Questions/Answers

According to the situations in high area, borderland, high mountains and forests which are remote and difficult to access, there are many tribes with beliefs, languages and cultures such as the tradition of welcoming guests with opium and using opium in treatment. For this reason, it is found that opium addicts in the community have a deteriorated physical condition which leads to work incapability, losing self-reliance, and living with pain. Thus they become a family burden resulting in broken families, and their children do not receive appropriate education. In addition, it is also difficult for them to receive treatment due to poverty and scarcity of nearby health units that they do no not have enough money to travel to receive treatment. For this reason, they cannot access government health services that their life cycle continues with poverty and underprivileged status. It is difficult for them to get out of this cycle or improve their quality of life. The solution to solve these problems is proactive implementation with a community based approach composed of entire integration of personnel participation and resources in the area along with changing the area zone from red to green and integration with external organizations in order to implement rule adjustments and legal amendments to facilitate the operations in the context of the area. Furthermore, a Harm Reduction Center (Drop in center) was established to solve physical dimensions such as long-term use of Methadone in treatment. For mental dimensions, opium addicts are encouraged to adjust their attitude by empowering themselves. As for the social dimension, the mindset is changed that opium addicts are recognized as patients together with solving poverty by vocational training and marketing assistance. The patients are supported until they can stop using drugs and improve their quality of life.

This project aims to 1) reduce opium addiction and improve quality of life of underprivileged opium addicts and their families. They receive equity and educational opportunities, 2) the opium addicts and their families can rely on themselves with their career and enough income for their living that they can get out of the vicious circle related with wrong beliefs about using opium. These wrong beliefs will make them become opium addicts who have health problems, work incapability, poverty, and scarcity of social opportunities, 3) help the opium addicts to better access government services, basic human rights and equal rights for health care focused on nearby rehabilitation centers in order to access public health services more easily, and 4) provide a stage for the community to have co-thinking, planning, implementation and assessment in order to solve the problems in the area sustainably.

Due to the lack of opportunities and scarcity of public health service access of these marginalized people, they have been suffering in the vicious circle that they do not have enough income and are still involved with drug use which results in problems of every dimension. This implementation stimulated community power by creating people and community leaders in the area, changing the concept of caring for opium addicts from "criminals" to "patients" and applying public health over suppression. Moreover, it has also included with constructing allies to have co-operation and power in management and distribution of resources transparently and appropriately for the context of the area. The knowledge was applied to adjust the searching system of drug addicts and plan the harm reduction system which resulted in easier access to health services, Drop-in centers and best practice in opium addict care. The opium addicts were in the treatment system up to 92.9%, and this project can reduce the number of opium taking to 100%. Furthermore, the opium addicts can stop taking opium (18%) that resulted in better family relationships, working capability and improved income.

In this project, the treatment system was developed to provide proactive services with the participation of all sectors which had never happened before. This implementation provided the opium addicts of various tribes with the complex problems in every dimension (such as living in remote areas, scarcity of government service, access both in education and public health and lack of career opportunities) to have the ability to access the new treatment service system more easily and receive health care in accordance with human rights. This will help the opium addicts to stop opium taking, and they can continue working on their career, be self-reliant, living and working normally and improving their quality of life. Moreover, this project can also reduce violence against women and children which is related to the third goal that aimed to ensure people’s quality of life and promote good health of all people by strengthening the opium addicts with methadone using in treatment together with counseling, creating a public-sector partnership, and promoting a career. As a result, the people in the area were ready to develop themselves and society together with strengthening the community sustainably.

In order to cut off the cycle of opium addiction including poverty and underprivileged status, this initiative is focused on health problems and improving human resources with effective physical and mental development by encouraging the patients to stop taking opium. In addition, they also promoted good health, perception, a good career and income so that they can look after their family. The strategy of this project is the ability to access to intensive health care services by establishing Drop-in Centers with networking workers (Networking) and setting the system of opium addict care in the community. Furthermore, personnel of all levels also received knowledge and understanding about the system with Harm Reduction approach, and also adjusted the attitudes about opium addicts. The rehabilitation system was developed for the opium addicts in the community covered with every dimension in a multidisciplinary form. Moreover, methadone has been provided to opium addicts in the Drop-in Centers of the community where they can access medication and public health services safely. The opium addicts who can stop taking opium completely will receive opportunities to become volunteers for opium addict care in the area in order to improve their quality of life.

According to the results of the implementation of caring and helping opium addicts with harm reduction approach by establishing harm reduction centers together with providing long-term methadone service and holistic health service which is the integrated treatment and rehabilitation of drug addicts from all sectors, it was found that the people in the communities had positive attitudes with taking care of opium addicts, and they also encouraged the opium addicts to receive treatment and monitor themselves. Furthermore, the opium addicts that were treated would be the leaders to search for patients in order to enter the continuous treatment system. This project is focused on the participation of families and communities to establish better quality of life (such as healthiness, good mood and earning income for their family with improved working ability) and improvement of the local economy which affected other families and communities to develop as well. This also resulted in a decreased demand for opium and less opium cultivation area that it can be utilized to grow traditional crops instead of opium so the tribe people will have more income and better quality of life.

