Amphetamine Abuse -Apinum Aramrattana - ISAM 2013 - Kuala Lumpur

The Uprising of Amphetamine Use - Are We Ready to Face It?
Apinum Aramrattana, Thailand


First Household Survey showed that drug abuse was far beyond what we anticipated for all drug and alcohol abuse
The rise in methamphetamine use in young and the early age at first use was extremely concerning.

2001 Government announced "Drug Users are Patients"
2002 Government issued "People power eradicates drugs'
2003 Government issued 'War on Drugs"

After that the communities had less disruptie events, stealing, car noise, gangs, etc
Drug Rehabilitation Laws followed with decrease in methamphetamine use but rise in alcohol use.
"many were killed and that scared the small drug dealers".
The policy came at the peak of social frustration.
Overwhelming number of drug users reported in short time, resulted in poor screening
Drug supplies  reduced sharply
Drug users were exposed and subjected to monitoring
After 2003 the war on drugs reduced the methampheatmine pills significantly but ice (methamphetamine crystal) rose again
Marijuana is re emerging. Ya Ba is increasing again with Ice emerging on top.

Great uprising of ice from no arrest to 30 cases/year in a couple of years
Suicide, Accidents and Aids caused death within a few years of drug abuses 8.2% mortality


Prisons over crowed. 60 % related to drugs
When government tried to seal borders the trafficking routes for methamphetamine just changed

Ya Ba more a problem in Bangkok than a comparable Chinese city, and the HIV in needle drug users is almost double

Military Conscripts - 81% of Non IV drug users - used Ya Ba.
Methamphetamine Users
-start mid adolescence
-most are boys
-rade and frequency use tends to increase from early adolescents the diminishes with adult
Vulnerability
-working/homeless/sexual abused
unemployed
incarceration
sex workers
men who have sex with men

Harms of Methamphetamines include
-mental illness, psychochos, sexually transmitted diseases
IV methamphetamin increasing
Supply reduction - failed to reduced drug availability, overcrowding prisons and increase from that of organized crime, human rights violations, health problems in jails.
Demand reduction - WHO Western Pacific - technical briefs 2011 -ATS Treatment
- lack of services and professional expertise and counsellor training, little experience of dealing with psychosocai and mental health problems of ATS users
-very few ATS users are screened, assessed and if apprehended by government, consequences
-many evidence based psychological interventions available, no single drug dependence treatment intervention alone
Involuntary detention common in asia - little 'treatment' available, human rights violations have emerged
Targetting special sub groups
MSM - men who have sex with men, male and female sex works and some prisoners


All treatment services for ATS dependence should seek an alliance with criminal justice system
- criminalization of ATS use is a problem for public health
-at community levee, closer collaboration with police will help facilitate and improve access to services

Community involvement participation and patient orientation
Treatment Systems policy development strategic planning and coordination of services.
It is critical to coordinate with other NGO and GO services  in community
Increasing training in screening a treatment of Methamphetamine Users - at drug treatment centres, psychiatric hospitals and general hospitals.  We hope that we will be able to address this epidemic in Thailand
Harm reduction have worked for opiates in reduction of HIV but ATS users rarely use harm reduction.  ATS users have been neglected and there is a need to address this epidemic.

Q&A
KL - we have problem engaging family in urban centres
Answer - in Thailand we have more success with family involvement especially older people who hope to have their children helping them in old age.So there's a real incentive to help the young.  We've started doing community activities together and it's helped.It's difficult to maintain this though.