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BY DEBORAH PHILLIPS
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Chinas drug-free reputation faltered in the 1980s with sweeping reforms and greater influence from beyond its bordersa move dubbed awakening the dragon. Along with other illegal goods smuggled through poorly guarded borders, drugs quickly found their way into Chinese society again. Attempting to preserve their countrys pristine social status, Chinas leaders kept silent about the problem.
In Asia, nobody wants to report bad news. So the best way to do it at the beginning is just to try and cover it up, says Shenghan Lai, Ph.D., adjunct associate professor of epidemiology at the School of Medicine and a key member of McCoys research team. A graduate of the prestigious Peking University and native of China, Lai first introduced McCoy to the problem on an initial visit. There is a very strong social stigma, Lai explains. A drug user in China shames his whole family, as well as his country. Uninformed of the heroin addiction problem in their country, Chinese citizens were not educated about the dangers and consequences of drug abuse. Twenty years later, the situation has become critical. Last summer, the United Nations outlined the severity of Chinas plight, calling one consequence of drug useHIV infectionan epidemic of titanic proportions. HIV cases have exploded in China, with more than two-thirds of them among people who inject drugs, primarily heroin. The solution, McCoy says, is to address the problem at its source. And in tracking the pathology of HIV infection in China, American researchers are discovering a new resource to help them understand drug use patterns in the United States.
Like opium before it, heroin found its way into Yunnan by way of a desolate highway stretching from the famed Golden TriangleMyanmar (Burma), Laos, and Thailand. Goods including fine wood, priceless gems, and highly concentrated, powdered heroin still pour in via the roadway, built in the 1940s as a passage for Allied troops during World War II. Because of the highways remote location, security is poor and smuggling is rampant. Like the road that connects the Golden Triangle to Yunnans vulnerable population, heroin has cut a path through Chinese society along which HIV infection can travel at breakneck speed, crossing borders and forever altering the health of its people. Researchers at Yunnan University routinely studied the consequences of injection drug use, like HIV and other bloodborne diseases. They joined University of Miami investigators for an international conference in 1995 that introduced the centers perspective on epidemic research through population studies. As chairman of the School of Medicines Department of Epidemiology and Public Health and director of the Comprehensive Drug Research Center, McCoy set out to offer his expertise to the troubled situation in China. Most participants at the conference were basic scientists, Lai remembers. They had never looked at the big picture. They had never linked drug abuse and HIV. Thats how Dr. McCoy made his contribution. He looked at the big picture.
With the center in place and epidemiological investigations under way in China, McCoy focused on developing standard research principles that would maximize cooperative study between the United States and China. The task is a familiar one. As director of the School of Medicines Executive Office of Research Leadership, McCoy regulates guidelines and directs investigators to enforce cohesive research practices in all of UMs laboratories. There has got to be equity between the researchers there and here, McCoy says. We are setting the standard by building infrastructure for doing research on drug abuse in China that is modeled after the study standards employed back home at our UM center. After years without awareness among Chinese citizens and scholars alike, questions are finally being answered through the work McCoy has introduced. Population-based studies are revealing why the heroin epidemic has been so far-reaching and how to curb consequences of unclean injection practices, such as HIV infection. At a concentration of up to 80 percent purity, the heroin smuggled into Yunnan is highly addictive. By comparison, the drugs purity in the United States is 6 to 25 percent. In studying the practices that led to injection of the drug, McCoy and his team found one of many stark differences between the two countries cultural adaptations to heroin use. Though families in China often keep syringes in the home for the administration of over-the-counter medications, illicit drug injection did not affect the population until the 1980swhen Western influence intervened and drug trafficking increased. Until then, users employed the technique of chasing the dragonheating heroin to inhale its flames. But users soon sought a more effective approach. Because of the inefficiency of the inhaled method, once addicted, users will look for more efficient practices, says McCoy. And with syringes readily available in the home, the cultural adaptation to injection was much easier there than here. We were shocked at the short time period involved.
One important addiction treatment unique to Eastern practices is the administration of a combination of native herbs. The therapy could hold an advantage over U.S. rehabilitation, which replaces one dangerously addictive substance, heroin, with another, methadone. A comparative study of the two treatments has been proposed by the U.S./China research team. The Chinese have 5,000 years of culture that is very different from our own, and if we dont see them as being Westernized, we think that difference is not as good, McCoy says. We need to realize that theyve survived with this knowledge for 5,000 years, so maybe they know some good things that we need to adapt to. Researchers should ask, What is best from both cultures that will improve the prevention and treatment of drug use? In China, its not Western medicine and its not traditional Eastern medicine, McCoy adds. Its what works. What works so far, if the success of the collaboration between the Comprehensive Drug Research Centers East and West sites is any indication, is continued study and partnership. At the invitation of People to People Ambassador Programs, McCoy and Lai will head back this winter and rejoin colleagues at Yunnan University to continue building the infrastructure for international research. The team also will focus on gender relationships to drug abuse, namely its prevalence among men compared to women. Questions do remain, as do Chinas epidemic of heroin abuse and its dire consequences including HIV/AIDS cases. But, as researchers at the University of Miami and in China have discovered, answers are best found and best employed by building bridges that span the globe. |
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Deborah Phillips (B.S. 98) is an editor in the Office
of Communication at the School of Medicine. Illustration by Peter Horvath.
Photography by Clyde McCoy, Ph.D., and Greg Baxer/AP.
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