Getting naloxone into the hands of people who use drugs in Thailand

by Karyn Kaplan, Thai AIDS Treatment Action Group (TTAG)

“Is it legal?” “What if you inject it in a vein?” “Does it work on a benzo OD?” ”Can you buy it in a pharmacy?” “Does it lead to more drug use?”

These were some of the many questions about naloxone posed by 40 harm reduction project staff and people who inject drugs (PWID) from 14 drop-in centers and NGOs across Thailand, at our first National Overdose Prevention and Management TOT in Bangkok (July 13-14, 2011). We had just distributed over 800 doses to the participants, along w/3mL syringes and 24G/1” needles. Most of them had never seen, let alone heard of, this miraculous drug.

Thailand, despite having roughly 50% IDU HIV prevalence for the past 20 years (HCV prevalence is even higher), does not embrace harm reduction, has no official policy to support it, and has just started “piloting” evidence-based HIV prevention interventions for PWID with Round 8 Global Fund money. Given that Thailand has known only violent government-endorsed drug crackdowns and stigmatizing anti-drug campaigns, it is no wonder our trainees were concerned about being seen as “promoting drug use” or being arrested for implementing a pioneering intervention that promotes the health and rights of people who use drugs.

In the past, common PWID responses to a peer’s OD included injecting salt water or fleeing. A recent research study at the Thai AIDS Treatment Action Group’s (TTAG) Mitsampan Harm Reduction Drop-in Center, done in cooperation with the Urban Health Research Institute of the University of British Columbia, found that nearly half of injectors who had ever responded to an overdose reported an incorrect response. More than 30% of the survey’s 252 respondents reported having experienced an overdose themselves, and over 93% of their most recent overdoses involved heroin. In a survey by Population Services International (PSI) among injectors accessing drop-in services at four locations in northern, central, and southern Thailand (n = 92), of 85 who had ever witnessed an overdose, only 3% reported performing rescue breathing as a response.

Last November, TTAG and PSI Thailand, the Principal Recipient for the harm reduction component of Thailand’s Round 8 Global Fund grant, brought consultant Matt Curtis to Bangkok to help create and implement an OD prevention and management training curriculum, including use of naloxone. Together we developed baseline and refill questionnaires to collect much-needed data on the national overdose situation, for education and advocacy purposes. The government does not collect information on overdose, and negative attitudes toward people who use drugs fuel shame and fear within families of users, who report that in most cases of overdose fatality families will request the police and medical authorities record heart- or respiratory failure rather than ”drug overdose” on the death certificate.

To date, nearly a dozen overdoses have been reversed in Bangkok, thanks to naloxone donations from heroic US-based groups and some very-expensively procured naloxone in Thailand (the cost of 1cc of naloxone in Thailand is approximately 5-6 USD, while the cheapest known alternative in the region is sold in China for 1 USD). PSI has committed to integrate OD programs including naloxone into its current HIV prevention programming for IDU. User activists have committed to learning more about overdose and response, collecting data and engaging in advocacy. Thai people with HIV made global history by successfully working with their government to make free antiretroviral therapy a reality, with more than 100,000 people accessing it today. If they can do that, naloxone advocacy should be a piece of cake. Stay tuned!