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When the waiter returns, a group of four men and two women openly cut and snort lines of ketamine, a powerful anaesthetic commonly used on animals, under dazzling laser beams. Before the military coup, this club was just like any other night-time entertainment venue — a place for Yangon residents to drink and dance away stress after a long work week. A doctor and the founder of a Yangon-based organisation helping victims of drug addiction told Frontier that he was dealing with an alarming rise in young patients since the February coup. Security forces responded to mass protests by slaughtering hundreds of civilians, sparking a broadening civil war, while erratic policy decisions collapsed the economy. During the previous administration, petty drug use among young people in Yangon was curbed by a campaign launched in by the military-controlled home affairs ministry that encouraged people to become whistle blowers, with authorities offering informants large cash rewards. In the months immediately preceding the coup, Chinese triad groups operating in the Greater Mekong region began a rampant expansion in the narcotics production. These groups have historically dominated the drug trade in Myanmar with the acquiescence and active participation of certain ethnic armed groups, military-aligned Border Guard Forces and individuals backed by the Tatmadaw. Key among these are precursor chemicals that enter Myanmar from China, either as mislabelled commercial chemicals or smuggled in unmarked containers. The pills are produced in their trillions in jungle labs throughout eastern Myanmar and exported to Asia and beyond. With production both rampant and unconstrained, post-coup conditions provide fertile ground for an upsurge in domestic drug use. Happy water is now so ubiquitous, that a sachet was recently accidentally consumed by a monk and his lay servants in Tachileik. From March, the military intensified its violent crackdowns in Yangon, killing hundreds. Ko Jeffrey told Frontier that, while the open sale narcotics such as methamphetamine used to only be prevalent in mining township gem markets, such as Mogok in Mandalay Region and Hpakant in Kachin State, they are now prominent in black markets in central Yangon. Heroin and crystal meth, known globally as ice, can now also be purchased across Yangon as if it were being sold legally, Ko Jeffrey said. While the cost of fuel and basic goods has risen dramatically since the military takeover, the price of street drugs has slumped — at the time of writing, a can of Coca-Cola K, or US 25 cents is almost twice the average price of a WY pill K, or US 15 cents. Some people arrested for possession of drugs told Frontier that they believed they were only detained so that police or soldiers could extort money from them, and many had been set free after meeting cash demands based on the type and quantity of drugs discovered. They said that security forces at checkpoints where most arrests are made are more concerned with detaining anti-military activists and resistance force members. There was also a pack of 10 WY pills in my bag, as well as some weed. But Frontier knows of at least one other case when a Yangon protester was arrested with demonstration materials and marijuana in his vehicle, and the regime was happy to pile on drugs charges to extend his prison sentence, which he is still serving today. To many users, including Hein Thant, casual drug dealing now represents a low-risk way of making ends meet. He sells cannabis — which he says many dealers now feel comfortable growing in their own homes — but yaba has become his mainstay. Although selling drugs in Yangon is no longer such a risky business, those working with users say that they are seeing more people fall prey to side effects and addiction. He said that nobody had tested the chemical composition of the latest batch of yaba pills being circulated in Yangon, and claimed to have personally experienced serious psychological damage, including hallucinations and bouts of severe depression. Sign up for our Frontier Fridays newsletter. This post is also available in: English. Issues Issues. Party goers dance in a private room in a KTV, where drugs are readily available. October 31, A baggy of ecstasy pills and ketamine. More stories. Doh Athan. How is your mental health these days? Many Myanmar people are said to be suffering from depression and anxiety, after enduring almost four years of destruction and deprivation. These include journalists, who are also traumatised by having to witness and document these disturbing events. BY Frontier. Related stories. News Feed , News Feed , News. Myanmar junta invites armed groups to stop fighting, start talks. Volunteers rush to help as Myanmar flood toll surges. Latest Issue. Volume 6, Issue January 27, Stories in this issue. Editorial , Opinion. Myanmar enters with more friends than foes. News Feed , News. Will the Kayin BGF go quietly? Become a Frontier Member. Support our independent journalism and get exclusive behind-the-scenes content and analysis. Get exclusive daily updates. Join the community. Facebook-f Twitter. Privacy Policy.

