The number of drug users in China has rapidly increased as the availability of illicit drugs has become more widespread over the last twenty years. By the end of 2005, over one million people were registered drug users  representing just the tip of the iceberg of illicit drug abuse in China with estimates of the actual number of drug users totalling 3.5 million . Injection drug use (IDU) contributes to a large share of fatal diseases including HIV/AIDS and hepatitis C. About half of all registered drug users in China inject drugs and about 42% of reported HIV/AIDS cases in China are attributable to IDU .
The city of Kaiyuan is located in the southwest region of China. It is near the 'Golden Triangle', including Myanmar, Laos, Vietnam and Thailand, where illicit drugs are produced in large quantities and the local government in Kaiyuan regards the reduction and prevention of illicit drug use as an important mission.
Traditionally, Chinese policy-makers have put great emphasis on supply reduction and abstinence therapy to control illicit drug use . According to Chinese legislation, drug trafficking and abuse are illegal, and people who participate in drug trafficking can be severely punished . The "Regulations on Prohibition against Narcotics" outline three levels of available treatment for drug users: 1) voluntary detoxification institutions run by the Department of Health; 2) compulsory detoxification institutions run by the Department of Public Security; and 3) "rehabilitation through-labour" units run by the Department of Justice [3, 5, 6]. In theory, convicted drug addicts are able to choose the rehabilitation option that best suits their situation. However, there are problems with the system. Most significantly, relapse rates are very high across all three rehabilitation pathways, and many "voluntary" patients cannot afford to go to a voluntary rehabilitation institution because they have to pay for it out-of-pocket. The average cost of attending voluntary rehabilitation is about CNY2000-5000 (about US$300-750). Therefore in practice, the compulsory detoxification or the rehabilitation-through-labour programs are the dominant pathways of rehabilitation for most drug addicts.
In Kaiyuan, local public security brought attention to issues with the traditional rehabilitation model and implemented a pilot program called 'Yulu Shequ' at an existing compulsory detoxification institution run by the Department of Public Security. The program was developed with the understanding that most addicts do not live in healthy social and personal environments due to a lack of acceptance by mainstream society and sometimes a lack of family support. The pilot program aims to reduce relapse rates by providing a healthy social environment which will ultimately foster reintegration into mainstream society. Recently, this pilot program has gained a national reputation for successful rehabilitation and could be the seed for a new era in Chinese drug offender rehabilitation using a gentler approach that could be a stepping stone towards an integrated harm reduction approach within the overall Chinese detoxification treatment policy which is still largely focused on a "zero tolerance" approach . In fact, a number of harm reduction strategies including methadone maintenance treatment and needle exchange programs have been implemented over the last decade by the Ministry of Health . However, these are mainly aimed at reducing the spread of HIV/AIDS and are not intersectorally integrated with the detoxification and rehabilitation programs run by the Departments of Justice and Public Security.
The aim of this study was to describe this pilot program to the international public and to assess the program's effectiveness in terms of reducing illicit drug abuse relapse rates and costs to participants and public payers.
To this end, we conducted 14 semi-structured interviews with key staff members of the Yulu Shequ program in Kaiyuan between January and March 2008, after permission for this study had been obtained from the Department of Public Security in Yunnan and from the Director of the Yulu Shequ program. The latter also nominated the staff members to be interviewed. Staff members included the head of the compulsory detoxification institution, supervisors, and nurses. The semi-structured interviews covered the following areas: 1) data on the infrastructure and on processes used in the program, 2) data on relapse rates and the definitions used for defining a relapse or a successful rehabilitation, 3) surveillance activities, 4) cost of rehabilitation to public payers and to addicts and their families, 5) data on successful reintegration into social life and employment, 6) health status data. Ethics approval (no.H-009-2008) for this study was obtained from the Human Research Ethics Committee at the University of Adelaide.