The innovation received from this initiative is to unlock the long-standing constraints of existing public service systems which aim to solve the problems and respond to the needs of those who are suffered from poverty and underprivileged status that they cannot access fundamental services. In addition, the service system was adjusted to proactive services with the participation of people and community leaders in the area. The Drop-in center was established to treat and rehabilitate opium addicts and to provide comprehensive health care services in all dimensions (physical, mind, social and soul). The patient care process with the participation of government officials, family members and the community has supported the patients until they can stop taking drugs, and their dignity would be restored. Moreover, they may realize their self-value and adjust their lifestyle which affected the well-being of their family and resulted in a safer community. The barriers were also eliminated by the operational management allowed the government to lessen the rules about more methadone dispensation, and traveling time to receive medication was also reduced. Furthermore, the methadone was pushed into the health insurance system together with helping the patients to obtainan ID card.

The projects continued from the royal project were inspired in the treatment and rehabilitation of the opium addicts in highland areas situated in remote locations consisting of different tribes, languages and cultures that it is very difficult to access. However, the complex problems were finally solved by applying the concept of Harm Reduction which aimed to stop opium taking. Thus the service management provided for opium addicts in various locations which are difficult to access, was the first challenge in the implementation. The innovation of comprehensive treatment and rehabilitation in the area was originated from experience learning, and P-D-C-A process had been applied in many cycles until the problems were solved. The implementation was done by applying the community participation process that people in community cooperated in planning, deciding and operating in the searching, screening and treatment in the Drop-in Center. The patients received health care during the treatment together with preparation for adjusting thoughts and behavior about opium using and their livelihood. There was a monitoring system implemented by families and communities to encourage them to stop using drugs, promoting a career to make income for self-reliance and family support in the long term.

This project has been implemented since 2012 and is mainly financially supported by the Department of Medical Services. It is also integrated implementation from the support of other organizations such as National Health Security Office that provided financial support for methadone, Department of Local Administration provided financial support for delivering the patients into the treatment system and monitoring, and Highland Research and Development Institute provided help for develop the agricultural profession and marketing access. The first step of implementation is to publicize the idea, listen to opinions and get to understand with the public health team and community leaders which is composed of officers from the involved sectors and public health volunteers. The team and involved persons had discussed in workshop meetings in order to share ideas, analyze, and set goals and operational plans for creating a community-based opium addiction care model and developing a multidisciplinary rehabilitation process that the community can participate in all dimensions. The “Drop-in” was established in District Health Promotion Hospital, District Hospital and Sub-district Administration Organization which resulted in easier access to health services, continuous receiving of health services and reducing expenses. Also there was an exchange platform for evaluating and modifying collaboration.

Yes

According to the establishment of the Drop-in Center, it was found that the combination of various knowledge from the implementation can lead to the health services covered with all dimensions. In addition, from the results of mentioned implementation, the lessons learned book was published, and the knowledge was also applied in extended results area (7 districts 3 provinces). The successful results were publicized and applied in Ban Pa Nah, Chai Prakarn District, Chiang Mai Province. This area was first in red zone in 2015; however, it had been adjusted to green zone in 2017 due to less opium cultivation. This successful project was mainly operated by a public health team, communities and government sector that they were also invited to lecture at various academic forums. In addition, this area is used as the study area in Thailand and abroad. For example, the visitors from Malaysia came to Thailand for a study visit and applied the knowledge in their country. Thus this project can be used as prototype model for the sustainable treatment of opium addicts and it is applied effectively with various contexts of beliefs in different localities.

According to the study of medical records of 800 opium addicts that were come into the treatment processes lead to the changing dimensions in social, economic and environmental factors. In the past it was showed that opium addicts had bad behavior changed such as they had no interest to do work that caused family problems and poor health. After entering the treatment process, opium addicts receive knowledge of the harmful effects of drugs, in current disease from drugs, mental care and also motivation that they can quit opium addiction by receiving treatment. This resulted in better quality of life that they can work and earn money for their families. In addition, communities are stronger and there has been a decrease in crime. On the part of the culture and beliefs to welcome guests by opium and the use of opium as medicine began to be changed by receiving treatment service. Furthermore, Security forces were responsible for providing security and prevention by destroying opium plantations and the Highland Research and Development Institute (Public Organization) was responsible for supporting and encouraging agriculture profession for the patients. As a result, the consumption of opium decreased so that opium addicts have a brighter future.

The sustainability of this project is based on the community and cooperation consisted of many involved agencies as the stakeholders in designing activities and co-operation in the treatment of opium addicts. All have positive thinking with the treatment of opium addicts and would like to help opium addicted can stop using opium by designing appropriate treatment program. The initiative of the treatment of the opium addicts is to apply harm reduction in the operations in order to provide care for the patients. There is also a development of the rehabilitation process for opium addicts in a holistic way. It can be continued from the search, screening, treatment, and follow-up care. In addition, it was agreed to work together by issuing an order appointing a committee to prevent and solve drug problems of the district and assign the clearly role of each partners. There is an agency that provides budget to operate the project. "Harm Reduction (drop in center)" was set up in the community to provide healthcare services to opium addicts. Then, there were 14 centers of harm reduction from drug abuse (Drop-in center) which help patients to receive medication and services conveniently and safely. There are opium addicts who can stop using opium to be become volunteers for the therapist and be empowered to be leaders in order to help in caring, screening and helping other patients. Although this project has ended, opium addicts still receive good care in the local community.

