See also:
Speed.
Consumers Union Report (see chapters 36-40)
OGD report 1997/98 on Japan

Cannabis in Japan (main index)
Hemp as a "drug"
Drug risks: How dangerous are the most common drugs?

History

Minimal data has been accessed of historical drug use in Japan. Between 1946-1956 amphetamine use was widespread and it was estimated that up to 2 million people were involved in injecting this drug.

Current Situation

Japanese government sources acknowledge that while Japan is not a major producer of illicit narcotics it has become Asia's largest consumer of methamphetamine. Approximately 90% of all drug arrests in Japan involve methamphetamine use. The minimal domestic production of methamphetamine has resulted in extensive trafficking networks, mostly controlled by Japanese organized crime syndicates, closely linked with foreign sources. Most illicit drugs are smuggled from China, Taiwan and Thailand. In 1996, government authorities seized 522 kgs of methamphetamine that were being smuggled from Taiwan. It is reported that the retail price of illicit drugs is high therefore making drug trafficking a very lucrative business in Japan. Drug arrests have declined in recent years; from 25,000 in 1984 to 15,000 in 1993.

Divergent viewpoints exist about the incidence/spread of illicit drugs in Japan with perceptions of some who see rising numbers and widespread use contrasting with those who see drug related activity as peripheral. Both international and national narcotic bureaus view Japan as unlikely to become a significant country for production or trafficking of narcotics in the near future. Methamphetamine use is by far the most favoured drug with cocaine, heroin, marijuana, opium, diazepam and ecstasy consumption believed to be small.

Drug Taking Practices

The favoured administration route for methamphetamine is by either injecting or by foil vapour. Heroin and diazepam are commonly injected. Marijuana is smoked. In 1996, a research study of drug dependent patients admitted to medical care institutions reported very high IDU rates; over 93% had injected sometime in the past and up to 70% had injected in the past 12 months. The rate of having shared syringes in the previous year was 70% and of sharing needles was 46%. In the same year, a study amongst non-hospitalised IDUs reported 88% having shared needles in the past year, with nearly 40% of the respondents reportedly injecting several times or more a day. Of those sharing, up to 39% did not know of the risk of HIV from sharing needles. About 70% of the participants implemented no cleaning techniques.

For those who claimed to employ needle cleaning practices, most proved completely inadequate. Up to 26% had trusted water to effectively rinse the needle before sharing and less than 4% used alcohol or boiling water. The use of bleach appears to have been completely non-existent. Many found accessing clean injecting equipment difficult (26%) and/or the desire to inject immediately was so strong there was no time to access clean injecting equipment (23%), resulting in shared syringes and needles. Less than 4% of the IDUs in that survey found injecting equipment expensive; information on where these items are purchased from has not been determined.

Needles and syringes are not able to be purchased from a pharmacy . There are some exceptions; those who can medically prove they are either an insulin dependent diabetic or a haemophiliac requiring a regular specific blood product. However, even most of these people generally obtain injecting equipment from doctors or health staff directly.

Prevalence

In 1996, based on arrests statistics, it is estimated that there could be a total of 400,000 to 600,000 users of methamphetamine. Of these, it is estimated between 150,000 to 500,000 are IDUs . The number of heroin users are not known. The use of illicit drugs is widespread but tends to be focused in the larger urban centres.

The prevalence of reported HIV infections has remained relatively low and stable in recent years. However, the number of cases reported has increased by 48% between 1995 and 1996 when 676 new HIV infections were documented. As of February 1997, the cumulative total of reported HIV infections was 4,200, of whom 14 are IDU and a total of 1,447 are reported to have AIDS. Ten AIDS cases have been identified as IDUs.

Recent studies amongst IDUs report that between 48.7% and up to 74.5% have Hepatitis C. These figures clearly indicate that this high risk group are very vulnerable to HIV transmission.

Government responses to drug control (including penalties)

Drug demand in Japan is considered to be low, but in 1995 when the Aum Shinrikyo religious sect accumulated large quantities of controlled drug precursor chemicals, the government were deeply alarmed. Soon after this event the government implemented registration by all individuals who purchase such precursors. The government are focused on supply and demand reduction. Currently the public service announcements on drug use and prevention programmes are limited in scope and effectiveness. The government imposes repressive methods on the trafficking and possession of drugs. Although there is no death penalty imposed for drug trafficking, it is reported the penalty is draconian. Details of penalties associated with drug possession have not been able to be determined but there are anecdotal accounts of substantial fines and various time periods of detention with police authorities. Drug treatment programs are not widespread in Japan and are generally run by private organisations. Methadone is not offered at any rehabilitation or detoxification centre in Japan. The relapse rates of drugs users, as in many other countries in the Asian region, is anticipated to be high.

Government response to drug use and HIV

HIV prevention and control programmes in Japan have been largely targeted at the wider population with minimal focus aimed at groups that are at great risk such as IDUs. Recent behavioural studies that have been undertaken amongst IDUs clearly indicate that many participants were significantly vulnerable to HIV transmission. The very low reported HIV infections among IDUs have proven deceptively reassuring for health officials and therefore a general absence of IEC materials targeted towards IDUs is in existence. There are no plans to introduce needle exchange programmes or harm reduction methods. Information on the existence of peer education programmes for IDUs has not been able to be confirmed.

National AIDS Policy

There are no specific details that focus on drug use and HIV.

Non-government responses

There are some NGOs that maintain rehabilitation programmes for drug users but details of their activities have not been able to be accessed. There are no known reports of any NGO that have peer education approaches or provide IEC materials targeted towards IDUs. The low rates of HIV infection amongst IDUs may explain why there are no NGOs that target this particular group in the community.