Myanmar says it burned nearly half-billion dollars in seized illegal drugs

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Official websites use. Share sensitive information only on official, secure websites. Competing Interests: The authors have declared that no competing interests exist. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Drug use disorder DUD is a serious health condition that imposes a heavy burden on the persons who have a drug addiction experience and their families, especially in countries, such as Myanmar, where few formal support mechanisms are in place and repressive drug laws exacerbate the situation. Yet, in Myanmar, little is known about how informal caregivers are affected. This qualitative study aims at exploring the socioeconomic and psychological burden that informal caregivers in Myanmar encounter, coping strategies they employ, as well as barriers to coping they face. Thirty primary informal caregivers were chosen purposively from a mental health hospital in Yangon for in-depth interviews. The recorded interviews were transcribed and the data were analysed using framework analysis. The results revealed that financial constraint, income loss, social limitation and negative impact on family cohesion are important dimensions of socioeconomic burden, whereas sadness, anger, helplessness, worry, fear and guilt are the main psychological distress factors encountered by caregivers of persons with DUD. Key coping strategies employed by caregivers include religious coping, financial coping, acceptance and planning. Neither the government nor any other organization in Myanmar provided financial support to the caregivers. The results of this study showed that caring for persons with DUD has devastating effects on caregivers and their families. While the National Drug Control Policy can potentially help alleviate the burden on substance users and their families, further amendments of the existing drug law are urgently needed. Moreover, strengthening prevention and harm reduction approaches, improving treatment and rehabilitation services, as well as stigma-reducing educational campaigns should be considered a priority. Drug use disorders DUD have become a major public health concern, increasing morbidity and premature mortality, and the burden of DUD has tremendous negative consequences for persons using drugs, their caregivers and families, as well as the society \[ 1 \]. DUD are mental and behavioural disorders caused by the use of psychoactive and dependence-producing drugs \[ 2 , 3 \]. Almost 13 percent of adults worldwide who used drugs in the previous year, that is about 0. The global burden of disease attributable to drug use and drug use disorders was estimated to be Not captured by these health loss estimates are related economic and social consequences, which are substantial. In the United States, the impact of opioid use disorder and fatal opioid overdose in terms of healthcare, substance abuse treatment, criminal justice, lost productivity, reduced quality of life and premature mortality costs, for example, was estimated to be about 1. For most individuals with DUD, the family is the predominant source of support and the primary caregiving role is often assumed by a family member \[ 7 — 9 \]. The impact felt by caregivers as a result of caregiving, the caregiver burden, is a multidimensional concept comprising social, economic, physical and emotional issues \[ 10 , 11 \]. In the literature, a distinction is made between objective and subjective burden \[ 12 , 13 \]. From a psychological perspective, the stress process associated with caregiving can be separated into four domains, namely the background and context of stress, primary and secondary stressors, mediators of stress such as coping and social support, as well as outcomes of stress \[ 14 \]. Primary stressors are stressors that arise from the need of the patient, overload and relational deprivation, while secondary stressors comprise role strains for example, economic problems, social limitations, family conflict and intrapsychic strains for example, loss of self-esteem and mastery \[ 14 \]. Ethnicity and cultural values also influence the stress process, especially through their effect on mediator variables \[ 15 — 17 \]. The presence of caregiver burden was also confirmed in studies that specifically focus on DUD or co-occurring substance and mental disorders \[ 7 , 31 \]. In fact, the caregiver burden from caring for adolescents in treatment for substance use disorders and adolescents with mental health problems was found to be similar \[ 32 \]. To mediate the effects of caregiving, active coping i. Stigma, lack of support, and lack of coping resources more generally, are identified in the literature as major barriers to coping \[ 31 , 35 , 36 \]. Myanmar is the second largest producer of opium and one of the largest producers of methamphetamines worldwide \[ 4 , 40 , 41 \]. Due to the criminalisation of drug use, official statistics on drug users in Myanmar are not available, but drug problems are believed to be widespread \[ 39 \]. While the National Drug Control Policy, which was developed with support from the United Nations Office on Drugs and Crime UNODC , focuses on public health and suggests decriminalizing drug use, the amended Narcotic Drugs and Psychotropic Substances Law, however, continues to impose harsh prison penalties on substance users \[ 43 \]. Given that the National Drug Control Policy was only announced in and is not yet supported by an adequate legal framework, DUD in Myanmar is still a very sensitive issue. This