ASIA PACIFIC COLUMN Substance use and treatment options in Cambodia RACHEL HUMENIUK, ROBERT ALI & WALTER LING WHO Collaborating Centre, Parkside, South Australia The Kingdom of Cambodia has a population of 13 million people and an estimated annual population growth rate of 1.8%. Approximately one-third of the population in Cambodia live below the poverty line. Substance use is a relatively new phenomenon in Cambodia in comparison with surrounding South East Asian countries, which have a much longer history of substance use problems. It is estimated that 6.1% of government budget spending in Cambodia is on health care. Since the mid- 1990s psychiatry has become part of the curriculum in medical faculties. Psychiatric services have been estab- lished and developed by the Ministry of Health in collaboration with non-government organizations. However, mental health services are still limited in Cambodia and there is currently no institutional mental health service. In 2001 there were over 4000 individuals treated in out-patient-based mental health services. Predominantly this was a medication-based practice with limited counselling being provided. Currently the ratio of psychiatric staff to patients is around 1 : 600. The first recorded case of HIV infection in the Kingdom of Cambodia occurred in 1991. Since that time there has been an increase in HIV with approxi- mately 157 500 people living with HIV in the Kingdom in 2002. In April 2003 the estimated HIV prevalence was 2.6% among the adult population aged 15 – 49 years. HIV in Cambodia is transmitted primarily through heterosexual contact; however, concerns exist regarding the potential for an increase in exposure attributed to injecting drug use. Cambodia lies near the major drug trafficking routes for South East Asia and shares borders with Thailand, Laos and Vietnam as well as a coastline with the Gulf of Thailand to the southwest. Since the mid-1990s Cambodia has had an increased role as a drug- transiting and -trafficking country, and reports of clandestine methamphetamine laboratories have sur- faced in recent years. There are indications that manufacture is taking place in the Koh Kong province and other locations along the Thai – Cambodian border. Production also has been reported in Battam- bang, Siem Reap, Kandal and Phnom Penh. In addition to the trafficking of heroin and methamphe- tamine, Cambodia is still considered to be a significant source of cannabis cultivation for the world market based on seizures made outside of the country, although the government considers the extent of the problem to have reduced significantly since the late 1990s. While there appears to be no systematic information available concerning drug consumption patterns and trends in Cambodia, a recent UNODC review indi- cated that there had been a noticeable rise in the level of substance use within the Kingdom in the last 7 years. In 1995 a World Bank situational assessment concluded that drug use was not a significant problem in Cambodia. By contrast, some neighbouring countries have long-standing significant drug problems. Since the mid-1990s Cambodia also has seen a rise in drug use, particularly of methamphetamine and solvents. While, previously, methamphetamine use was restricted to wealthy Khmer youth and foreigners, Yama (the local name for methamphetamine) is now being used by a much broader section of the community. Groups that are most at risk of Yama use in Cambodia include students, street youth, street work- ing youth, commercial sex workers and labourers. A non-government organization survey of street children in 2000 found that over 75% interviewed were using inhalants and increasing numbers were using Yama. Since the time of that survey the organization con- cerned believes there has been a dramatic shift towards Yama use, including injecting. UNODC estimates Rachel Humeniuk, WHO Collaborating Centre, C/-161 Greenhill Road, Parkside, South Australia 5063; Robert Ali, WHO Collaborating Centre, C/-161 Greenhill Road, Parkside, South Australia 5063; Walter Ling, UCLA, 11075 Santa Monica Blvd., LA 90025, USA. Correspondence to Dr Rachel Humeniuk, WHO Collaborating Centre, C/-161 Greenhill Road, Parkside, South Australia 5063. Tel: + 61 8 8303 8056; Fax: + 61 8 8303 8059; e-mail: Rachel.Humeniuk@adelaide.edu.au Drug and Alcohol Review (September 2004), 23, 365 – 367 ISSN 0959-5236 print/ISSN 1465-3362 online/04/030365–03 # Australian Professional Society on Alcohol and Other Drugs DOI: 10.1080/09595230412331295133