Dr Htay Oung (L) and Dr Aung Myint (R) discuss use of methadone with a drug user at the UNODC drop-in centre in Lashio.

SETTLED over a game of carom, Kyin Aung is explaining the different kinds of highs available in Shan State. Although he often interrupts his speech with expressive hand gestures, his opponent does not lift his eyes from the game.

Kyin Aung remains an addict. But the substance he is now addicted to is given to him every 36 hours by a nurse at a government hospital in Lashio.

The drug is methadone, and with none of the destructive side-effects of heroin, Kyin Aung says it has changed his life. A synthetic form of opium, methadone stops the body from reacting to heroin while overcoming the symptoms of withdrawal.

He is not the only one at the UNODC-supported centre who is on the substance, which Dr Aung Htet, a doctor who works there describes as “one of the most effective ways of overcoming heroin addiction”.

“I’ve tried to withdraw from heroin several times. The symptoms are aching all over, pain, loose motion, muscle spasms – it’s terrible,” says 30-year-old Nya Saw, who has spent eight months on the methadone program. “I’ve tried five days of cold turkey and each time I relapsed.”

He is not alone. Even at some of the world’s best drug detox centres, the relapse rate for heroin addicts is 75 percent, according to a report in the UK-based newspaper The Independent.

“Now I’m on methadone. Now I can work. And my family is so pleased,” Nya Saw says, growing quieter when he speaks about his family. “I have four sisters, and if they started taking drugs I’d feel terrible. I’d feel it was my fault.”

The ability for methadone users to function normally in their community is part of the appeal of the treatment, says Dr Aung Htet.

“It is also cost effective, as heroin addicts commit crime and often can’t work. And if it is made in-country locally, it can be pretty cheap.”

For Nya Saw, methadone has restored more than just his livelihood; it has also allowed him to make peace with his family and move away from the stigma of being a junkie – a status that makes it tough to get work and make friends.

I meet Htay Nga, a truck driver, at a nearby govern-ment-run drug rehabilitation centre on day three of his first attempt at complete with-drawal from heroin. A local NGO is giving him medicine to help him sleep and overcome some of the pain.

“Without that, it would be impossible,” he tells me.

He says he began his descent into heroin addiction after he was fired by his boss for using opium during his long truck rides between Tachileik and Lashio.

“Once I lost my job I started injecting. It is difficult to get a job if people know you do drugs. The stigma is difficult to overcome. I just want my job and my life back.”

Unfortunately, there is a high probability that Htay Nga will return to heroin. Funding for the centre does not, at present, cover follow-up care, so the four staff care for batches of 20 or so young men a time. Once the 35 days of physical exercise and trainings are over and the clients leave, the staff have almost no way of knowing what happens to them.

It is one of the few heroin rehabilitation centres functioning in Shan State, even though there is no shortage of young men and women who are looking to kick their drug habit..

“I just couldn’t afford it anymore,” says Lwin Htu. “I want to earn money. I want to marry a girlfriend and have a family. You can’t do that when you’re on drugs. If I have money then the girls will come.”

But Dr Aung Htet’s experience shows that without treatments like methadone, the chances of overcoming the physical addiction of heroin are slim. His years spent watching clients overdose and die of HIV/AIDS have convinced him that methadone is a treatment that is viable and should be made more accessible.

“At the moment [in Myanmar] you can only get a methadone prescription through a registered psychiatrist, but in China there are places where you only need a nurse to prescribe the drug. It makes it much easier,” he says.

“Even if an addict is tempted to return to old habits, methadone supp-resses the desire.”

“If you’re taking methadone, then the heroin doesn’t work even when you inject it,” Nya Saw explains. “And you don’t need to inject methadone, so you are not going to get HIV or AIDS.”

“If it is available, I will just keep using methadone forever,” says Khin Aung.

What is striking about the UNODC drop-in centre, located in a region with some of the highest numbers of injecting drug users in the country, is how lively it is.

The courtyard outside is bright with sunshine, the walls painted forget-me-not blue. The clients – almost exclusively men – sit around swapping cigarettes, watching television or waiting to see one of the doctors or the councillor.

Some sit looking moody, others are clearly sick – hooked up to a drip, listless and obviously weak – but a good number joke and tell stories over cups of Chinese tea and the carom board.

True, there are posters on the wall that advocate what one might expect – safe sex and clean needles – but it is surprising to see that the liveliness of any particular client seems mostly depend-ent on whether he is lucky enough to be receiving anti-retroviral treatment for HIV/AIDS or taking methadone.

“If I stopped taking methadone I would relapse in eight to 12 months,” said Kyin Aung. “If I wasn’t taking methadone I would want that feeling again. I tried to get that feeling without taking drugs but it was impossible. You can’t get it without drugs. I’m an addict now, but methadone allows me to live a normal life.”