Yes

The initiative was evaluated by the Office of the Narcotics Control Board (ONCB) found that harm reduction and treatment for opium addicts in hill tribes can help the opium addicts in highlands to reveal themselves and access treatment services. Furthermore, the patients also reduced and quit opium addiction when they were ready. This resulted in better quality of life and more peaceful society. The initiative focused on community participation and was the best project on the implementation of harm reduction in local communities. This project was awarded the “Thailand Public Service Awards” by Office of the Public Sector Development Commission . Furthermore, it has received the evaluation from Ministry of Public Health to be promoted as “The development initiative of community participation focusing on opium addicts”.

The families which consisted of opium addicts have financial problems, family violence and other social problems. They face social stigma and discrimination from the community. For example, the financial support from the government is not provided to these families so their children are uneducated because they have to work to earn money to support their family. When opium addicts participate and remain in treatment, they will have better health including with the recognition from the community to continue their career that they will have enough income for living and saving. The family problems will be decreased, and acts of violence on women and children will be reduced. As a result, the women will have a better quality of life that they will not have to work hard and be solely responsible for nurturing the family. Furthermore, the women will have better physical and mental health that the problems raised from drug abuse of their husbands are eliminated. The children will receive love, care and warmth from their parents resulting in appropriate development and better education that they will grow up as good citizens to develop their country in the future.

According to the operation results in 5 years, it was found that the opium addicts in 7 districts in highlands, the epidemic of HIV, Hepatitis B and C. decreased. Moreover, it was found that 1) The quality of life of opium addictsthat participated in the Drop-in center was found at a high level approximately 3.65 %. Furthermore, the psychological and social aspects and physical wellbeing of opium addicts are also at a high level as well, an average occupancy rate was 3.21%. 2) The opium addicts had more interest inparticipating in the treatment service system. The results showed that the patients still participating in the treatment system was 92.89%. 3) There were 14 centers of harm reduction from drug abuse (Drop-in center) that provide methadone medication and services conveniently and safely. 4)The working network of seven districts consisted of physicians, nurses, public health officers, government administrations officers, security forces, the office of the Narcotics Control Board, the network of community leaders and civil society. 5) The Best Practice was received as the centers of harm reduction in communities to conduct study visits and exchange knowledge between Thai and overseas drug abuse treatment agencies.

The project based on community and cooperation consisted of many involved agencies as the stakeholders in designing activities and co-operation in the treatment of opium addicts as follows. 1. The Princess Mother National Institute on Drug Abuse Treatment (PMNIDAT) was mainly responsible for project implementation of all areas and driving the policy to provide methadone medication into health services of the community, for example, coordinating with the Food and Drug Administration in order to increase the dispensation of methadone drug in community hospitals and taking care of long-term methadone medication services in the concession of the National Health Security Office (NHSO). 2. The regional Thanyarak Hospitals (Thanyarak Chaingmai Hospital and Thanyarak Mae Hong Son Hospital) were responsible for managing, monitoring, following up the operations in the areas of responsibility to match with the objectives and report progress to the PMNIDAT. 3. Community hospitals/district health promoting hospitals were responsible for the implementation of treatment services in the areas and integrated coordinating with the involved organizations to help the opium addicts. 4. Security forces (military and police) were responsible for providing security. 5. Community Sectors such as local government, village chiefs, headmen, community leaders and NGOs were responsible for searching, forwarding and following up action. 6.The Highland Research and Development Institute (Public Organization) was responsible for supporting and encouraging agriculture careers for the patients. 7. The Office of Narcotics Control Boards provided budget and integrate policy coordination. Meetings will be held periodically at the start of the fiscal year to assess the performance of the past year including obstacles and work together to find solutions and to continue the project. There are meetings during the fiscal year to monitor the progress of the operation and complete the project.

According to the operation results in 5 years,we have learned the following: 1)The problem analysis which needs to be solved can be identified and responded to their problems positively by the people in the area. 2)The networking of work feels like the same family and not being alone in the risk and dangerous area. 3) The building of cooperation was composed of trust that the budget management was implemented with transparency. As a result, mutual work ownership was created in the area. 4) Harm Reduction is the new concept for treatment in Thailand by providing methadone medication which is the challenge that requires cooperation from all sectors. 5) The establishment of Drop-in centers in the community will provide a safe area for patients to access medication and public health services and also affect the area’s sustainability and the system safely. 6) Reducing social stigma and discrimination of the opium addicts will provide a better quality of life for the patients, women and children and decrease family violence. 7) Implementation of this project made stateless people have improved access to public health services and apply to use in the areas that relate to other local beliefs.