study, therefore, aimed at analysing the socioeconomic and psychological burden of caregivers. It also explored the coping mechanism used by caregivers to tackle the problems they encountered when caring for people with DUD, as well as barriers to coping. This study employs a qualitative research design, using data collected through in-depth interviews. Major DTC are attached to mental health or general hospitals and provide inpatient services, while minor DTC offer outpatient services \[ 44 \]. Thirty primary informal caregivers of persons with DUD who received treatment at the YMHH between April and July were chosen purposively, based on a priori determined eligibility criteria. Eligibility criteria included i being a primary family informal caregiver of a family member with DUD, ii co-residing with the family member, iii being 18 years and above, and iv having at least one year of caring experience. Psychiatrists working at the research site identified caregivers based on perceived availability, willingness and ability to participate in the research, given their familiarity with the history of patients and caregivers. If they agreed, an appointment for the in-depth interview was scheduled. All thirty caregivers accepted the invitation to participate in this study. Face-to-face in-depth interviews were conducted one-on-one with the caregivers in the Burmese language using a semi-structured data collection instrument \[ 47 \]. Structured questions were used to elicit information about socio-demographic characteristics of caregivers, their families and the substance using family member, while unstructured questions focused on the socioeconomic and psychological burden of caregiving, coping methods and barriers to coping. The purpose of the study was explained to interested caregivers and written informed consent was received before the start of the interview. The interview was completed at a place convenient for the respondent and took approximately forty-five minutes to one hour. While conducting the interview, each participant was given snacks and coffee worth about 4 US dollars. All respondents were Myanmar nationals and the in-depth interviews were conducted, recorded and transcribed in the Burmese language. Verbatim transcriptions were prepared after each interview and subsequently translated into the English language. The data were analysed using framework analysis \[ 48 \]. The transcripts were read several times to become familiar with the data and pinpoint pre-identified and new themes. Pre-identified themes were derived from the literature and comprised socioeconomic burden financial and income losses, social limitation, family conflict and psychological burden sadness, anger, helplessness, fear, guilt, worry , active and avoidant coping strategies and barriers to coping stigma, lack of support \[ 7 , 13 , 14 , 28 , 30 , 31 , 35 \]. Codes were developed and refined until no new codes emerged. A matrix table was then used to group codes into themes and analyse the data across cases and themes. The last step involved reviewing and refining the themes. No new themes related to caregiver burden emerged, but revisions were made to include drug use risk factors, reasons for seeking treatment at the YMHH and national drug laws and policies. National drug laws and policies were identified as an additional barrier to coping, increasing caregiver burden. Sociodemographic characteristics of the thirty caregivers are summarized in Table 1. More than four-fifths of respondents were from Yangon and more than half were female and aged 45 years and above. Almost two thirds of caregivers were the parent of a family member with substance use disorder and had their own business. According to the respondents, the majority of substance using persons were young, male, single and unemployed. Regarding the type of illicit drugs used by the family member, amphetamine was mentioned most often, followed by heroin and cannabis. Most of the care recipients were reported to also consume other types of psychoactive substances such as tobacco, alcohol and betel, while some had co-occurring use of heroin or cannabis and amphetamine. Respondents felt it was important to share their opinion about the risk factors for drug use prior to discussing caregiver burden. Risk factors for drug use was a new theme that emerged from the data analysis, possibly motivated by associative stigma experienced as caregiver of a family member with DUD \[ 49 \] and resulting feelings of social desirability. Easy accessibility of drugs and peer pressure were identified by several respondents as the most important risk factors. Seven caregivers pointed out that there is an abundance of illicit drugs in their community and that drugs can be obtained easily. In this day and age , drugs are very easy to get and use , even if there is only a little bit of money. I am worried about the future. He will use drugs again; I will have to send him to the hospital again. And I want to ask how long I have to survive in this circle? Until he dies or until I die? An equal number of caregivers shared that their family member tried drugs when attending university since they met friends who used drugs. One caregiver said her child became addicted because of her partner. The wife of an alcoholic uses alcohol. Like this. She injected when she could not protect her husband from using drugs and she became addicted herself. Four caregivers said that their family member started using drugs because of family problems such as growing up in a broken family, death of the mother or not living together with