Are drug dependent people in China being forced to have brain surgery?

People who are dependent on drugs are stigmatised and treated badly across the world. One of the countries where this is particularly true is China. In the 19th Century British merchants tried to make money by trying to get as many Chinese people as possible dependent on opium. This led to the Opium Wars and ‘The Century of Humiliation’. The Chinese have not forgotten, which partly explains why thousands of drug traffickers are executed every year.

But in recent decades the treatment of people who are drug dependent by some doctors in China has taken a rather disturbing turn. Ablative brain surgery involves drilling a small hole in the skull, then inserting a long electrode. The surgeons aim for the nucleus accumbens, the ‘pleasure centre’ of the brain, which is particularly active in dependent people when they consume their drug of choice. Electrical current then passes through the electrodes, killing the brain cells and causing irreversible lesions. In theory this will reduce if not eliminate the desire for the drug.

Although the procedure is much more precise than a lobotomy, clearly there are risks associated with having an electrode stuck in your brain. A study showed that 60% of people following surgery had lasting side effects. 21% of people had problems with their memory and 53% of people had a change in personality. The authors of the study described them as becoming more ‘mildness orientated’, which presumably means they became quieter and less prone to moments of joy and excitement. This is hardly surprising, since the nucleus accumbens does not deal solely with drug dependency. There have even been cases of people losing all sexual desire after the surgery.  

Almost half of people who have the surgery are still drug-free 5 years later, which is much better than the results of other treatments. But nevertheless the fact that more than half of the patients underwent the surgery for nothing proves that the method is far from perfect. The nucleus accumbens is not the only place in the brain which is affected by dopamine (a chemical in the brain associated with pleasure), so it is not the only source of dependency.

This is not a solely Chinese phenomenon. India had an extensive programme of psychosurgery to treat drug dependency, until the 1980s. So did Russia until it was banned in 2002. Because of growing condemnation of the practice around the world, the Chinese authorities passed a law forbidding it in 2004. However some doctors have used a loophole in the law, namely that is allowed if it is done for research purposes. One such doctor claimed that he performed a thousand of these operations between 2004 and 2007. The risks may be the same, but doing this very invasive procedure “for science” seems even more sinister than doing it for someone’s well-being.

Of course the central ethical question here is: do the patients consent? If someone has tried all other treatments and gotten nowhere, and they’re willing to risk brain damage to beat their dependency, then perhaps we wouldn’t blame them for wanting the surgery. But there are grave concerns that the patients aren’t aware of the risks. China is not known for its freedom of information, and in a society where drug dependency is heavily stigmatised, the doctor may neglect to tell the whole truth. Even if the patient is completely aware of the risks, the pressure from their family and friends to beat the dependency may be so great that they feel as though they have no choice but to have the surgery.  

Given that it is more likely to change your personality than it is to actually help you, the fact that this barbaric surgery is still performed in some places is a testament to the stigma that drug dependent people can face, and changing the perceptions that people have of drug dependency will be the best way to stop this horrific practice.