Estimated number of IDUs	150,000 - 500,000
Drugs that are used	methamphetamine (cocaine, heroin, opium, marijuana, ecstasy and diazepam are reportedly used in small quantities)
Drugs that are injected	methamphetamine (heroin, cocaine and diazepam are injected but it is reported not to be common)
Estimated number of HIV infections amongst IDUs	Unknown. As of August 1997, the official known cumulative total of HIV infections among IDUs was 14

Japan:- Activities

Government Organizations:
In recent years a few studies have been undertaken to assess the behavioural patterns of drug users. One such institution National Centre for Psychiatry and Neurology conducted a study on drugs use and HIV. Overall the activities are minimal and HIV preventative measures are essentially aimed for the wider community not IDUs.

Non-government Organizations:
There are reports of some NGOs that support those with HIV/AIDS resulting from IDU. However, as the number of drug users with HIV infection in Japan is small, there are no known NGOs that target this group of people for preventative education or in the support of rehabilitation programmes.

Results
Japan has a significant (but officially unknown) number of IDUs. Recent studies have indicated that injecting equipment is commonly shared, cleaning techniques are inadequate and a significant number of IDUs were unaware of the risk of HIV infection associated with sharing needles. The findings of these studies need to be acted upon and educational information targeting IDUs urgently needs to be implemented. The potential difficulties associated with purchasing injecting equipment needs further assessment. The figures of HIV infection linked to IDU are currently low but, recent studies have shown high Hepatitis C rates among IDUs. Once HIV infection enters the IDUs community, the potential for an explosive epidemic is very strong. The need for regular assessments, surveillance, monitoring and evaluation of this target group are essential.

Some contacts for situation report (not all necessarily responded)

Dr Kiyoshi Wada
Director, Division of Drug Dependence and Psychotropic Drug Clinical Research

Manzoor Ahmed
Chairperson, UNAIDS Theme Group, Tokyo

Yasushi Sawazaki
Japanese Foundation of AIDS Foundation (JFAO), Tokyo

Dr Masaui Matsuda
The Research Institute Of Tuberculosis, Tokyo

O Sam Mu Minami
Independent Researcher

Yuriko Kitano
Hiroshima AIDS Dial, Hiroshima

Dr Masahiro Kihara
Kanagawa Cancer Centre Research Institute, Yokohama

Japan:- References

Bureau for International Narcotics and Law Enforcement Affairs, U.S Department of State Washington, D.C, March 1997 International Narcotic Strategy Report, 1996. Japan. [ http://www.state.gov/www/global/narcotics_law/1996_narc_report/index.html]

Ichimura H., Kurimura O., Tamura K., Tsukue I., Tsuchie H et al. 1995. Prevalence of blood-borne viruses among intravenous drug users and alcoholics in Hiroshima, Japan. International Journal of STD & AIDS 6: 441-443.

Japan International Cooperation Agency. 1994. Control of AIDS (Acquired Immunodeficiency Syndrome). National Health Administration, Japan.

Kihara M., Ichikawa S., Kihara M., Yamasaki S. 1997. Descriptive epidemiology of HIV/AIDS in Japan, 1985-1994. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 14 (suppl 2): S3-S12.

Kitamura T. 1994. Summary of the epidemiology of HIV/AIDS in Japan. AIDS 8 (suppl 2): S95-S97.

Ministry of Health and Welfare. 1995. AIDS control in Japan: the seven-year stop AIDS plan 1994-2000. Unpublished report, Ministry of Health and Welfare and Japanese Foundation for AIDS Prevention.

Ministry of Health and Welfare. 1996. Measures for AIDS control: Annual report on Health and Welfare 1994-1995. Ministry of Health and Welfare.

Ministry of Health and Welfare. 1996. Annual report on health and welfare: AIDS (1992-1995). Unpublished report, Ministry of Health and Welfare. [ http://jin.jcic.or.jp/stat/data/12MED51.html]

Miyazaki M., Naemura M. 1994. Epidemiological characteristics on human immunodeficiency virus infection and acquired immunodeficiency syndrome in Japan. International Journal of STD & AIDS 5: 273-278.

Munakata T., Tajima K. 1996. Japanese risk behaviours and their HIV/AIDS-preventive behaviours. AIDS Education and Prevention 8 (2): 115-133.

National Police Agency. 1996. White Paper on Police: Drug Abuse Violations (1984-1995). Unpublished report, National Police Agency. [ http://jin.jcic.or.jp/stat/data/14CRM41.html]

Poshyachinda V. 1993. Drug injecting and HIV infection among the population of drug abusers in Asia. Bulletin on Narcotics XLV (1): 81.

Saito N. First Secretary for Science, Technology and Environment, Embassy of Japan. Personal Communication. October 1997.

Sankary T., Ohashi H., Soda K. 1997. Behavioural risk for HIV/AIDS in Injecting Drug Users in Japan. Unpublished report, Department of Epidemiology, University of California.

Sawazaki Y. Chief of International Cooperation and Research and Training, Japanese Foundation for AIDS Prevention (JFAP). Personal Communication. October 1997.

Stimson G.V. 1992. The global diffusion of injecting drug use: implications for human immunodeficiency virus infection. Presentation at the Eight International Conference on AIDS/Third World Congress on Sexually Transmitted Diseases, Amsterdam, July 1992.

Yamazaki O.S. 1997. Studies into HIV epidemiology and countermeasures. Unpublished report, AIDS countermeasures research promotion organization.

World Health Organization (WHO). 1997. Table of reported cases of HIV infection and AIDS cases in the Western Pacific Region by year of diagnosis. In STD/HIV/AIDS Surveillance Report Newsletter, No. 9, June

The Hidden Epidemic
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