Anti-drug policy: Govt harm reduction strategies

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Progressive public health approaches to ending Thailand's drug problem, big contribution of junta generals to Thailand's future.

DRUG ABUSE, PUBLIC HEALTH & CRIME

Anti-drug policy: Govt harm reduction strategies

20/02/2017
Onnucha Hutasingh

Thailand has introduced a harm reduction programme to combat Thailand's national drug addiction problem.

Worldwide, the use of only punitive measures to combat drug abuse has failed to put an end to the drug abuse problem and people and communities worldwide continue to suffer from drug addiction and the problems it causes for families and communities.

The willingness to try out more progressive approaches to solving the national drug problem has to be ranked as a major achievement of Thailand's military government installed in a 2014 coup (see International Drug Policy Consortium here, here & here & evidence-based medical approaches to drug rehabilitation here).

THE WAR ON DRUGS WAS NEVER WON

Thailand declared a war on drugs more than 10 years ago.

This war on drugs which focused on criminal law measures and police crackdowns, criminal punishment in the form of prison terms (incarceration), the death penalty and for a very short period under the Thaksin regime, extra-judicial killing (EJK).

The so-called "war on drugs" was never won, however, as the number of people who got caught caught abusing drugs did not decrease.

Thailand is "seeing the light at the end of tunnel" as it has now implemented harm reduction strategies to tackle drug problems, according to Department of Narcotics Litigation deputy director-general Jitnara Nawarat.

MASS INCARCERATION THAT HARDLY NO ONE KNOWS ABOUT

Thailand has one of the world's highest prison population rates (mass incarceration).

About 70% of prisoners are incarcerated for drug-related offences, especially minor offences.

PRISONS NOT RIGHT PLACE FOR DRUG REHABILITATION

"A prison is not a place where substance abusers come to receive drug therapy treatment," Mr. Jitnara said.

"Under harm reduction programme, they are urged to come out to see health personnel who can give them care."

A harm reduction programme lets a user continue to use a drug, but at a lighter level.

METHAMPHETAMINES NOW CLASSIFIED AS NORMAL DRUG

The programme is also a by-product of the removal of methamphetamines (ya ba) from the narcotic lists, a programme initiated by former justice minister Paiboon Koomchaya.

Last year, General Paiboon made the proposal to classify ya ba as a normal drug as current measures to suppress the drugs had failed.

HARM REDUCTION PRACTICES

Harm reduction practices focus on community support services and strategies to help the families of drug users and communities in which they live and fight the problem from the inside out.

The measures can also help empower substance abusers to improve their quality of life, kick their habit and ultimately benefit their families and communities, advocates of this more subtle approach say.

The harm reduction programme is also aimed at solving several social problems:

1. The problem of crime associated with addicts trying to get money to buy drugs,

2. Overcrowded prisons from mass incarceration for minor drug violations,

3. Reducing illegal substance use (such as opioids found in heroin and opium) and,

4. Behaviours that put people at risk of HIV and AIDS such as sharing needles.

HOW DO HARM REDUCTION PROGRAMS WORK?

Centres in three northern provinces, Chiang Mai, Mae Hong Son and Tak, provide harm-reduction-based methadone treatment services.

Under the programme, methadone is prescribed by doctors under monitored, controlled conditions to people who have used heroin and opium.

With the treatment, they can take small steps to reduce the use of drugs over time, Mr Attaporn said. Some wean themselves off drugs altogether, but at least who are not will not be stealing money from people in the community to buy drugs.

Methadone treatment is a proven method for reducing drug use and related crime and can be effective for treating opioid and heroin addiction.

"Our goals are to distract drug users from the illicit drug circle and come under the supervision of [public] health personnel who are able to care for them and help them return to society," Mr Attaporn said.

He said many drug users who attend the programme have now turned their backs on methadone and opiate drugs, so now take no drugs at all.

GRADUAL INCREASE IN HARM REDUCTION PROGRAM PARTICIPATION

Methadone has been used by health personnel to treat heroin and opioid addiction in Thailand since 2012. It is listed as a category 2 drug on the narcotics list,

the number of drug addicts who voluntarily undergo harm-reduction-based methadone treatment has gradually increased over time.

During 2013 and 2015, a total of 7,423 people who were addicted to opium took part in the programme. That had grown to 9,573 by last year.

This is according to Attaporn Limpanyalert, assistant to the director-general of National Health Security Office (NHSO).

CRITICISM OF HARM REDUCTION POLICIES

Mr Jitnara dismissed criticism about the impacts of harm reduction-based methadone treatment, saying it could help keep drug users healthy and safe.

Harm reduction-based methadone treatment has been slammed by officials who disagree with the method and claim it's a way to promote the use of drugs among drugs users.

Mr Jitnara urged the public to study the measures and encourage people who use substances to participate in harm reduction activities.

CRITICISM OF PROGRESSIVE DRUG CONTROL POLICIES

General Paiboon's progressive drug control measure was widely misunderstood and criticised by members of the public.

The criticism stemmed, perhaps, from it being such a radical break from previous "war on drugs" policies which focus solely on punishing and imprisoning people caught with some even small amount of drugs.

However, worldwide there is a growing consensus that idea of a punitive "war on drugs" has not worked in the past, that the "war" will never be won and, in fact, provides a rationale for the continued existence (raison d'etre) of an expensive branch of law enforcement that never achieves the very goals it sets out to achieve, namely putting an end to drugs and drug abuse (see here & videos above).

Eliminating a drug lord supplier or a low-level drug mule transporting drug will almost immediately result in them being replaced by someone new and the supply and drug abuse problem then continues, or so the argument goes.