Usaneya Perngparn, Ph.D.Director, Drug Dependence Research Center

WHO Collaborating Centre for Research and Training in Drug Dependence and Assistant Dean, College of Public Health Sciences

Chulalongkorn University Bangkok 10330, THAILAND

E-mail: usaneya.p@chula.ac.th

In 2011, between 167 and 315 million people aged 15–64 were estimated to have used an illicit substance in the preceding year.  This corresponds to between 3.6 and 6.9 per cent of the adult population. The prevalence of illicit drug  use and the numbers of problem drug users — those with drug use disorders or dependence – have remained stable.

Since 2009, the prevalence of cannabis, opioids, and opiates use has gone up, while the prevalence of use of cocaine, amphetamine‐type stimulants and “ecstasy”‐group sub‐stances appears to have followed a declining trend between 2009 and 2011. 

Global Situation: 2013World Drug Report

Primary Drug Use

UNODC World Drug Report 2013

Amphetamine­type stimulants :

Use of ATS, excluding “ecstasy”, remains widespread globally, and appears to be increasing. The use of ATS was already a problem in East and South‐East Asia, 

there are reports of increasing diversion of precursor chemicals, as well as increased seizures and manufacture of methamphetamine, combined with an increase in its use. 

High levels of ATS use are reported in Oceania (2.1 per cent in Australia and New Zealand), Central and North America (1.3 per cent each) and Africa (0.9 per cent), while the estimated annual prevalence of ATS use in Asia (0.7 per cent) is comparable with the global average.

Opioids

The use of opioids (heroin, opium and prescription opioids) has increased in Asia since 2009, particularly in East, South‐East, Central and South‐West Asia. Reliable data do not exist for most parts of Africa, experts report 

an increase in the use of opioids there. North America (3.9 per cent), Oceania (3.0 per cent), the Near and 

Middle East/South‐West Asia (1.9 per cent) and East and South‐Eastern Europe (1.2 per cent) show a prevalence of opioid use that is higher than the global average. A high prevalence is reported in the Near and Middle East/South‐

West Asia (1.2 per cent), primarily in Afghanistan, Iran (Islamic Republic of ) and Pakistan, as well as Central Asia (0.8 per cent), Eastern and South‐Eastern Europe (0.8 per cent), North America (0.5 per cent) and West and Central Africa (0.4 per cent)

Cocaine

The two major markets for cocaine, North America and Western and Central Europe, registered a decrease in cocaine use between 2010 and 2011, with annual prevalence among the adult population in Western and Central Europe decreasing from 1.3 per cent in 2010 to 1.2 per cent in 2011, and from 1.6 per cent to 1.5 per cent in North America. While cocaine use in many South American countries has 

decreased or remained stable, there has been a substantial increase in Brazil that is obvious enough to be reflected in the regional prevalence rate for 2011.  Australia has also reported an increase in cocaine use. 

Ecstasy

Overall, use of “ecstasy” (i.e., methylenedioxymethamphetamine(MDMA)) has been declining, although it  seems to be increasing in Europe. The three regions with a high prevalence of “ecstasy” use 

continue to be Oceania (2.9 per cent), North America (0.9 per cent) and Europe (0.7 per cent). Use continues to be associated with young people and recreational and nightlife settings in urban centres. For example, of the 2 million past‐year users of  “ecstasy” in Europe, 1.5 million were between 15 and 34 years of age.

Non­medical use of prescription drugs

The misuse or non‐medical use of tranquillizers and sedatives such as benzodiazepines and barbiturates remains high and, at times, higher than that of many illicit substances. Along with the single use of tranquillizers (e.g. benzodiazepines), their use is commonly observed among polydrug users, especially among users of heroin who use benzodiazepines to enhance its effects, as well as those on methadone medication. Benzodiazepines are also often cited among the other substances reported in both fatal and non‐fatal overdose cases among opioid users  

Non­medical use of prescription drugs 

The misuse of prescription opioids is also increasingly being reported from different regions. Tramadol is an opioid painkiller that is not under international control, whose misuse is being reported from many countries in Africa, the Middle East, Asia (including China) and the Pacific Islands. The misuse of dextromethorphan is quite common among 

adolescents and young adults. For instance, in the United States of America, the annual prevalence of non‐medical use of cough syrups among students in eighth, tenth and twelfth grades was reported as 2.7 per cent, 5.5 per cent and 5.3 per cent, respectively. When cough syrup containing dextromethorphan is taken in quantities higher than the recommended dosages, the dextromethorphan acts as a “dissociative hallucinogen”, producing effects similar to those created by other hallucinogens such as ketamine and Phencyclidine.

