Illicit Drug use in the Asia Pacific Region - Burnet Institute

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Situational analysis of illicit drug issues and responses in the Asia–Pacific region 254 As the availability of opium slowly decreased, heroin began to enter from refineries in the Golden Triangle (Gray, 1995; Treerat et al ., 2000) . Heroin production rapidly increased during the 1960s and 1970s, fuelled by the presence of 40,000 US servicemen fighting in the American War in Vietnam (Phongpaichit, 2004), the gradual closing of the Turkey– Marseilles heroin trading route to the United States of America (Lewis, 2003) and later supply for a burgeoning domestic market (Barrett, 2003) . Over the last three decades Thailand has also played an important role as a transit country in the global narcotics trade . Given its proximity to the Golden Triangle and porous borders, drugs flow easily into Thailand whence they are shipped to other cities via Bangkok’s busy sea and air ports (Lewis, 2003) . This constant flow of drugs also supplies the domestic market . In the early 1990s, heroin use (almost exclusively by injection) was documented in 150 villages in northern Thailand, with 1145 people registered in the Community-Based Drug Abuse Control programs (Renard, 2001) . However, the actual number of dependent users was estimated at well over 3000 (Punpanich et al ., 2004) . Injecting drug use quickly spread beyond the hill tribe villages of the north and was reported among urban youth, migrant fishermen and other marginalised groups (Lyttleton & Cohen, 2003) . By 1997 4 .2 per cent of young Thai males had reportedly injected a drug (Punpanich et al ., 2004) . In 1996, the heroin market was disrupted by the surrender to the Burmese Government of Khun Saa, considered at that time as the leader of one of the biggest heroin trading networks in the world . Following this, heroin availability in the region decreased significantly, causing the price to rise sharply after a long period of stability (Treerat et al ., 2000) . Many analysts suggest that the reduction in heroin supply and tightening law enforcement led to increased production of illicit methamphetamine (ATS) (Lewis, 2003; Phongpaichit, 2004) . Thailand had already witnessed a period of high prevalence of ATS use during the 1970s before the synthetic medulla drug, available over the counter, was taken off the market and classed as a narcotic (Treerat et al ., 2000) . However, various new forms of stimulant drugs, made from legal substances such as caffeine, ephedrine and pseudo-ephedrine, continued to be consumed by people working long hours, especially transport workers and unskilled labourers, as well as farmers and fishermen (Phongpaichit, 2004) . Attempts to control the precursor chemicals for the production of these drugs by amending the Psychotropic Substances Act had little effect and, by 1988, 15 clandestine methamphetamine labs and over a quarter of a million methamphetamine pills were destroyed in Thailand (Treerat et al ., 2000) . Lyttleton (no date) suggests that the dramatic increase in the use of ATS over the past two decades has been driven by both demand and supply factors . While the reduction in the availability of heroin during the mid- to late 1990s resulted in many opiate users shifting to ATS, this cannot account for the huge flood of ATS onto the market . Phongpaichit (2004) suggests that another factor contributing to the increased demand for ATS was that users shifted from orally ingesting the drug to smoking it, which resulted in a more rapid onset of its effects and feelings of increased euphoria . Similarly a growing market was being created among urban Thais, harnessing its effects for social events and nightclubbing . These events also occurred at the same time as the 1997 Asian economic crisis which saw about 2 million Thais lose their jobs . Some Thais began using drugs as consolation and many began selling drugs as a means of income generation to replace lost income . The huge profit margins in methamphetamine pills which cost about US$0 .05 each to manufacture and which sell for US$2–5 meant dealers could make a living from selling a few pills a day . The large markup also allowed many people to profit from the sale of the drugs along a supply chain and meant that dealers could afford to lose considerable amounts of drug to law enforcement efforts without it greatly affecting profits (Phongpaichit et al ., 1998) . In parallel to increasing