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Kanna Hayashi Lianping Ti Karyn Kaplan Paisan Suwannawong Will Small Julio Montaner Evan Wood

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.

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Kanna Hayashi Lianping Ti Karyn Kaplan Paisan Suwannawong Will Small Julio Montaner Evan Wood

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  1. 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

  2. HIV Epidemic among Thai IDU

  3. Thai Drug Policy War on drugs in 2003 2,800 extrajudicial killings 50,000+ people into drug detention centres

  4. Thai Drug Policy ` • 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

  5. 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 : Mahitthirook, A., Laohong, K.-O., 2012. Phones, CDs seized at prison. Bangkok Post, May 18. Photo from the Office of the Narcotics Control Board, Thailand, website: http://en.oncb.go.th/document/e1-act-D-Day2009-1.asp

  6. Mitsampan Community Research Project • Acollaborative research effort involving: • Serial cross-sectional • mix-methods study • 32 former/active drug users • trained as peer researchers • Peer researchers involved in • all stages of the project Thai AIDS Treatment Action Group Mitsampan Harm Reduction Center Chulalongkorn University Summer 2008, Bangkok, Thailand

  7. 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

  8. 48% of IDU reported having had drugs planted on them by police

  9. 38% reported being beaten by police Hayashi, BMC Public Health, 2013

  10. 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.

  11. 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.

  12. 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)

  13. 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.

  14. 25% of participants report avoiding healthcare

  15. 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

  16. RESULTS • 209 (49.5%) individuals stopped injecting for greater than one year • 92 (21.7%) individuals stopped injecting between 3 and 12 months.

  17. 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).

  18. 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).

  19. 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%).

  20. 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%).

  21. 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 45-day 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

  22. 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

  23. 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 PaisanSuwwanawong, Evan Wood, Nadia Fairbairn, the Peer Researchers Team & co-investigators • Our funders: Open Society Foundation, Michael Smith Foundation for Health Research

  24. Further information http://www.ttag.info/ http://uhri.cfenet.ubc.ca/

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