leadership made a stunning announcement: China was effectively drug-free. No official statistics were released, but addiction rates are widely believed to have plummeted, thanks to the new measures.
Later, when China started registering drug addicts in the 1990s, it found only 70,000 – a dramatic drop compared with the millions four decades earlier. That number, however, would climb as China grew increasingly prosperous.
Techniques for treating addiction from the early Communist era survived into modern times.
Shirley encountered the mandatory detention system, a brand of treatment the United Nations denounces the world over. In a 2016 joint letter, several UN bureaus stated that these systems are “not scientifically valid”. Moreover, they warned that mandatory detention can lead to “some of the most egregious forms of human rights abuses”.
The Chinese government, for its part, fired back at its critics during a UN special session on drugs this April. In his speech, state councillor Guo Shengkun warned other world leaders not to “interfere in other countries’ internal affairs”.
He said that the country had recorded 1.21 million instances of “compulsory isolation” for addicts over the past decade. It remains one of the most common forms of treatment.
Shirley’s family discovered her drug habit when she was about 22. Her father sent her out of Beijing to stay in a different province for eight months, hoping that the distance would help her get clean.
“That was the longest time I’d stayed away from drugs,” she says.
When she returned home, she dropped to her knees and swore to her father that she would never take heroin again. But then she relapsed.
“This time I felt completely crushed,” she recalls. “It gives you the feeling that the confidence and dignity you harbour inside your heart is collapsing, little by little.”
She tried to stop. She even came up with a strategy: For every three days she was using, she would spend three days clean.
“During that time, I would stare at the clock every day until the last minute of the third day. Then I would storm out to find drugs,” she says. “I felt as if my whole body was being torn apart.”
She even came up with a strategy: For every three days she was using, she would spend three days clean.
Her boyfriend, whom she had known since childhood, had been held in custody for drug use, and she arranged to meet him after his release. He was furious to find out that she had been seeing other men in his absence.
Their meeting didn’t go as planned. Shirley had come over to resolve their dispute, but the police had arrived too, to check up on her boyfriend. The officers ended up taking them both to the station for drug tests.
“It was like a car being side-swiped by another car,” Shirley recalls.
Shirley tested positive.
She was sentenced to mandatory detention, in a new programme modelled after Daytop, a therapeutic treatment option founded in the United States.
She was allowed to leave in 2003, after six months of detoxification, but she chose to stay on longer, doing volunteer work for several years. The whole process was a relief, she says.
“I felt relaxed from the moment I was caught by the police,” Shirley says. There were no more drugs or boyfriends to be bothered with, she explains with a laugh. “I felt free.”
But not everyone who passes through China’s mandatory detention system has such a good experience.
In 2012, the United Nations released a statement condemning compulsory drug detention worldwide. It said that detainees were denied their legal rights, and that they faced violence, forced labour and heightened health risks while in lock-up.
The system has its share of supporters in China, notably Zunyou Wu of the Chinese Centre for Disease Control and Prevention. He wrote a rebuttal to the UN’s statement, saying that the UN focused too much on the individual rights of drug users.
“Under some circumstances, the individual’s autonomy must be overridden for the sake of the community as a whole,” Wu wrote. He also attacked the science behind the report.
Yunnan-based activist Gao Qiang ended his last stint in detention in 2007, after spending more than a decade in and out of mandatory treatment. Like Shirley, he became addicted to heroin at a young age, 15, without understanding much about drugs.
He was only a teenager in 1992 when he was first arrested and placed in a compulsory treatment centre.
For three months, Gao says that he was locked in a room no bigger than 20 square metres, where he was left to fight his addiction cold turkey.
“There was no so-called treatment at all. The only treatment was to lock you up every day,” Gao says.
For three months, Gao says he was locked in a room no bigger than 20 square metres, where he was left to fight his addiction cold turkey.
Multiple relapses forced Gao back into custody several times after that and he soon became intimately familiar with the two institutions China employs for drug treatment: compulsory detoxification centres and “re-education through labour” camps.
Both systems required detainees to work, Gao says, but they were worse than any normal job. The hours were long, the workloads heavy. He also alleges that police would beat the inmates.
Gao preferred the “re-education through labour” camps, a system created in the 1950s to hold a range of criminals, including political dissidents, often without trial. There, he farmed sugar cane and rice from 8am to 6pm.