Drug Seizures

Opium Production

Heroin Seizures

Methamphetamine Seizures

Ecstasy Seizures

Methamp Pill Seizures

UNODC World Drug Report 2013

UNODC World Drug Report 2013

Inject Drug Users

Inject Drug Situation

UNODC World Drug Report 2013

HIV situation

HIV Prevalence Rate

Hep B&Hep C Prevalence

Rate

THAILAND SITUATION

Re – X ray

Feb

Policy declaration

The new policy known as the “Power of the Land” was established in October 2002 to control problems from substance abuse

The National Command Center for Combating was established in January 2003

The War on Drug was implemented between February, 1 and April 30, 2003

2003Mar Apr Oct Nov Dec SepMay Jun Jul Aug

Ended up the first wave of War on Drug December 3,

2003

Jan Nov Oct Dec

The discontinuation of drug dependent treatment information system of the Ministry of Health. Establishment of the new registry system of population involved with drug.

Drug user indictment decreased to 1 / 5 of pre-WoD

Drug dependent treatment population decreased to 1 / 3 of pre-WoD and dramatic change of population profile entering treatment.

Increase of inhalant user among the juvenile detainees population

Major impact of “War on Drug”

Substitution with alcohols, sleeping pills and inhalants reported.

Treatment data 2001 2002 2003 2004 2005

Re-entry cases 15,696 16,984 33,228 8,683 9,157

New cases 30,912 42,832 267,436 28,014 35,715

Total 46,608 59,816 300,664 36,697 44,872

Treatment data 2006 2007 2008 2009 2010*

Re-entry cases 11,219 13,459 19,491 26,204 17,919

New cases 41,413 51,447 76,577 94,571 64,420

Total 52,632 64,906 96,068 120,775 82,339* Jan-Sep

2010Source: Office of Narcotics Control Board, Thailand

28 10 9 9 3 9 61

511

43 54 76

508

65

626

444

538 75

7

2168

3002

4508

0500

100015002000250030003500400045005000

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

Kg.

December 2000 Institute of Health Research, Chulalongkorn University

Source: Office of the Narcotics Control Board, Office of the Prime Minister.

Methamphetamine seizure during 1980-99

DRUG DEPENDENCE TREATMENT POPULATION 1990-2010: NEW CASES

71.1 72.5 73.7 78.2 83.4 84.976

47.832.1

24.1 19.6

16.5 13.812.8

6

0.4 0.6 1.1 1

10.6

34.1

53.757.460.3

19.3

6.6

5.7

6.3

5.3

5.37.7

1.7 2.6

0%

20%

40%

60%

80%

100%

1990 1992 1994 1996 1998 2000

Heroin Opium Cannabis

Inhalants Methamphetamine Others

2010200820062004

69.9 79.1 78.9 80.2 84.5 82.1 84.6

Source: Office of Narcotics Control Board, Thailand

Methamphetamine epidemics

Source: Office of Narcotics Control Board, Thailand

Treatment Population 1990-2010: Methamphetamine new cases

0.1 0.2 3.3 7.3

66.0 66.8 67.671.5 70.3 68.7 68.2

99.3 98.0 92.4 91.3

16.2 13.5 16.3 16.1 17.7 17.1 20.4

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

CorrectionCompulsoryVoluntary

%

16,52120,805

29,276182,176

19,37828,312

32,83341,601

65,23777,735

54,525Number

Number of heroin dependent treatment patients: new cases

20062007

2008

persons personsperson

Source: ONCB and PSI harm reduction program, Thailand

Route of heroin administration: Treatment patients, re-entry and new cases

Source: Office of Narcotics Control Board, Thailand

0.0

20.0

40.0

60.0

80.0

100.0

2004 2006 2008 20102000 2002

IV rate of methamphetamine treatment population = 0.0-0.5%

%

Re-entry cases

New cases

Source: Office of Narcotics Control Board, Thailand, 2011

7,000

5,000

3,000

0

384.2

Heroin

Drug situation before and after war on drug:

2003 – 2010

Seized methamphetamine reduced. Seized heroin cases reduced. Ice has recently increased at alarming rate.

