Landmark study calls for greater investment in evidence-based healthcare and harm reduction initiatives for injection drug users in Thailand to save lives, prevent HIV infections
Despite aggressive drug policies and compulsory drug detention, the availability of illicit drugs in Bangkok increased significantly between 2009 and 2011
Bangkok, Thailand [March 11, 2013] — A new study from the BC Centre for Excellence in HIV/AIDS (BC-CfE), Thai AIDS Treatment Action Group (TTAG) and Thailand’s Mitsampan Community Research Project, finds the Thai government’s longstanding war-on-drugs, involving the mass incarceration of people who use drugs, has failed to suppress the availability and use of illegal drugs in the country.
The study, soon to be published in the prestigious peer-reviewed journal Drug and Alcohol Dependence, assessed changes in the availability of five substances commonly used among people who inject drugs (IDUs) in Bangkok between 2009 and 2011. The study also investigated drug-using behaviour, and various factors influencing drug availability.
The study findings showed that the availability of heroin, methamphetamine, crystal methamphetamine, midazolam and illicit methadone increased significantly between 2009 and 2011. The largest increase in availability was found with crystal methamphetamine. There was an almost six-fold increase in proportion of IDUs reporting that crystal methamphetamine was available in less than 10 minutes: from 6 per cent in 2009 to 36 per cent in 2011. During the same two year period, the retail price of all drugs analyzed remained the same.
“These findings raise some serious questions about the effectiveness of the government’s aggressive war-on-drugs approach and years of significant investment in law enforcement efforts, despite which, the illicit drug markets continue to flourish in the country,” said Paisan Suwannawong, the Executive Director of TTAG and a co-author of this study. “There is an urgent need for the Thai government to rethink its drug policy and focus on prevention, treatment and rehabilitation of people who use drugs.”
Another significant finding was that the increase in the availability of methamphetamine was associated with exposures to prison environments. This finding is of particular importance given between 2011 and 2012, Thai authorities implemented a six-month crackdown in prisons across the country and seized a total of 58,991 methamphetamine pills (Laohong and Rakrun, 2012). Researchers believe the study’s finding indicate that incarceration of IDUs may have facilitated the establishment or enhancement of relationships between IDUs and methamphetamine dealers who were incarcerated together, which increased the ease of future drug purchases after release from prisons.
“For far too long, we have focused on compulsory drug detention as a way to address the rampant issue of illicit drug use, but this study and reports before it, have showed that this approach has failed,” said former Senator Jon Ungphakorn. “The time has come to move away from incarcerating people who use drugs and instead invest in proven addiction treatment and harm reduction programs to meaningfully address their treatment and care needs.”
Researchers believe the Thai government’s reliance on compulsory drug detention as a way of linking people to drug treatment should instead focus on providing voluntary, long-term drug treatment in community settings. In addition, given the twin epidemics of human immunodeficiency virus (HIV) and hepatitis C (HCV) among Thai IDUs, and continued high rates of HIV/HCV risk behaviour, such as syringe sharing, evidence-based prevention services tailored to IDUs need to be urgently scaled up.
There has been a longstanding epidemic of illicit drug use in Thailand. In response, the Thai government has adopted an aggressive drug law enforcement approach, which has seen a dramatic increase in incarceration rates for drug-related offenders since the 1990s. In 2002, a system of compulsory drug detention was introduced and has rapidly expanded in recent years. In 2010, the Thailand Office of Narcotics Control Board (ONCB) reported that 116,500 people were admitted to drug treatment facilities, and as many as 63 per cent of these “patients” were in compulsory drug detention.
“Drug addiction is a chronic, relapsing health condition and research shows that it is best addressed through evidence-based drug treatment,” said Dr. Thomas Kerr, senior author of the study and co-director of the Urban Health Research initiative, a program of the BC-CfE. “The findings of this study and various prior reports provide significant evidence that simply incarcerating people who use drugs will not help achieve the objective of reducing the demand and supply of illegal drugs. In fact, this approach has led to unintended negative consequences such as strengthening the link between users and drug dealers and health risks such as HIV/HCV transmission.”
Researchers undertook two survey cycles involving a total of 757 community-recruited IDUs in Bangkok between June 2009 and October 2011. Participants were recruited through peer outreach efforts and word-of-mouth. All participants completed an interview-administered questionnaire eliciting a range of information, including socio-demographic characteristics, drug use patterns, availability and street price of illicit drugs, experiences with drug law enforcement and accessing healthcare.
In collaboration with the BC-CfE and the University of British Columbia, data for this study were derived from the Mitsampan Community Research Project, a collaborative research effort involving the Mitsampan Harm Reduction Center (a drug user-run drop-in center in Bangkok, Thailand), TTAG, and Chulalongkorn University in Bangkok.
For a full copy of the study Increasing Availability of Illicit Drugs among People who Inject Drugs in Bangkok, Thailand, please click here.
About the British Columbia Centre for Excellence in HIV/AIDS
The BC Centre for Excellence in HIV/AIDS (BC-CfE) is Canada’s largest HIV/AIDS research, treatment and education facility and is internationally recognized as an innovative world leader in combating HIV/AIDS and related diseases. BC-CfE is based at St. Paul’s Hospital, Providence Health Care, a teaching hospital of the University of British Columbia. The BC-CfE works in close collaboration with key provincial stakeholders, including health authorities, health care providers, academics from other institutions, and the community to decrease the health burden of HIV and AIDS. By developing, monitoring and disseminating comprehensive research and treatment programs for HIV and related illnesses, the BC-CfE helps improve the health of British Columbians living with HIV.
About Thai AIDS Treatment Action Group (TTAG)
TTAG is a PLWHA-led grassroots advocacy organization fighting for equal access to HIV treatment for people living with or at high risk for HIV in Thailand. Through direct empowerment, education and rights documentation and advocacy, TTAG puts a spotlight on the health and human rights of criminalized and highly stigmatized groups, including people who inject drugs, migrant sex workers, and people in and recently released from prison.
About the Mitsampan Community Research Project
The Mitsampan Community Research Project is an initiative of the Urban Health Research Initiative at the BC-CfE. This community-based research project involves investigators from the BC-CfE, Thai AIDS Treatment Action Group, the Mitsampan Harm Reduction Center (a drug user-run drop-in center), and Chulalongkorn University in Bangkok, Thailand. The project was launched with the dual aims to collect representative data on IDU in Bangkok and connect local IDU to the Mitsampan Harm Reduction Center.
The findings of the Mitsampan Community Research Project have been published in a number of peer-reviewed journals, presented at various conferences, introduced in media reports, and translated and shared with the community at the Mitsampan Harm Reduction Center and other data collection sites.
About the University of British Columbia
The University of British Columbia (UBC) is one of North America’s largest public research and teaching institutions, and one of only two Canadian institutions consistently ranked among the world’s 40 best universities. Surrounded by the beauty of the Canadian West, it is a place that inspires bold, new ways of thinking that have helped make it a national leader in areas as diverse as community service learning, sustainability and research commercialization. UBC offers more than 55,000 students a range of innovative programs and attracts $550 million per year in research funding from government, non-profit organizations and industry through 7,000 grants.
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