Advocacy on Drug Treatment: Thailand

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Advocacy on Drug Treatment Thailand

• Karyn Kaplan, Thai AIDS Treatment Action Group
  (TTAG)
• Paisan Suwannawong, TTAG and Thai Drug Users
  Network (TDN)
• IHRD Partners Meeting
• Amsterdam, November 13-15, 2006

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(No Transcript)
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For Oom JunsudaFirst and fiercest Thai
woman PLWHA IDU activistDied 2006
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Thailand

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Situation Drugs

• 2002
• Est.2.2 m. addicts 100,000/yr. in drug tx
• 56 Heroin, 60 injectors, gt90 male
• Methadone detox (forced taper), herbal detox, TC,
  Matrix, forced cold turkey (prison, detention)
• 2003
• Major ATS consumption incl. male and female
  youth a political opportunity
• Thaksins War on Drugs marked by egregious
  rights violations and switching to alcohol/benzo
  and other over-the-counter drug use and abuse
• MOPH et al. reclassify drugs, increasing legal
  penalties (Amphetamines, Midozolam, etc.)

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Situation HIV

• 570,000 HIV
• 1.5 adult prevalence rate
• 50 prevalence among IDU
• IDU exclusion from ARV (2002 national guidelines)
• gt90 Hepatitis C
• gtMDR-TB in prison
• OD fatality ??
• Extreme social exclusion and stigma
• If you died from amphetamine abuse, dont even
  think of being cremated here sign, Buddhist
  temple, Trat Province

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Thai Drug Users Network (TDN)

• Est. 10 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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2003 2006 War on Drugs

• 2,500 killed in first three months
• -forced military boot camp rehab
• -quotas, reward/punishment
• -uninvestigated extra-judicial executions
• -blacklists and unsubstantiated accusations
  leading to mass arrest
• - Driven underground, away from services
  persistent fear of disclosure to provider
• - Switched drugs, ways of using more alcohol,
  methamphetamine, over-the-counter drugs and
  injecting methadone, midozolam, etc.
• 2003 law drug users patients, not criminals
• - ARV scale up not meeting needs of users -
  accessing unknown (tx guidelines excluded IDU in
  2003)

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Patients, not criminals law

• Legal environment/law enforcement mandate and
  public health contexts at odds
• Methadone/drug tx not covered under universal
  health care scheme
• Insufficient coverage
• Provider attitudes and treatment of clients
  (they treat us like dogs)
• Police harassment on-site
• Providing client names to law enforcement
  officials
• Lack of linkages or effective referrals between
  drug treatment and HIV services, prison and HIV
  services
• Lack of information or guidelines for providers
  (ex., ARV/methadone interactions)
• Limited tx options (no buprenorphine, etc.)
• Lack of harm reduction services (no NSP) or
  comprehensive, targeted services (even less so
  for drug-using women or gay/transgendered)

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(No Transcript)
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Severe rights abuses forced cold turkey,
shackling, differential tx, disproportionate
overincarceration, profiling, planting, forced
confession, arbitrary arrest and detention, etc.

• AI excerpt
• On 7 December 2001, two Akha tribesmen, Ateh
  Amoh, aged 34, and Ajuuh Cheh Cuuh Gooh, aged 42,
  were forcibly taken by soldiers from their
  village of Ban Mae Moh, Mae Fah Luang district,
  Chiang Rai Province, to the 11th Cavalry military
  camp in order to be treated in a opium
  detoxification program. According to Ateh Amoh,
  they were pushed into a small hole in the ground
  where three other Akha men were already detained.
  Soldiers then poured water, coal and ashes on the
  five men and left them there until the evening
  when they were blindfolded and taken separately
  for questioning. Mr. Ateh said
• ''The soldiers never talked about the opium
  detoxification programme. They tried to force me
  to admit the drug charges by electric shocks to
  my ears, kicking my face and body, punching me
  hard in the body and hitting me with a gun handle
  on my head and chest several times...When they
  felt that I could no longer stand it because my
  body was soaked with blood, they took me back to
  the hole and left me there for a night and a
  day.''(4)
• One man escaped, and as a punishment Ateh Amoh
  and Ajuuh Cheh Cuuh Gooh were severely beaten
  again. Ajuuh Che Cuuh Gooh died from the beatings
  on 9 December and Ateh Amoh spent six days in the
  hospital being treated for a ruptured lung and
  other injuries. Army Commander-in-Chief General
  Sarayud Chulanont acknowledged that some soldiers
  used ''violent means'', including detaining drug
  addicts in pits, in treating tribal people
  alleged to be drug users or traffickers in the
  Thai-Myanmar border area. He said that
  investigations would be conducted and those found
  guilty would be transferred and punished.(5)
  Other army officers claimed that Ajuuh Cheh Cuuh
  Gooh died from the effects of opium addiction.

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Drug Treatment Advocacy

• TDN/TTAG/AH GFATM project
• Promotion of user involvement in policy solutions
• Educating and training users to advocate and
  document abuses
• Harmonization of public health and drug control
  approaches toward rights-based framework
• Advocate for harm reduction policy and legal
  reform (ex., explicit ordinance supporting
  legality of NSP)
• Demand integration of HIV and Drug Treatment
  services
• Demand drug treatment/MMT guidelines that reflect
  best international practise
• Lobby for government budget allocation to user
  groups, NGOs and harm reduction work
• National and intergovernmental advocacy use
  international rights frameworks to demand
  accountability to obligations (ex., UNCHR)
  Initiated National Harm Reduction Task Force
  held first national Harm Reduction meeting on
  International Day Against Drugs (2006)
• Methadone Bup. On EDL (intl. coalition)