2004 2006 2008 2010

Ice400

300

200

100

0

Kg.

cases

2004 2006 2008 2010

800

400

1000

600

200

Kg

cases

0500

1,0001,5002,0002,5003,0003,5004,0004,500

0200400600800

1,0001,2001,4001,6001,800

cases

10x1,000 tabletsMethamphetamine

020,00040,00060,00080,000

100,000120,000140,000160,000

Logo % mg methamphetamineaverage

% mg caffeineaverage

WY 24.2 64.2

Wy 23.9 69.9

wY 22.8 64.0

wy 23.0 60.2

OK 16.01 66.4

ฬ/99 11.5 66.7

888 35.2 66.4

R 20.4 57.9

Chemical and Physical properties of Yaba (Methamp)

Source: Office of Narcotics Control Board, Thailand : 2005-7

Prevalence by country region

Prevalence by type of substances

0

0.5

1

1.5

2

2.5

3

3.5

krat

om

cann

abis

met

hamp

inha

lant

s

opium

ecta

sy

hero

in

Lifetime Current

43.2640

46.8850.77

47.1750

44.9146.842.22

37.6436.33

25.62

48.1552.38

0

10

20

30

40

50

60

Blood Donor

IDU

ANC

Male at STI clinics

Direct FSW

Indirect FSW

1997 1999 2001 2003 2005 2007 2009

%

Source: Sentinel Sero-Surveillance, Bureau of Epidemiology, Ministry of Public Health

Methamphetamine users : Injection practice, 2004-9Chiang Mai Chiang Saen Chiang Mai

(2004) (2008) (2009)Survey methods Snow-balling Rural Household

MA users, 18-25 yrs. 14-29 yearsMedian Age 21 19 19% Male 84.2 88.6 67.5Median age began using methamphetamine 17 15 15% injection exposure

Ever seen injection 27.9 37.3 23Ever been offered 22.9 37.3 13Ever injected 4.4 7.6 1.0

MA Injection is increasing?Source: Research Institute for Health Science, Chiang Mai University and John Hopkins University, 2004 6

Bangkok Chiang Mai (n=750 ) (n=300 )

% Age < 25 years 3 42% Male 83 83% Injection drug experience

Heroin 34 34Methamphetamine 63 32Midazolam 42 4Methadone 13 6Opium NA 14

% Shared needle at last injection 5 48% HIV prevalence 24 11

Drug users that inject multiple drugs including Methamphetamine (Respondent Driven Study, RDS, 2009)

Source: Administrative Committee of Substance Abuse Academic Network, RDS study, 2009

Chlamydia trachomatis Neisseria gonorrhea

18.5

29.4

5.5 7.7

0

10

20

30

40

50

Male Female Ref. Male Female Ref.

Perc

ent p

ositi

ve

Chlamydia trachomatis

Neisseriagonorrhea

Source: Research Institute for Health Science, Chiang Mai University and John Hopkins University, 2004-6

Prevalence rates C. trachomatis and N. gonorrhoeae infections, methamphetamine users, Chiang Mai, Thailand, 2005

V.Poshyachinda, 2003

40.7

34.2 34.332.1 32.8

43.445.3

41.7 41.2 40.4

5.4 4.7 3.4 3.5 4.28.2

6.18.8 10.3

4.4

50

30

40

20

10

0

%

Heroin injector Heroin smoker

HIV seropositive prevalence of heroin injector and smoker

20011992 1993 1994 1995 1996 1997 1998 1999 2000

Heroin smoker

Heroin injector

Cannabis Inhalant Methamphetamine Alcohol

16

8

12

4

0

%HI

V se

ropo

sitive

prev

alenc

e

20011995 1996 1997 1998 1999 2000

8.1 ( 74)6.4 (125)

4.7 (192)6.9 (130)

10.2 ( 909)8.2 (2005)

3.4 ( 952)3.2 (1072)

2003 %(N)2004 %(N)

V.Poshyachinda, 2003

HIV prevalence among young MA usersChiang Mai(2004) Chiang Mai(2009)

Survey methods Snow-balling Rural HouseholdParticipants MA users General populationAge 18-25 14-29Median Age 21 19Sample size 712 2,020HIV prevalence 1.1 0.8

**HIV prevalence in general pop. aged 15-49= 1.4(0.9-2.1)

[UNAIDS/WHO 2008]

Source: Sirirojn and Aramrattana. Drug use related HIV epidemic in Thailand, Chiang Mai University, 2010.

In Sum

The available information is considerably substantial and adequate for synthesizing the national substance abuse scenario while the information specific to drug use and public health aspects are very limited. Therefore, a proactive approach to prevention and control of abuse and health impact especially HIV related to substance abuse should be thoroughly considered.