It was an easier schedule than that he faced at the rehab centres, where he says he worked from morning until midnight, with days off only for public holidays. His jobs included manufacturing shoes on an assembly line and making artificial diamonds for clothing.
China abolished the system of “re-education through labour” camps in late 2013. But, human rights activists like Shen Tingting say “they just changed the [camps’] names”. Now they’re simply drug detox centres, too.
Shen, the advocacy director for the NGO Asia Catalyst, does believe the treatment facilities are improving.
The law now acknowledges that addicts should be seen as patients, rather than criminals, and China has built the world’s largest system of methadone therapy to wean users off drugs such as heroin.
That said, Shen still sees a number of flaws in the system. For instance, law enforcement officials often operate the detention facilities, rather than medical professionals. Shen is also emphatic about the need for more voluntary treatment alternatives, but for these to succeed, the mandatory detention system needs to ease up.
“Basically, now, it’s arrest and detention. I think that’s made people really scared,” Shen says. “Even if you have voluntary treatment, in a system like that, people won’t show up.”
It’s hard for her to be optimistic about change. A few years back, she remembers letter-writing campaigns and advocacy work being done on behalf of drug users. “Now it’s just silence. There’s just no voice at all,” she says. “I just think the [drug advocacy] community is getting smaller but not stronger.”
Part of the dilemma lies with a lack of international engagement, Shen says. As the world’s second-largest economy, China no longer attracts as many donors for its social issues as it used to. And besides, international groups are increasingly met with suspicion. Just this April, China passed a law requiring foreign NGOs to submit to police supervision.
Then there’s the issue of stigma. When it comes to drug users, many Chinese still hold staunchly conservative opinions, Shen says.
Shirley’s family had trouble accepting her as an addict. While she stayed at the detention centre, an uncle from her mother’s side was the only family member to visit her.
“Though my family loves me very much, they still think that I, as a drug addict, am a humiliation,” she says.
“Humiliated” was exactly how Gao felt, even after he had finally become clean. Now, at 42, he still remembers his first trip from Yunnan to Beijing. He and a friend visited Tiananmen Square, then he retired to his hotel for a rest. A knock at his door interrupted his sleep.
The police were there with handcuffs, ready to take him to the station for a random urine test, Gao says. He didn’t even have time to grab a shirt.
In China, addicts are registered on a police database, unless they can prove that they have been clean for three years. Each time they use their ID cards, like at a hotel, the police are made aware of their whereabouts.
“It was like a surveillance camera watching you 24/7, leaving you no privacy at all,” Gao says.
He doesn’t deny that addicts need some level of supervision, but he finds the current system excessive.
Gao dedicated himself to learning about Chinese law, to help other drug users overcome addiction and face down discrimination.
You have no social credibility, which makes it almost impossible to make a living.
Many of his friends returned to drugs after confronting the difficulties of life as a registered addict. Their drug histories prevent them from landing jobs and even getting a driver’s licence.
“You have no social credibility, which makes it almost impossible to make a living,” Gao says.
It was a sense of social acceptance that drew Shirley to Narcotics Anonymous. She travelled all the way from Beijing to Shanghai for her first meeting, and left shocked. She had never been among people so tolerant of drug addicts. That’s when she and other NA attendees decided to hold their own meetings in Beijing.
But it hasn’t always been easy to cope with her addiction since then, Shirley explains one afternoon at an Italian restaurant.
She is now 38, with two young daughters to take care of.
While she talks, her youngest, a blur of lavender tulle and strawberry hair charms, bounces around the restaurant booths. Her mischievous smile, flashed in a game of peekaboo, reveals two missing front teeth.
Shirley was racked with postnatal depression after her daughter’s birth. But taking medication was out of the question. She had been clean since 2007 and didn’t want to risk a relapse.
“Every night after my family fell asleep, there were different voices resonating around my ears,” Shirley says.
One voice would remind her of her pain, and another would taunt her: “Just die. Everything will be fine after you are dead.”
Returning to Narcotics Anonymous after her pregnancy helped Shirley to overcome those suicidal impulses, she says, but she knows it’s not for everyone.
When it comes to offering treatments, “diversity is the word,” Shirley says. “With more methods, more people will be helped.”
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