Illicit Drug use in the Asia Pacific Region - Burnet Institute

Situational analysis of illicit drug issues and responses in the Asia–Pacific region
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Incarceration has long been known to be a
significant risk factor for HIV in Thailand .
Choopanya et al . (2002) found that incarceration
is related to the incidence of HIV infection
through multiple pathways: injecting while
incarcerated, recent incarceration without
injecting and previous incarceration . Many
studies have also highlighted the association
of HIV, IDU and incarceration . Choopanya
et al . (1991) found that IDUs in Bangkok were
twice as likely to be HIV-positive if they had
been incarcerated .
HIV prevention services within Thai prisons
are limited to basic HIV education . Despite
evidence of drug use within prisons (Choopanya
et al ., 2003), prisoners do not have access to
clean needles and syringes or bleach . Other
harm reduction tools such as drug treatment
or condoms are also not available .
Health and treatment responses
As discussed above, Thailand’s response to
drug issues changed dramatically with the
introduction of the Drug User Rehabilitation
Act in 2002 and the subsequent Fight to Overcome
Drugs which commenced in late 2002 .
The Office of the Narcotics Control Board lists
12 official treatment centres on its website
(Office of the Narcotics Control Board,
2005a) . However, many other programs are
run by both public and private hospitals, as
well as private clinics and NGO programs .
Some monasteries also conduct detoxification
programs which combine spirituality
and meditation to help drug users stop using
drugs (Lewis, 2003; United Nations Office on
Drugs and Crime, 2004a) .
While all policies point toward increased
access to a variety of drug treatment services,
whether or not these policies have been implemented
effectively is difficult to ascertain .
According to Pol . Gen . Pracha Promnok, the
Deputy Minister for Public Health, Thailand
would be prepared to treat 600,000 drug
users in 2003, 50,000 of whom would be
treated as in-patients in hospitals and military
camps and the rest in the community setting
(Lewis, 2003) . As stated above, treatment
data are not available from the year 2002
onwards . While anecdotal reports suggest a
large number of drug users entered treatment
in 2003, there are no data available about
the type of treatment patients received or
about treatment outcomes .
Limited methadone treatment has been
available in Thailand for 12 years . Methadone
treatment is based on providing the drug user
with a decreasing dose of methadone over
a set period of either 21, 90 or 180 days .
However, according to Sivalee (K . Sivalee,
personal communication, April 2005), who
is a former treatment provider in Thailand,
doctors have some flexibility in tailoring
methadone treatment for patients, including
increasing doses over time . She further stated
that once a patient has completed a program,
they can apply to start another . According to
Sivalee, buprenorphine-facilitated detoxification
treatment is available at the Parmonkout
Military Hospital .
The majority of drug treatment for ATS offered
in Thailand is based around a combination detoxification
and the Matrix model of treatment,
which is an outpatient treatment experience
that combines behavioural, educational and
12-step counselling techniques .
A report on the situation of drug treatment
in Thailand is currently being prepared by
Professor Vichai Poshyachinda, Head of the
Drug Dependence Research Centre, Chulalongkorn
University, but was not available
for this report .
Other responses
Since the early 1990s Thailand has placed
a strong emphasis on disseminating health
information through media campaigns .
The Ministry of Public Health in Thailand
has orchestrated various drug education
campaigns emphasising the negative aspects
of drugs . They have also focused on awareness
building around needle sharing as a
major mode of HIV transmission among IDUs
(Perngmark et al ., 2003) .
The most recent prevention education campaign
is the ‘Kingdom Unity for Victory over
Drugs’ campaign . In addition to mass media
advertising, the strategy plans to recruit three
million community-based volunteers who
will provide education about the dangers of
drugs and encourage drug users to register
and to seek treatment .
Considerable attention is still being directed
toward primary prevention of drug use . In
association with Chulalongkorn University and
the ONCB, the United Nations Office on Drugs
and Crime has recently funded and published
a research study looking at improving primary
prevention of ATS abuse among Thai youth
(Sthapitanonda, 2004) . Education campaigns
are focusing drug education messages to
school children and through sporting clubs
and at community events .
School-based education targets four subgroups
of students: those who have never
used drugs, those who have tried drugs,
those who have become addicted and those
who have become sellers . Drug education is
conducted through the Ministry of Education
with the assistance from the ONCB (United
Nations Office of Drugs and Crime, 2002) .
Drug user organisations
and advocacy groups
(a) Thai AIDS Treatment Action Group
(TTAG)
Established December 2002
To promote equal access to AIDS treatment
for all through policy advocacy,
coalition building, and strengthening the
capacity of people living with or highly
vulnerable to HIV/AIDS to advocate for
their human rights .
(b) Thai Drug Users Network (TDN)
Established December 2002
To promote the basic human rights of
people who use drugs, in order to be able
to live equally and with dignity in society .
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Country profiles: Thailand