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Harm Reduction: A lifeline for drug users we cannot afford to lose

Jun 26. 2014
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By Sutthida Malikaew
Special to

While the insurgency steals the headlines, a separate and growing problem remains "under the radar" in Thailand's South. The number of injecting drug users (IDU) is on the rise in the three southernmost provinces of Yala, Pattani and Narathiwat. At the sa
One of the few initiatives tackling the problem is the Ozone Centre, which is using a harm-reduction approach.
Heroin is relatively easy to access locally and also affordable – at least for those in the early stages of addiction. A high proportion of drug users in the South are IDUs. Injecting as a method brings its own problems, including diseases contracted from unclean equipment and HIV and Hepatitis B and C transmitted through sharing needles. 
In 2011, the PSI Foundation, backed by the Methadone Maintenance Treatment available at Sungai Kolok Hospital plus information on the number of local drug users, established its first Ozone Centre, in Sungai Kolok District, Narathiwat. The centre aims to reduce the negative consequences associated with drug use, an approach known as Harm Reduction. Those negative consequences can be to personal health, the economy, the community and wider society 
The Ozone Centre has an outreach programme manned by drug users who act as volunteers to help their fellow users in the community. Each volunteer offers peer knowledge that helps others reduce the harmful effects of drug use. To mitigate the risk of HIV transmission, Ozone runs a needle exchange programme, with users given clean equipment in exchange for their used needles. As addiction is hard to quit immediately, the Methadone Maintenance Treatment (MMT) was introduced to help those who want to get off drugs and enable them to escape the risk of HIV and Hepatitis carried by injecting. MMT is included under the national health insurance scheme and available free at the hospital, where many addicts have joined the programme. Ozone Centre serves as their comfort zone and a place where they can escape the daily routine of drug use in their normal environment and find support and inner fortitude. 
The number of IDUs entering methadone treatment has increased significantly since Ozone opened, says Ladda Nignor, PSI Foundation coordinator for the South. Panida Wanwong, a nurse for the MMT Programme at Sungai Kolok Hospital, can vouch for that: she has seen a rising number of drug users take up the service in the last three years. The success of Ozone in Sungai Kolok convinced the PSI Foundation to establish another centre to serve the needs of users in Narathiwat’s Waeng District. There are currently 494 registered IDUs in both districts – 177 in Sungai Kolok and 214 in Waeng. Over 60 per cent are infected with HIV. 
HIV-plus users who join the methadone programme also get access to antiretroviral drugs (ARV). Injecting drug users who are on methadone as well as prescribed ARV say that they are healthier, have lower expenses and suffer fewer family problems. Family members confirm their words. In addition, users in the programme report that residents resume accepting them as members of the community. Eighty per cent of drug users who join Ozone’s programme go on to maintain a regular methadone regimen as prescribed.
Users who work as Ozone volunteers say they are motivated by the pride they feel in helping friends who have fallen prey to addiction, and even saving their lives. Some volunteers describe having gone from being nothing in community – just “a useless junkie” – to being accepted by people in their neighbourhood. They feel they have got their dignity as human beings back.
Other methods such as forced treatment and punishment have also been used to tackle drug abuse, but neither has succeeded in reducing the problem. 
The Harm Reduction approach launched by Ozone in Narathiwat has proved to be a better and more effective model in finding long-term and sustainable solutions. It should now be applied to other provinces to ensure better quality of life for drug users, to uphold their rights to health and to lessen the social and economic impact on their communities. Unfortunately, Ozone Centres are facing difficult times because of budget limitations. Financial support from the Global Fund for Aids will end this year, making it hard even to maintain the existing centres, let alone expand Ozone’s services to other districts and provinces.
In fact, this should not be a problem for PSI alone. All the agencies concerned must consider whether they can afford to let Ozone and the successful Harm Reduction approach disappear when the Global Fund budget runs dry. It’s time for those within Thailand to step up and contribute. 
Sutthida Malikaew is an independent consultant working on the treatment of people with HIV-Aids. Yesterday, June 26, marked the International Day against Drug Abuse and Illicit Trafficking.

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