thomson an overview of amphetamine use in the greater

An Overview of Amphetamine Use in The Greater Mekong Subregion Risk Profiles, Health Implications and Opportunities for Response Nicholas Thomson, Johns Hopkins School of Public Health

An Overview of Amphetamine Use in The

Greater Mekong Subregion

Risk Profiles, Health Implications and

Opportunities for Response

Nicholas Thomson, Johns Hopkins

School of Public Health Kunming, April 2011

What drugs are we really talking

Regional Research Activities

• Chiang Mai (Research Institute for Health Science) and Johns Hopkins): Peer based network intervention

• AusAID Illicit Drug Initiative: 3 Country

ATS and STI Risk

• UNODC and SODC: National Awareness Survey

Who are we talking about?

• Tend to be younger people

• Methamphetamine tablets mainly young people

• Ecstasy wealthy young people

• ICE: different demographics

Selected Demographic Characteristics by Country

Thailand Cambodia Lao PDR

%Drinking alcohol 4 or more

days per week 20.5 40 23.3 Median age began using ATS 17 18 16

% Using ATS 4 or more days

per week in past 3 months 13.3 46.1 9.2

% Ever in drug treatment 64 60.9 15.6

% Sexually active 93.7 87.3 70.7

% Reporting genital sore ever 14.2 15.1 12.2

Highest education completed

Median of age at the first time using

ATS in Vietnam

ATS related cases in Vietnam

Sexual Risk and ATS

We can’t prove causality but…

• STI rates appear higher in ATS users

• STI/HIV risk behaviour is also high

ATS Users

Comparison of Chlamydia Rates Among ATS

Users to Sentinel STI Data by Country

Thai Females (HIVNET 021) 1

Thai FSW (URT) 3

Cambodia- Police 4

Lao PDR – Female Factory Workers 5

Lao PDR – FSW 5

Self Report for ever been diagnosed with any STI (Vietnam)

Injection of ATS

• Concerns that injection of ATS is increasing

• Increased in ICE availability which is easier to inject

• Heroin injectors also injecting ATS

• Mixing of injecting and non injecting drug using networks

Injection Drug Experience

Thailand Cambodia Lao PDR

Have ever seen

Asked or offered

Figure 5 Findings from the Thai US Collaboration on Disease

Control (TUC) Study of PWID in Bangkok and Chiang Mai

Volatile drug scene in Cambodia

Implications for public security?

• In Thailand, Laos, Cambodia and Vietnam ATS users have high rates of arrest

• Increased pressure on the criminal justice system

• Overcrowded prisons and increasing

numbers of compulsory drug detention

centres

Arrest History by Country

• Percent ever having been arrested by police:

Thailand: 72.1%

Chiang Rai Province: 34.2Cambodia: 40.5%

Lao PDR: 19.9%

Ever been arrested

Where and what sort of responses

do we need?

• A supply reduction, demand reduction,

harm reduction…….and clinical

management where required

• Understanding the difference between

casual use, dependent use, problematic use and dependent problematic poly

substance use

Borders, casinos, pre cursor

chemicals

• The porous nature of many borders in the GMS mean that trafficking and production are the concern of all countries in the

region

• Increasing number of casinos in many

border areas enhancing risk environment for ATS use

• Pre cursor chemicals move freely and

often legally

Demand reduction

• In all countries ATS use is mainly initiated within

a peer network, outside of school systems

• Demand Reduction strategies need to work

structurally to reduce social risk factors (keeping people in school/university systems, economic opportunities, mainstream SED)

• Understanding the root causes that impact on the social risk environment is critical

Harm Reduction

• It is clear that a transition to injection

poses significant HIV risk for this group

• Taking existing harm reduction programs

to scale is omnipotent

• Incorporating drug use and sexual risk

reduction strategies into mainstreamed peer based harm reduction efforts

Treatment and Care?

• Medically sound judgments on the need to treat or not treat

• If clinical management is required it should only be administered within a health care framework

• Psychosocial interventions may be

appropriate on a need basis but needs to

be contexualised, trialed and evaluated in each particular country’s context

Thank you

• Our Research collaborators come from civil society, public health and public security:

• UNODC and SODC (Vietnam),

• RIHES, JHSPH, ONCB and the Thai

Academic Network (Thailand)

• Friends International, Korsang, NACD and NCHADS (Cambodia)

• LCDC, Laos National University (Laos

People’s Democratic Republic)