their parents. Since I am the household head , I could not stay besides him. So , there was no one to control him. He started to hang out with many friends and did not go back home at night. More than half of the caregivers subsequently also explained why their family member was hospitalized. Some caregivers, especially parents and siblings, said that they insisted their family member to go to the hospital since they could not control their behaviour and aggressiveness anymore. Underlying reasons given include an intrinsic yearning to overcome the drug problem, feeling sorry for family members, regret and fear of imprisonment. But he tried to get rid of drugs by himself and he can still be a role model for accepting his mistake. We do not know how to go to the hospital. He drove to the hospital himself. DUD take a heavy financial toll on the substance using person and their caregivers in terms of financial costs and income losses. The financial costs of DUD comprise drug, medical, religious, and legal costs. Depending on the type of substance use, the cost of the drug itself can be substantial. Second, almost all of the respondents incurred both direct medical and non-medical expenses when their family member was hospitalized to access treatment. Direct medical expenses other than bed charges, however, were borne by the YMHH. Hospitalization-related out-of-pocket expenses commonly encountered by caregivers, therefore, mainly included bed charges, and expenses for food and transportation. Even for caregivers living in Yangon, transportation was a major component of expenses, as the hospital is very far from the city centre. Caregivers from other regions incurred additional accommodation expenses. However , accommodation was just 1 , MMK per day. Over 1 , , MMK were spent on his legal case. I am very worried that I could not afford the expenses for him any more if I do not have money. Lost income due to caregiving mainly comprised time missed from work and activity restrictions. The income loss associated with accompanying their family member to the hospital was higher for the 63 percent of caregivers, who had their own business, compared to employed caregivers who received relatively low wages. It is more tiring than working. Not only caregivers, but also persons with DUD experienced income losses. A few caregivers pointed out that their family member is not interested in working any more, but one caregiver added that persons with DUD, even if willing to work, face job limitations. You see! Which employer wants to give him a position? Before starting to use drugs , he worked. Nearly , MMK of his income were lost and this made it more difficult for me to survive. My income was , MMK per month. Now , it has been sold and I get only , per month in the new place since there are only a few customers. I also pawned my jewellery. Seven caregivers broke into tears during the interview saying that their financial crisis made them feel so sad, depressed and worried about the future. Since then , the house has been sold to be able to pay off some of the debt. For a long time , I have not been able to attend weddings and other social activities. Almost one third of the respondents pointed out that the DUD of the family member negatively affected other family members and family cohesion. Stealing to be able to purchase drugs was a common behavioural problem faced by caregivers and other family members. The family member with DUD threatened other family members when asking for money and sometimes they pawned things, which increased the indirect financial cost of the household and destroyed family relationships. One female caregiver described that her brother even tried to take the money she put aside for religious offerings. But if he is at home , even the money I had hidden disappeared. He stole the money which I intended to donate for monks and god. How stupid he is. Two caregivers, both mothers of persons with DUD, said that they neglected other family members because of taking care of the substance using family member. I am worried that my adolescent son imitates his father. My son is in grade 11 and he always goes to school and tuitions. He returns late at night and it is a dangerous condition for him as he risks being wrongly accused under drug laws by the police. Emotional distress was widespread among caregivers. Almost all respondents said they experienced emotional distress when taking care and dealing with the behavioural problems of their family member with DUD. Common negative emotions included sadness, anger, helplessness, fear, worry and guilt. More than half of the caregivers, especially mothers, felt sad and hurt of seeing their loved one suffering from DUD. If I could , I would like to exchange her blood for new cells. She used to be afraid of syringes and she never had injections , even when she was ill. I cannot imagine how she injected heroin by herself. She is always asking for drugs. Parents expressed feelings of guilt and hopelessness for their children and some reported feelings of shame together with anger when their children became rude and physically abusive towards them. I have always scolded him and he may not have wanted to live at home. I regretted that when seeing the psychiatrist speaking to him kindly and guiding him patiently. I have never spoken to my son like this. He pulled my hair hard and I thought that it is better for him to die or for me to escape from this retribution. The feeling of helplessness was emphasized by three caregivers who were the main breadwinners of the family. I wish I was mad. I have to