demand, producers in the Golden Triangle region, particularly in Burma, realised the profitability and ease of manufacture of ATS compared to heroin and began producing ATS in ever-increasing amounts . According to the UNODC World Drug Report (United Nations Office on Drugs and Crime, 2004c), seizures of ATS in Southeast Asia accounted for 22 per cent of global ATS seizures in 1990, rising to 41 per cent in 1998, the same year Thailand had the largest seizures of ATS in the world . Social concern and government campaigns to reduce demand rose in line with increasing prevalence of drug use in the late 1990s . The Thai Government recruited popular figures to communicate anti-drug messages . It began using the term ‘yaba’ meaning ‘crazy drug’ to refer to methamphetamines and published many stories about the harmful effects of yaba in the media . At the same time the government raised the penalty for dealing yaba to death . In 2001, the Thai public began to report methamphetamines as their worst perceived social problem (Phongpaichit, 2004) . Another important impact drug use has had on Thailand is its association with HIV . The first cases of HIV among injecting drug users were noted in patients treated at the Thanyarak Hospital in Bangkok (Razak et al ., 2003) . Following these initial cases HIV prevalence among injecting drug users in Bangkok rapidly increased from between 1 and 2 per cent in 1988 to about 40 per cent within a year (Vanichseni et al ., 1991) . HIV/AIDS surveillance over the past 15 years in Thailand has shown a steady prevalence of about 30–50 per cent among IDUs throughout the country . HIV incidence studies among IDUs report rates ranging from 57 per 100 person years ((Kitayaporn et al ., 1998) to 11 per 100 person years (Perngmark et al ., 2003) . It is estimated that 5 per cent of all HIV infections in Thailand are related to IDU (United Nations Office on Drugs and Crime, 2004b) . While HIV remains a major public health consequence of drug use in Thailand, rapidly changing drug markets, patterns of use and characteristics of users will continue to challenge policy makers, as well as health and law enforcement agencies . 255 Country profiles: Thailand
Situational analysis of illicit drug issues and responses in the Asia–Pacific region 256 A11 .2 Prevalence of drug use and profile of drug users Data collection systems in place Thailand has a range of comprehensive routine data sources that include arrest data and seizure data, and national surveys conducted to assess prevalence of drug use among the general population and among school children . A considerable amount of independent research is also conducted investigating drug use in Thailand . A proportion of this research is conducted and coordinated by the Administrative Committee on Substance Abuse Academic Network, which also organises an annual conference focused on substance abuse in Thailand . Population estimates of drug use Estimates of drug users in Thailand in 2003 ranged from two to three million or approximately 5 per cent of the population (Aceijas et al ., 2004; Office of the Narcotics Control Board, 2003a; United Nations Office on Drugs and Crime, 2004d) . The United Nations Office on Drugs and Crime (2004b) suggests that 25,000 naive drug users are initiated into drug taking each year . According to the 2003 National Household Survey on Narcotic Use, the most commonly used drugs in 2003 were ATS (n = 1,925,000), followed by cannabis (n = 667,000), kratom* (n = 643,000) and inhalants (n = 199,000) . It was estimated that 22,700 people used heroin in 2003 . The survey suggests that about 3,500,000 people have ever used ATS in Thailand (National Household Survey, 2003) . About one million people reportedly used ATS in the previous year, representing a three-fold reduction in use as compared to the 2001 survey . Use of ATS in the previous 30 days was estimated at about 490,000 people, with 73 per cent of the population aged 12–24 years old reporting use in the previous 30 days (Klongyut, 2004) . Heroin and opium use in the last 30 days was estimated at 94,000 and 123,000 people respectively . The prevalence of the use of other drugs such as ketamine and cocaine was estimated at about 30,000 or 0 .1 per cent of the population (National Household Survey, 2003) . According to the Household Survey, about 100,000 people have ever used ecstasy in Thailand . Ecstasy users were typically male, aged 12–24 years and lived in major cities (National