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Introduction and Aims: This paper reports on the public health intervention of harm reduction to address drug use issues in the Asia-Pacific region., Design and Methods: It is based on the report 'Situational analysis of illicit drug issues and responses in Asia and the Pacific', commissioned by the Australian National Council on Drugs Asia Pacific Drug Issues Committee. A comprehensive desk-based review based on published and unpublished literature and key informant data., Results: Drug use in the Asia--Pacific region is widespread, resulting in serious adverse health consequences. Needle and syringe programmes are found in some parts of Asia, but not in the six Pacific Island countries reviewed. Outreach and peer education programmes are implemented, but overall appear minor in size and scope. Substitution therapy programmes appear to be entering a new era of acceptance in some parts of Asia. Primary health care specifically for drug users overall is limited., Discussion and Conclusions: Harm reduction programmes in the Asia--Pacific region are either small in scale or do not exist. Most programmes lack the technical capacity, human resources and a limited scope of operations to respond effectively to the needs of drug users. Governments in this region should be encouraged to endorse evidence-based harm reduction programmes.

This paper reports on the prevalence of drug use in Asia and the Pacific. It is based on the report "Situational analysis of illicit drug issues and responses in Asia and the Pacific", commissioned by the Australian National Council on Drugs Asia Pacific Drug Issues Committee. Review of existing estimates of the prevalence of people who use illicit drugs from published and unpublished literature and information from key informants and regional institutions was undertaken for the period 1998 - 2004. Estimates of the prevalence of people who use illicit drugs were conducted for 12 Asian and six Pacific Island countries. The estimated prevalence of those using illicit drugs ranges from less than 0.01% to 4.6%. Countries with estimated prevalence rates higher than 2% are Cambodia, Hong Kong, Philippines, Thailand, Indonesia, Laos and Malaysia. China, Myanmar and Vietnam have estimated prevalence rates ranging between less than 0.01% and 2%. Data to estimate prevalence rates was not available for Pacific Island countries and Brunei. Estimates of the prevalence of drug use are critical to policy development, planning responses and measuring the coverage of programs. However, reliable estimates of the numbers of people using illicit drugs are rare in Asia, particularly the Pacific.

This paper argues that the history of the international drug control system of the League of Nations/United Nations can be divided into three cumulative stages. The first stage, the supply stage, dates back to early part of the 20th century, and aimed to reduce the supply of drugs through careful monitoring and trade regulations. This has remained the dominant control strategy. In the middle of the century, demand control, in the form of treatment and criminalization of the individual user, began to appear. This was the least successful stage. Finally, in the 1980s, the dangers of the drug traffic assumed an important place on the international agenda and measures to reduce drug-related organized crime were enacted. To date, this has been a process of proliferation of regulatory strategies. Recently, new challenges to the international drug control system have emerged, including well-funded non-governmental organizations critical of the war on drugs, and the adoption of harm reduction measures in national policies around the world.

This paper first reviews the identity of historical and contemporary users of the areca nut. It then considers the reasons given by users for indulging in areca consumption, drawing upon historical, ethnographic and experimental sources of evidence for the effects which users have sought to derive from it. Particularly important is the social context in which consumption occurs, and the social meanings attached to areca use and exchange. Finally, a possible evolutionary hypothesis is postulated to explain the origins of areca use as a form of behaviour indicating reproductive availability. However, diverse culturally explicit reasons underlie usage and what may once have been a sufficient rationale for consumption may no longer justify this pattern of behaviour.

This paper aims to describe the sociocultural context of areca nut use through exploring people's norms and values and the meaning underlying a wide range of different practices. A historical review is followed by an examination of more recent evidence, including quantitative and qualitative research conducted in the United Kingdom. It is concluded that some reports involving the various uses of areca nut and the conclusions drawn are confusing and that future studies need to be more explicit. While a sound scientific background is required, important sociocultural and religious issues around areca nut use must also be understood if health promotion initiatives are to be considered.