run the business by myself , take care of children and take care of him as well. How can I handle all this by myself? Some caregivers were worried that their family member would use drugs again upon discharge from the hospital. Moreover, nearly two thirds of respondents, especially female caregivers, reported feelings of fear. The largest fears concerned injuries inflicted by substance using persons on family members and others, legal problems and negative judgements from people in their surroundings. Caregivers also pointed out that magnitude and characteristics of the psychological burden were affected by the nature of the relationship between caregiver and family member, as well as between other family members and the family member with DUD. While negative relationships were perceived by respondents to exacerbate the psychological burden, positive attitudes were thought to lower it. Two caregivers added that caregiving also had negative effects on their physical health. They reported suffering from sleep disturbances, since they were too worried about their family member, and increased physical health problems such as hypertension, diabetes and heart diseases which were associated with stress. Coping strategies can be classified as active coping and avoidant coping \[ 50 \]. Most respondents used active coping, whilst only a few revealed that they tried to disengage from the problem. Engaging in religious activities, accepting the situation, seeking information, planning for the future and financial coping are active coping strategies used by caregivers to tackle the challenges associated with caring for persons with DUD. As most caregivers interviewed were Buddhists, religious activities included prayers, paying homage to Buddha, becoming vegetarian and performing religious activities for their family member, as well as for the peace of their mind. Three caregivers made offerings to spirits, while two sought advice from fortune tellers. One of the two Muslim caregivers described that she sent her husband to Saudi Arabia to perform the Hajj pilgrimage. However , he came back from the Hajj , used the drug and the cycle started again. I remembered that nearly 6 , , MMK were paid for this activity. I have to take care of the whole family , including him. Sometimes I became angry with him and sometimes I wanted to die. But gradually , I tried to devote my mind to religious activities. Now I am more peaceful than before and I can think that it is just fate that I cannot change. Several caregivers tried to understand their family member better, and some mentioned that they tried to obtain relevant information from television, radio and social media. It allows me to improve my knowledge about the disease. You cannot be too serious and angry with drug users. Caregivers also made plans for the future of the person with DUD such as sending their family member to a rehabilitation unit after leaving the hospital, encouraging them to work or continue studying and spending more time with them. Most of the respondents also used financial coping strategies such as selling properties, pawning, borrowing money and cutting other expenditure to cope with financial hardship. I tried to be in a good relationship with doctors and nurses at the hospital. I work and I wear what they give to me. Avoidant coping strategies such as denial, behavioural disengagement i. Only three caregivers said that they thought about disengaging from the stressful situation and the large responsibility. Yet, no one had ever abandoned their substance using family member. Also, substance use alcohol and sleeping pills was rarely used as a coping method to deal with problems. Two male respondents said that they drank some alcohol when they were tired and annoyed though. The two main barriers to active coping respondents identified were stigma and the lack of support \[ 31 , 35 , 36 \]. Nearly one third of the respondents said that they were exposed to stigma associated with DUD and related negative sentiments from relatives, neighbours and friends. Stigma is perceived to be a barrier to financial coping and seeking social support. There is no mother who gives their children money for drugs. There is no mother who encourages them to use drugs. Three caregivers said that even very close relatives tried to end their relationship since they are worried about their own children imitating the behaviour of the person with DUD, increasing social isolation. There was a person who graduated with a specialization in law and he said that if someone is a criminal , the police will arrest only this person. However , if the suspect is involved in drug cases , the whole family cannot escape. Associative stigma exacerbated the social isolation of caregivers and was a barrier to seeking emotional support. Moreover, some caregivers emphasized that the persons with DUD themselves were also exposed to high levels of stigma. He has no future. I am afraid that he cannot enter into society again. I am very depressed of seeing these things…. Almost all of the caregivers said that they did not receive any help from outside the family to deal with the wide range of issues. One caregiver shared that even the local authority failed to issue the referral documents in time to send the substance using family member to the hospital and gave wrong advice. I was greatly surprised by his suggestion , because he told us to give alcohol or sleeping pills for my patient to control aggressiveness instead of sending him to the hospital. One caregiver from Kayin State about kilometres away from Yangon by road pointed to