About Nepal & context

Nepal is a landlocked South Asian country with immense cultural and geographical richness and diversity. The Himalayan country of Nepal (population ~31 million) is bordered to the north by China and on all other sides by India. 

Its capital Kathmandu lies in the Kathmandu valley, comprising the cities Lalitpur, Bhaktapur and Kathmandu. This bowl-shaped area, which is bordered by some of the highest mountain ranges on the planet, is home to over 3 million inhabitants, making it the most densely populated area in the country.

History and Politics
The Kingdom of Nepal remained largely inaccessible to the outside world until the 1950s. In 1953, New Zealander Edmund Hillary and Sherpa Tenzing Norgay from Nepal became the first climbers to reach the summit of Mount Everest. Shortly after, Nepal joined the UN. 

In 1996, a Civil War broke out, launched by Maoist insurgents after they were prohibited from participating in the national elections. Among their primary aims were to overthrow the monarchy, get rid of caste discrimination and establish a ‘People’s Republic’. On 1 June 2001, Crown Prince Dipendra killed nine members of the Royal Family, including his parents, before shooting and ultimately killing himself as well.

After more than 15,000 people had died in the Civil War, peace treaty was finally signed in November 2006. After the royal family of Nepal had been massacred, the country abolished the monarchy in 2008 and established the Federal Democratic Republic of Nepal.

Politically, Nepal has been quite unstable, with frequent replacements of governments and permanent unrest over the drafting of the constitution, finally effectuated in September 2015. In April of the same year, a massive earthquake hit Nepal, killing over 8,000 people. International relief still makes it way to reaching the affected population slowly, compounded by the blockade of the India-Nepal border – which lasted until February 2016 – as a result of which the Nepali people experienced fuel, food and medicine shortages. 

Drugs in Nepal
Nepal has a long history of substance use. Cannabis is sanctioned for use on certain religious occasions. The use of smoked opium has been quite common in the country. However, drug use only began to be seen as a problem in the country in the 1960s with the influx of Western hippies. Local drug consumption increased rapidly with the introduction of brown sugar (heroin), morphine and other drugs (Shrestha 2012).

By the 1980s, the number of heroin chasers had increased considerably and increasingly users shifted from chasing heroin to injecting the so-called ‘South-Asian Cocktail’, consisting of buprenorphine, phenargan (an anti-histamine) and a benzodiazepine.

It is hard to find reliable data about (injecting) drug use in Nepal. A recent nationwide mapping study estimated the number of people who inject drugs (PWID) to be in the range of 30,000 to 33,000 compared to 91,000 PWUD.

The current estimated prevalence of HIV among PWID is said to be 6.3%. However, since the ‘prevalence’ decreased from 68% in 2002 to 6.3% in 2011, it can be concluded that these figures are not realistic.

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Country Manager for Nepal: Nick Veldwijk
Mainline conducted a comprehensive baseline study of the drug situation in the country in 2016. Contact Nick Veldwijk if you would like to learn more.

Harm reduction in Nepal
The Government of Nepal announced a National Drug Policy in 1996, making Nepal the first developing country to establish a Harm Reduction Programme for PWID. Nepal was also the first South Asian country to introduce methadone as part of their OST programme in 1994. Although the programme was stopped in 2002, it was reintroduced in 2007. In that same year, buprenorphine was added.

Methadone Maintenance Treatment (MMT) was started in 1994 at the Mental Hospital in Kathmandu Valley, making Nepal one of the first South Asia countries to start an OST programme.

A lack of structural funding prevents the effective implementation of harm reduction interventions in Nepal. The Nepalese legal framework allows for the exchange of needles and syringes and opioid substitution treatment, but most of the funding for such interventions comes from external donors.

The Global Fund implements the biggest programme to prevent HIV among key populations. However, many people cannot access services. There is limited investment in outreach work, no harm reduction in prisons, very little attention for female drug users and a limited reach and quality of needle and syringe programmes (NSP). Mainline is currently one of the major donors for harm reduction in Nepal.

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