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 Kunming, April 2011 What drugs are we really talking about? • Methamphetamine Tablets • Ecstasy • Ice • Ketamine???? Regional Research Activities • Chiang Mai (Research Institute for Health Science) and Johns Hopkins): Peer based network intervention • AusAID Illicit Drug Initiative: 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 Median Age % Male %Single % Completing High School % Unemployed %Drinking alcohol or more days per week Median age began using ATS % Using ATS or more days per week in past months % Ever in drug treatment % Sexually active % Reporting genital sore ever Thailand 21 84.2 59.8 13.4 33.1 Cambodia Lao PDR 22 20 96.3 89.6 81 91.4 29.7 44.2 31.7 39.1 20.5 17 40 18 23.3 16 13.3 64 93.7 14.2 46.1 60.9 87.3 15.1 9.2 15.6 70.7 12.2 Highest education completed Median of age at the first time using ATS in Vietnam Comparison of Chlamydia Rates Among ATS Users to Sentinel STI Data by Country Thai Females (HIVNET 021)1 Thai FSW (URT)3 Cambodia- Police4 Lao PDR – Female Factory Workers5 Lao PDR – FSW5 ATS Users 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 drug injected 21.9% 43.3% 14.7% Asked or offered to inject drugs 17.4% 14.4% 9.7% Injected drugs 2.2% 4.8% 1.4% Recent findings from TUC surveys of PWIDs Figure Findings from the Thai US Collaboration on Disease Control (TUC) Study of PWID in Bangkok and Chiang Mai Injection (past 30 days) Bangkok (n = 746) Chiang Mai (n = 309) Heroin 34% 34% Midazolam 42% 4% Methamphetamin e 63% 32% Opium NR 14% Methadone 13% 6% 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: 34.2 Cambodia: 40.5% Lao PDR: 19.9% Ever been arrested Where and what sort of responses 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) ... • 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... 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... 9.7% Injected drugs 2.2% 4.8% 1.4 % Recent findings from TUC surveys of PWIDs Figure Findings from the Thai US Collaboration on Disease Control (TUC) Study of PWID in Bangkok and Chiang Mai Injection