supply-side barriers and said that she had to travel to Yangon because of the shortage of treatment centres in Kayin State. A few caregivers stressed financial problems and suggested that it would be good to have charitable organizations at the existing mental health hospitals to provide financial support for medication and other necessities for persons with DUD. Another caregiver drew attention to the legal framework by expressing his disappointment with the existing drug law and policy as follows:. The police imprison offenders with only two or three amphetamine-type stimulants in hand while large scale traffickers still escape. Surprisingly, half of the caregivers who discussed the lack of support indicated that they did not hope for any support from anywhere because they thought that it was not the responsibility of the public to help and that it was shameful to talk about this openly. Some even stated that it was not worthwhile for the government to support persons with DUD. So , when your child becomes addicted , it is totally your responsibility. It is too shameful to admit even to close relatives. So , how could I announce this to the public? DUD impose a burden on substance using persons, their family members, and family caregivers \[ 7 , 31 , 35 , 38 \]. Yet, evidence is limited, especially for Southeast Asian countries. Caregivers highlighted the importance of background as well as context and argued that it is important to understand the factors underlying substance use. Peer pressure was also identified as a key risk factor in Sibeko, et al. Evidence, however, suggests that persons with DUD often do not seek speciality care on their own \[ 53 \]. Since , when cost-sharing was introduced, out-of-pocket health expenditures have been the main source of finance in Myanmar, accounting for 79 percent of total health expenditure in \[ 54 \]. Only 0. The mental health treatment gap is estimated to be almost 90 percent due to factors such as stigma and insufficient knowledge about mental disorders, despite the fact that community mental health care has been developed since \[ 54 \]. Therefore, the bulk of the financial and non-financial burden related to DUD is typically borne by the substance using person and their family members, which is echoed by the findings in this study. All respondents were financially affected as they had to pay for direct medical and non-medical expenses such as bed charges, and expenses for food and transportation. Moreover, caregivers living outside of Yangon had to bear additional accommodation expenses. Other expenses included legal fees, payments to police officers and expenses for religious rituals. In addition, caregiving was found to result in substantial indirect cost. Prior research also found that caregivers faced income losses as they either had to cut back working hours or were unable to work due to the responsibilities associated with caregiving \[ 20 , 30 \]. Moreover, taking care of persons with mental disorders limits social interactions and can result in social isolation and withdrawal \[ 28 , 30 \]. Consistent with the literature, some caregivers felt socially isolated due to their caregiving responsibilities, which prevented them from participating in social activities. Moreover, caregiving and harmful behaviour of persons with DUD such as stealing and physically or verbally abusing family members were found to negatively affect family relationships. Usher, et al. As expected, caring for a person with DUD was found to negatively affect respondents emotionally. Feelings of grief, hopelessness and guilt were particularly pronounced among parents, who were taking care of a child with DUD. Moreover, feelings of guilt were stronger in case of poor caregivers as they thought that they could neither support their family member well enough financially nor devote sufficient time to provide care, given that they have to work to survive. Feelings of guilt related to caregiving were also discussed in prior work \[ 25 — 27 , 31 \]. Behavioural problems of persons with DUD triggered feelings of sadness and anger in caregivers, which supports that behavioural problems of patients are predictors of negative emotions in caregivers \[ 7 , 32 \]. To deal with these challenges, most of the respondents adopted active coping strategies such as performing religious activities, accepting their situation and planning ahead, which is consistent with studies that analysed the coping mechanisms of caregivers of persons with schizophrenia and breast cancer \[ 50 , 57 \]. Furthermore, some of the caregivers would like their family member to use religious coping strategies after being discharged from the hospital and to spend time in a monastery. This is similar to the findings of a study in Ghana, where caregivers sent their mentally ill relatives to prayer camps \[ 28 \]. Financial coping strategies used by caregivers who participated in this study comprised selling belongings, pawning assets, borrowing money from relatives and others, as well as cutting other expenditures, which is likely to worsen their situation. Reducing other expenses is a common coping strategy to deal with financial difficulties \[ 28 , 30 \]. Given that no public health education programmes about DUD were offered at the community level and the perceived need for information, caregivers tried to obtain related information from other sources such as television, radio and social media, which helped them to better understand DUD and how to deal with these. Caregivers experienced associative stigma and explained that not only persons with DUD