Transcript Powerpoint

Experiences with Compulsory Drug Detention
in Thailand: Evidence from the Mitsampan
Community Research Project
Kanna Hayashi
Lianping Ti
Karyn Kaplan
Paisan Suwannawong
Will Small
Julio Montaner
Evan Wood
Thomas Kerr
HIV Epidemic among Thai IDU
Thai Drug Policy
War on drugs in 2003
2,800 extrajudicial killings
50,000+ people into drug detention centres
Thai Drug Policy
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The Narcotic Addiction Rehabilitation Act B.E. 2545
•Reclassified people who use drugs as “patients” not
“criminals”
•“A rehabilitation centre shall be an institution for
treatment under the Penal Code…and a unit of the
Department of Probation, Ministry of Justice”
•There are now >85 drug detention centres in Thailand
•Programming based largely on military and physical
exercises, religious activities, therapeutic community
work
•Near total lack of evidence-based addiction treatment
Thai Drug Policy
Five Fences strategy in 2009-2010
300,000 drug users into drug treatment
Kingdom's Unity for Victory over Drugs strategy in 2011
400,000 drug users into drug treatment
Photo from the Office of the Narcotics Control Board, Thailand, website:
Photo from : Mahitthirook,
A., Laohong, K.-O., 2012. Phones, CDs seized at prison. Bangkok Post, M
http://en.oncb.go.th/document/e1-act-D-Day2009-1.asp
Mitsampan Community Research Project
• A collaborative research effort involving:
Thai AIDS Treatment Action Group
Mitsampan Harm Reduction Center
Chulalongkorn
University
• Serial cross-sectional
mix-methods study
• 32 former/active drug users
trained as peer researchers
• Peer researchers involved in
all stages of the project
Summer 2008, Bangkok, Thailand
Project Design
• Three surveys completed by 700+ IDU in
Bangkok (2008, 2009 & 2011)

Recruitment through peer-based
outreach and word-of-mouth

Peer-administered interviews at the
drop-in centres
• In-depth qualitative interviews
• 48% of IDU reported having had drugs planted on them by
police
38% reported being beaten by police
Hayashi, BMC Public Health, 2013
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Violence & Neglect in
Compulsory Drug Detention
They did not provide any therapy…they just
brought us into an environment that was like
torture. As soon as they arrived, they just shoved
us and kicked us behind bars, and then left us
there
without
doing
anything…I
suffered
withdrawal symptoms…I couldn’t sleep, couldn’t
eat and threw up whatever I ate.
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Violence & Neglect in
Compulsory Drug Detention
I told them I was HIV positive and had a doctor’s
letter…They just didn’t listen. They didn’t try to
contact my relatives even though they knew I was
sick. I needed medicine and had to see a
doctor…Yet they just didn’t care.
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• 96% of those who had been compulsory detention had
injected in the past week
• No differences in intensity of drug use were found
between those who had and had not been in compulsory
detention (p < 0.05)
Impacts of Compulsory Detention on Drug Use
And does having been in the camp affect the way you use
drugs?
I think it hasn’t had any impact on me. It doesn’t affect me.
Actually, I think for the younger people…they could use
even more heavily…I used to be like that too. I was in
prison for a long time…When I got out, I just released that
pressure through a big hit. Things can go so wrong. People
can just turn to do bad things...Just go extreme. It’s a way
to push back.
25% of participants report avoiding healthcare
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Kerr et al, IJDP, 2013
COMPULSORY DRUG DETENTION AND INJECTION DRUG
USE CESSATION AND RELAPSE
IN BANGKOK, THAILAND
Nadia Fairbairn
Kanna Hayashi
Lianping Ti
Karyn Kaplan
Paisan Suwannawong
Evan Wood
Thomas Kerr
RESULTS
• 209 (49.5%) individuals stopped injecting for greater
than one year
• 92 (21.7%) individuals stopped injecting between 3 and
12 months.
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Model 1 – Cessation of >1 year
• Incarceration (AOR = 13.07, 95%CI = 6.64 – 25.72)
• Voluntary drug treatment enrollment (AOR = 2.75,
95%CI = 1.30 – 5.83)
• Number of years since first injection (AOR = 1.07, 95%
CI: 1.03 – 1.11)
• Midazolam injection (AOR = 2.48, 95%CI = 1.23 – 4.98)
• Older age (AOR = 0.42, 95% CI: 0.21 – 0.83).
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Model 2 – Cessation of 3-12 months
• Incarceration (AOR = 5.47, 95%CI: 2.65 – 11.32)
• Compulsory drug detention exposure (AOR = 2.61,
95%CI = 1.18 – 5.80)
• Midazolam injection (AOR = 3.80; 95%CI: 1.55 – 9.33)
• Voluntary drug treatment enrollment (AOR = 2.83,
95%CI = 1.25 – 6.39)
• Methadone treatment exposure (AOR = 0.38; 95%CI:
0.17 – 0.86).
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RESULTS
Self-reported reasons for injection cessation:
•becoming incarcerated (74.0%)
•feeling the need to “take a break” from drug use (60.7%)
•entering voluntary drug treatment (13.0%)
•being sent to compulsory drug detention (10.1%)
•hospitalization (9.5%).
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RESULTS
Self-reported reasons for relapse into injecting:
•
•
•
•
•
•
released from prison/compulsory detention (66.3%)
feelings of boredom (59.4%)
being exposed to triggers (55.2%)
having some money (54.4%)
feelings of depression (40.8%)
personal problems or family issues (19.9%).
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SUMMARY & INTERPRETATION
•50% of participants stopped injecting for > year and this
was associated with incarceration, which likely reflects
lengthy sentences for drug offences in this setting
•Compulsory drug detention was associated with short-but
not long-term cessation, as well as relapse, which likely
reflects the fact that compulsory detention consists of a 45day assessment and 4 months of detention
•Voluntary addiction treatment appears to promoting
cessation of injecting, while methadone treatment is not,
which is likely due to the well-described deficiencies in
Thailand’s methadone program
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CONCLUSION & IMPLICATIONS
•Thailand’s compulsory detention system appears to have
failed to meet its basic objectives
•Compulsory drug detention is associated with various
forms of police misconduct and violence, elevated HIV
risk behaviour, interruptions in HIV treatment, and relapse
into injecting
•This system interacts with access to care by perpetuating
stigma, shame and avoidance of healthcare
•The system of compulsory drug detention should be
replaced with evidence-based harm reduction and
addiction treatment programs
ACKNOWLEDGEMENTS
• The people who use drugs who participated in and
supported the research
• Our community and NGO partners, including the staff of
Mitsampan Center and Ozone House staff
• The research staff at the BC Centre for Excellence in
HIV/AIDS
• Research team: Kanna Hayashi, Mint Ti, Karyn Kaplan
Paisan Suwwanawong, Evan Wood, Nadia Fairbairn,
the Peer Researchers Team & co-investigators
• Our funders: Open Society Foundation, Michael Smith
Foundation for Health Research
Further information
http://uhri.cfenet.ubc.ca/
http://www.ttag.info/