Household Survey, 2003) . Use of ecstasy is thought to largely be confined to wealthy youth and students as well as nighttime workers in entertainment compounds in the big cities (Office of the Narcotics Control Board, 2003a) . A number of recent studies have investigated drug epidemiology in more detail . A qualitative study conducted by Danthamrongkul et al . (2004) in southern Thailand revealed widespread use of cough medicine by students and adolescents . The research showed that cough medicine was widely available through peer networks, certain commodity shops or selected pharmacies and is most commonly consumed with soft drink . Other studies have shown increasing use of diverted anti-anxiety * Kratom is a tree native to Southeast Asia (Thailand, Malaysia, Myanmar) . Its botanical name is Mitragyna speciosa . The leaves of kratom have been used as a herbal drug from time immemorial by peoples of Southeast Asia . Kratom is used as a stimulant (in low doses), sedative (in high doses), recreational drug, painkiller, medicine for diarrhoea, and treatment for opiate addiction . medication (Assanangkornchi, 2004) and ice (Apinum, 2004) . An increase in the use of performance-enhancing drugs by athletes has also been reported (Siripol, 2004) . Estimates of the number of injecting drug users are harder to obtain . Estimates range from 100,000 to 240,000 (United Nations Office on Drugs and Crime, 2001), while Aceijas et al . (2004) suggest that the figure may be as low as 48,000 (C .I . 20,076,000) people . This later figure seems to correspond more closely to the number of heroin users estimated by the National Household Survey . A11 .3 Drug supply, production, availability, cost and trade While drug production in Thailand has decreased over the past decade, opium and cannabis are still grown and amphetaminetype substances are still produced . Heroin, ATS, cannabis, opium, MDMA, ketamine and cocaine are imported into Thailand . Opium Thailand’s opium crop currently accounts for less than 1 per cent of the regional production of opium and is no longer a major source of opiates internationally . Opium cultivation occurs mainly in the northern border areas near Myanmar and Laos (Chiang Mai, Chiang Rai, Hong Son and the Tak Province) . Since 1973, extensive development and crop substitution and eradication efforts have continually reduced opium production in Thailand . In 2003, UNODC estimated that 1 .81 tonnes of opium were produced in Thailand, a 70 per cent reduction from 2001 . It also estimates that 80–90 per cent of opium cultivated in Thailand is eradicated every year (United Nations Office on Drugs and Crime, 2003b) . Cannabis Cannabis cultivation is scattered throughout Thailand with the most concentrated areas of cultivation in the north-eastern region of the country (United Nations Office on Drugs and Crime, 2003b) . Phaileeklee and Kanato (2004) state that cannabis cultivation in Thailand has decreased over the past decade, with drugs imported from neighbouring countries making up the shortfall for local consumption and export . Large quantities of cannabis are still thought to be sent to Europe via air postal services from Thailand (Office of the Narcotics Control Board, 2003a) . Amphetamine-type substances ATS production in Thailand still occurs, however authorities believe that the majority of ATS production is at the endstage of pressing powdered drugs into pills . Seven methamphetamine laboratories were discovered in 2003; however, none was capable of producing ATS from scratch (Office of the Narcotics Control Board, 2003a) . The majority of ATS pills are believed to be produced and smuggled into Thailand from the Wa region of eastern Myanmar (Transnational Institute, 2003; United Nations Office on Drugs and Crime, 2005) . The cost of ATS pills has fluctuated in Thailand over the past three years . Before the Fight to Overcome Drugs the retail price for one methamphetamine pill along the northern border region was 15–35 baht (US 60–90 cents) . During this time the price rose to about 100–300 baht a pill, but has subsequently returned to about 20–40 baht (Office of the Narcotics Control Board, 2003a) . Currently the price of ATS is 80–100 baht in Chiang Mai and upwards of 200 baht in Bangkok . These price fluctuations are due 257 Country profiles: Thailand
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Illicit Drug use in the Asia Pacific Region - Burnet Institute

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