but also caregivers were discriminated against by their surroundings and close relatives. This is consistent with findings from Australia, where parents of substance using persons had to endure blame and criticisms from their neighbours \[ 31 \]. A few caregivers indirectly pointed to the existing drug laws and explained that these increase stigma as people are afraid of the police, the court of law and imprisonment. According to the Narcotic Drugs and Psychotropic Substances Law, a person is sentenced to about five to ten years in prison if he or she is found to possess only a small amount of illicit drugs \[ 39 \]. Almost 50 percent of all prisoners countrywide serve sentences for drug-related offences \[ 41 \] in prisons that are known for their appalling conditions \[ 59 \]. Yet, most large-scale drug traffickers have remained unscathed \[ 39 \], which a few respondents also pointed out. In , the National Drug Control Policy was announced, heralding a shift from a punitive and coercive towards a harm reduction approach to drug use \[ 43 \]. Yet, the National Drug Control Policy needs to be supported by further amendments of the Narcotic Drugs and Psychotropic Substances Law to ensure that standards of proportionality in sentencing for drug offences are met as discussed in Cachia \[ 43 \]. In Myanmar, support from the government and other organizations for people with DUD, their caregivers, as well as other family members is inadequate at all levels. Supply side factors increased the socioeconomic and psychological burden of households with persons experiencing drug dependence. There are only two tertiary-level mental health hospitals and most of the drug treatment centres in other states and regions are not functioning well as evidenced by their low utilization rates \[ 61 \]. Similar findings were reported in rural Ghana, where caregivers did not receive financial and social support at the community level because of poverty, lack of sympathy and high stigmatization \[ 28 \]. The results of this study further underline that a shift from a punitive approach to a health-focused and evidence-based harm reduction approach to deal with drug-related challenges is urgently needed as envisaged in the National Drug Control Policy. To facilitate harm reduction approaches, interventions such as targeted education campaigns to reduce the stigma associated with drug use and DUD should be prioritized. Moreover, reducing the stigma enshrined in the current drug law is likely to facilitate access to treatment and rehabilitation services. It is important to point out that this study has several limitations. First, only caregivers of persons who received treatment at the YMHH were included, which introduced a bias. In addition, the burden caregivers are facing is likely to be largely underestimated as caregivers of those persons with DUD who do not receive treatment or caregivers of imprisoned persons with DUD were not included. The small sample size did not permit a clear distinction between caregivers of persons with DUD by type of substance use amphetamine, heroin and cannabis. Last not least, given that this study uses a qualitative research design, the findings cannot be generalized. Future studies should consider a wide range of caregivers, including caregivers of patients who receive treatment at facilities other than the YMHH, patients who do not receive any treatment, and patients who are imprisoned. These studies should adopt a quantitative or mixed methods research approach to better understand the situation of caregivers and complement the findings of this research. A larger sample size would also permit an analysis by type of substance use. Last not least, while none of the caregivers who participated in this study pointed to positive experiences from caregiving, possible benefits of caring for patients with DUD could be explored. Myanmar has been facing extensive drug-related challenges, including widespread drug use despite the fact that substance users continue to face five to ten years of imprisonment. The results of this study suggest that the socio-economic and psychological burden of caring for patients with DUD is tremendous in Myanmar. Socio-economic burden consists of financial constraint, income loss, social limitation and negative impact on family cohesion. Sadness, anger, helplessness, worry, fear and guilt, on the other hand, are the main psychological distress factors. Most caregivers used active coping rather than avoidant coping, but barriers to coping exist. These include perceived stigma towards persons with DUD and their caregivers and a lack of support. The authors would like to express their sincere gratitude to the caregivers for participating in this research, as well as the YMHH staff for their support. This research article is based on her thesis. Relevant excerpts of transcripts are made available within the article. Since the data contain sensitive information, the researchers cannot share a de-identified data set due to ethical restrictions. This section collects any data citations, data availability statements, or supplementary materials included in this article. As a library, NLM provides access to scientific literature. PLoS One. Find articles by Khin Zar Khaing Thein. Find articles by Chantal Herberholz. Find articles by Win Pa Sandar. Find articles by Yadanar. Bronwyn Myers : Editor. Received Sep 12; Accepted Sep 22; Collection date Open in a new tab. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. Characteristics of the family member with DUD.

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