“I started using drugs when I was 15,” says 49-year-old Prapat Sukkeaw. “I smoked marijuana, but it was laced with heroin. I felt like I was floating, and that meant I could forget all the troubles I faced as a teenager. It was a beautiful feeling.”
Prapat Sukkeaw is one of an estimated 57,000 people currently injecting drugs in Thailand. His drugs of choice, marijuana and heroin, reflect a time in Thailand’s recent history when both illicit drugs were the main stimulants smuggled out of the fabled Golden Triangle, a remote and somewhat inaccessible region that encompasses northern Thailand as well as Myanmar and Laos includes.
Prapat Sukkeaw, 49, has been using drugs since he was 15.
As an employee of a non-governmental organization (NGO), he occasionally wanted to stop using heroin due to pressure from family and friends. Now he’s realized that drug use “is my preference and my right,” even as he admits to being an addict. He has now started taking the synthetic drug methamphetamine as heroin has become more and more expensive.
His focus shifted from abstaining from drugs to living with the side effects and dealing with the potential harms of prolonged drug use, such as by not sharing needles.
Like all Thai citizens, Mr Sukkeaw has access to universal healthcare but has found he was stigmatized and discriminated against as a drug user by healthcare workers. He was referred to Ozone, an NGO based in a suburb of the Thai capital, Bangkok.
Ozone’s goal is to reduce the health and social impact of drug addiction, to promote abstinence, but also to support clients who wish to continue using drugs and ensure they have access to the healthcare services they need.
A hepatitis C test is being prepared for a customer at Ozone.
“Our clients, who travel to Ozone from across Thailand, appreciate our unbiased approach,” said Ngammee Verapun, the center’s director, who is a regular multi-drug user himself. “We are a community that values all people. We are customer centric and offer peer support, treating everyone equally regardless of their background.”
Ozone offers a variety of services including needle exchange and HIV testing, as well as PrEP (pre-exposure prophylaxis), which reduces the risk of HIV infection through sex or injecting drugs. In addition, the company works with Dreamlopments, a hepatitis C service provider that offers integrated healthcare free of charge. Hepatitis C is a viral liver infection transmitted by sharing needles. Its activities are supported by UNODCalthough a funding shortfall has meant the center has had to close many of its outreach services elsewhere in Thailand.
Karen Peters, UNODC.
From punitive to progressive drug laws
Historically, Thailand has severely punished people who violated strict drug laws. However, since a change in the law in 2021, the legal system has shifted towards rehabilitation for drug users.
speak in advance International Day Against Drug Abuse and Illicit TraffickingOn June 26 every June 26, Karen Peters, UNODC’s Bangkok-based regional focal point on drugs and health, said: “Now people are being given alternatives. It’s not an ideal choice, but they have a choice of going to a treatment facility or going to jail.”
The law is progressive in other ways, too, specifically emphasizing harm reduction as a goal that, according to Karen Peters, allows organizations like Ozone to “operate within the confines of the legal and judicial system.”
It also helps “shift the narrative about people who use drugs in Thailand away from social marginalization,” she said.
fight stigma
The stigma of drug users still persists, but according to Dr. Phattarapol Jungsomyatepaisal, director of the National Committee for Addiction Treatment and Rehabilitation at the Ministry of Health, said the new legislation means that “more healthcare providers will be trained to act in a non-stigmatizing way”.
He says the response from people who use drugs has been “good,” realizing that under Thailand’s universal health insurance system, they should eventually receive better care in hospitals and health centers, while at the same time should continue to be able to access services from community-run centers such as Ozone.
HIV and hepatitis C
A major concern remains the high prevalence of HIV and hepatitis C among drug users in a country where HIV rates are otherwise falling. In Thailand, an estimated eight percent of drug users have HIV, about 3,800 people.
At 42 percent, the hepatitis C rate is “very frightening”, according to Dr. Patchara Benjarattanaporn, the country director of UNAIDSthe UN agency leading the global effort to end AIDS as a public health threat by 2030.
Despite ongoing concerns about the health consequences for people who use drugs, Dr. Benjarattanaporn that Thailand could become a model for countries in the region facing similar challenges.
“The new narcotics law and the community-led aspect of treating drug users offer hope that Thailand can bring cases under control, and this is a development that other countries are watching,” he said.
Back at Ozone, one client is being counseled on PrEP and HIV prevention and another is undergoing a hepatitis test. Peer support remains a key element in attracting people to use its services, and there is now hope that the new legislation will lead to less discrimination and allow others to access similar services through more government health facilities.
