The Thai Drug Users' Network (TDN) has introduced a harm reduction programme called "Mobile Methadone Therapy for Drug Users" to international audiences at the International Conference 2023 (HR23) in Melbourne, Australia.
According to John Hopkins University, harm reduction refers to "protecting the health of people who use drugs" by "providing the services and resources they need".
Nilawan Pitakpanawong, of the TDN, said harm reduction plays a significant role in preventing drug-related deaths and offering access to healthcare, social services and treatment.
Ms Nilawan said she has been working with the TDN and the Development for Quality of Life for Lahu Association for more than a decade in Chiang Mai to help drug users stay safe.
The TDN, formed in 2002, is a group of activists working to promote harm reduction among drug users in Thailand, especially members of marginalised groups, she said. It also works internationally to reduce drug-related harms and deaths, Ms Nilawan said.
Mobile methadone therapy
Last year, the TDN launched its Mobile Methadone Therapy initiative for drug users within ethnic groups in Chiang Mai's Fang district, and it has been well-received there, she said, adding residents, officials and police have worked closely with the group to carry out the project.
"I think that methadone therapy is important in helping ethnic groups who use heroin and opium here," she said.
Methadone is a synthetic opioid used as a replacement to treat opioid addiction. It is used in the short term to treat withdrawals and in the long term as part of replacement therapy.
Methadone is longer acting when compared to other opioids, such as heroin, morphine and codeine, and can be administered once a day to prevent withdrawal symptoms during detoxification from other opioids.
Hospitals that provide methadone treatments must be registered with the Ministry of Public Health.
Ms Nilawan said the mobile methadone therapy service brings methadone to drug users in remote villages. Health officials visit the communities and provide locals with the service and the move is expected to boost treatments and help people who cannot travel to receive the treatment in hospitals.
Last year, 118 people received free methadone therapy from government health services, 80% of whom were from ethnic groups. Some worked on their farms while others earned money for their families. Some users reported a reduction from five to one or two injections per day due to the treatment.
"As a result, they had more money to spend on other things, their health improved and they had better family lives," Ms Nilawan said. "Once drug users in the community began to have a better life, other drug users became motivated to receive the treatment."
Nilawan: Helps addicts up north
Ms Nilawan said the North of Thailand borders Myanmar and is home to several ethnic groups. People in these groups have been using opium to treat illnesses such as stomach aches and diarrhoea or as a pain killer or to ease work fatigue.
Members of the younger generation have begun to use opium due to peer pressure, while others resorted to drug use due to personal problems, she said.
She said the TDN recently conducted a survey and found that several drug users want to try methadone therapy, which requires continuous treatment, which can be challenging for users.
"The distance between the ethnic group villages in the hills and the governmental methadone services is a key factor," she said. "Most drug users are poor, without vehicles, so regular long-distance travel is a huge obstacle."
"[Private] transport can be costly and public transport is not readily available," she added. "This leads to treatment discontinuations."
Needle delivery service
The TDN is not the only organisation promoting harm reduction among drug users.
Angkhana Kantapapa, deputy director of the Ozone Foundation from Nonthaburi, a Central Plains province in Thailand, introduced a harm reduction project called the "needles and syringes service delivery" model during the Covid-19 pandemic in Thailand to help ensure safety among drug users.
Angkhana: Runs needle deliveries
Ms Angkhana said her foundation developed the project after learning that many drug users struggled with travelling outside their homes to buy clean needles and syringes during the pandemic.
"We designed a solution to provide them with clean needles and syringes through our online channels, and we delivered them via the Thai postal system," she said. "We also gave them condoms if they wanted them."
She said the users learned about the service via online channels, including Facebook, Twitter and LINE. Those who were interested in the free service were able to contact foundation staff and request the types of products they wanted. After that, the items were delivered twice a week.
From July 1, 2020, to Aug 31, last year, there were 301 recipients and 8,060 sets of clean needles and syringes were delivered, she said.
The average number was 26.8 sets per person per month or 321.6 sets per person per year, she said.
"We are happy that we are helping these drug users stay safe," she told Bangkok Post. "They had clean needles and syringes."
She said her foundation facilitates sustainable, community-based delivery and the expansion of health service access for people who use and inject drugs in Thailand towards an integrated national response to HIV and other health issues.
Both representatives from the TDN and the Ozone Foundation were among dozens of Thai activists working to promote harm reduction during HR23, held at the Melbourne Convention and Exhibition Centre from April 16–19.
The conference, held under the theme of Strength in Solidarity, was attended by 1,200 delegates from 60 countries. The conference is seen as a global gathering of professionals active in the area of health and social services.