By Karyn Kaplan, co-founder, Thai AIDS Treatment Action Group (TTAG)
It’s safe, it’s effective, it’s affordable, and has no potential for misuse. It’s on the World Health Organization (WHO) Essential Medicines List (EML). So why is naloxone, a chemical compound that can reverse the effects of opioid overdose, not widely available everywhere there is opioid use?
Obstacles such as the lack of a comprehensive national harm reduction policy, strict drug classification practices, and negative attitudes toward people who use drugs restrict naloxone access in Thailand. People who inject drugs and their advocates, impatient with these obstacles that lead to unnecessary overdose, have taken the situation into their own hands. Over the past several years, Thai drug user activists have introduced overdose prevention and management activities –including the distribution of naloxone-- into community-based harm reduction programs.
Worldwide, overdose is the leading cause of preventable death among people who inject drugs. In Thailand, no official figures on opioid overdose (fatal or non-fatal) exist. However, a recent study found that 30% of people who inject drugs in Bangkok experienced at least one overdose.
Over the past couple of decades, methamphetamines replaced heroin as the number one drug consumed in Thailand, but opiates including opium and heroin are once again on the rise. Yet the government has failed to adequately respond.
In Thailand, an estimated 40,000 people inject illicit drugs. This figure is considered a gross underestimate, however, in light of the repressive legal and social environment – the majority of people in prison are incarcerated on for drug-related crimes.
There are persistently high rates of blood-borne viruses such as HIV (22%-50%) and hepatitis C (90%) among people who inject drugs in Thailand, yet evidence-based interventions such as needle and syringe programs (NSP) and opioid substitution therapy (OST) to reduce drug-related harm and promote drug user health are scarce. The Thai government only nominally supports harm reduction, and in practice refuses to provide clean injecting equipment to people who inject drugs. The few harm reduction programs that exist are run by nongovernmental organizations (NGOs) and peer outreach workers, primarily with HIV prevention funding from the Global Fund to Fight AIDS, TB and Malaria (GFATM).
Jirasak Sripramong is the Director of Harm Reduction at the Thai AIDS Treatment Action Group (TTAG), a community-based human rights and HIV/AIDS treatment access organization run by people living with HIV/AIDS and people who use drugs. TTAG was one of Thailand’s first implementers of peer-led harm reduction, including user-run drop-in centers that provide NSP, outreach and education, counseling and linkages to HIV testing and healthcare, and other services. TTAG introduced the first overdose prevention and management program, including a pilot project to distribute naloxone, a chemical compound used to reverse the effects of opioid overdose. This naloxone (also called Narcan) was donated from the Chicago Recovery Alliance in the US, where naloxone programs are more widespread.
TTAG brought a community-based overdose trainer from the US to Bangkok, to help develop an overdose prevention and management curriculum based on the needs and situation of people who inject opiates in Thailand. Hundreds of people who inject drugs have been trained in Bangkok and northern and southern Thailand, where opiate injecting is most prevalent. TTAG also developed a policy brief as part of its broader harm reduction advocacy work, with widespread support and input from the broader harm reduction community, including Population Services International (PSI), the largest provider of harm reduction in Thailand, and the Thai Drug Users’ Network (TDN).
Overdose Prevention Training in Bangkok Photo Credit: Karyn Kaplan
Significant barriers remain to be overcome, as naloxone is a controlled substance in Thailand and requires a prescription or special permission to be distributed. PSI, whose harm reduction programs in Thailand are funded through a grant from the Global Fund to Fight AIDS, TB and Malaria, was helping to procure affordable naloxone. TTAG is working both at the grassroots to educate and empower people who use drugs to have life-saving information and tools such as naloxone, and at the policy level to ultimately have a broader impact.
In 2012, The United Nations (UN) Commission on Narcotic Drugs (CND) passed a resolution that urges countries to take steps to prevent overdoses, but in Thailand, little progress has been achieved at the national level. On the ground, however, harm reduction activists are at the forefront of promoting drug user health and human rights. “I don’t want to see my friends die in front of me. I have used naloxone to save my friends’ lives over a dozen times,” says Jirasak. “I want to make naloxone available to people who use drugs and their families so our drug-using friends don’t have to die.”
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