Feature story

Compassionate care for people who use drugs in Thailand

26 June 2023

At the Ozone Foundation clients talk about their drug use with as much openness as they discuss their jobs or families. In the yard of their Bangkok drop-in centre we sit under the cannon ball tree. Prapat Sukkeang shares his story first.

He is the Chair of the Thai Network of People who use Drugs (ThaiNPUD). He’s used substances of some kind for more than three decades. He says he started because of “small problems”. Once his family found out, he was immediately alienated: “the community and society around me became distant,” he remembers. Mr Prapat still uses. He might have yaba—a mixture of methamphetamine and caffeine—once a month.

“Ozone is the place I get knowledge about my health and about drug use. They give you information for your safety. I think without Ozone I might have overdosed,” he says plainly. “I feel very good to come here with service providers who see us as friends and provide healthcare services according to our needs. I feel respected. When we go to other places we always feel like criminals. If we go to a hospital they serve us last or reject us to get treatment. The service that we get is not equal to others.”

Jamon Aupama, a motorcycle taxi driver, lives with his wife in Bangkok. He goes to a state-run methadone clinic to avoid heroin withdrawal. He wishes he could take the methadone home and didn’t have to go there every day.

The experience at Ozone is different. Here the service delivery more closely matches his needs. He relies on Ozone for tests, clean equipment and “to hang out with friends”. He also goes for information.

“They give me detailed advice on how to protect myself from illness,” he says. “Some Ozone staff know personally about drug use, some do not. The trust comes from knowing them and the way they are trained,” Mr Jamon says.

From the ‘war on drugs’ to a more humane drug law

This people-centred service—and even these honestly told stories—were unimaginable just two decades ago. During the first three months of Thailand’s 2003 “war on drugs”, police killed almost three thousand people. Human rights groups reported widespread arbitrary arrests, beatings, forced confessions and compulsory detentions for “rehabilitation”. Use of HIV services by people who use drugs declined sharply. Terrified, people shrank into the shadows.

This chaotic context was the spark for Ozone’s formation. Back then they set up their first drop-in centres as safe spaces where clients could take a shower, have a meal and share their experiences.

Today the political and social climate is far different. A new Narcotics Law introduced in December 2021 provides for differentiated sentencing on drug crimes and alternatives to imprisonment for some offences. For the first time, the health and wellbeing of people who use drugs are being considered. There are provisions for harm reduction although it isn’t precisely defined. The United Nations Office on Drugs and Crime (UNODC) notes the continued existence in Thailand of compulsory treatment centres, deemed by the United Nations to be ineffective and a violation of human rights. Still, this more humane drug law is a first in Southeast Asia.

“Community-based treatment should be the way to provide care. Through community literacy we can understand the patient and the situation they face to get them to have a good outcome,” says Dr Phattarapol Jungsomjatepaisal, Director of the Department of Health Service Support at the Public Health Ministry.

Ozone’s holistic service package

Ozone Foundation’s Director, Verapun “Noy” Ngammee, explains that the organisation’s raison d'être is to respond to clients’ unique situations.

“They have bad experiences with stigma and discrimination,” he starts. “It’s difficult to trust people. Many of them have been suffering for a long time. We need to have peer organisations that are community-led and driven or you would not get clients coming to services. We respect the human dignity of all people. And we believe that safety is available to people before, during or after drug-use.”

Their model identifies each person’s specific risks and needs. They’ve found that much of the harm clients experience is not directly due to drug use, but rather to the environment—anything from the inability to access healthcare to harassment by police. Ozone employs a holistic approach that puts the client at the centre. One person might only require harm reduction counselling and tools while another is ready for support to quit.

The organisation collaborated with C-FREE, a laboratory service, for screening and monitoring of Hepatitis B and C, HIV and other sexually transmitted infections (STIs). They also offer the Hepatitis B vaccine. Research nurse Kewalin Kulprayong says her team has a welcoming approach.

“Clients know it is not a hospital,” she says. “It is safe. They can speak about everything here, drugs also.”

A doctor is available once a week. Some conditions can be treated at Ozone. In other cases, clients are referred to government facilities but with the benefit of peer support. These services are critical. An estimated eight per cent of people who inject drugs in Thailand are living with HIV while Hepatitis C prevalence is 42%.

"Universal Health Coverage in Thailand paves the way for comprehensive care, including essential services like HIV testing, pre-exposure prophylaxis or PrEP, treatment referrals, and screening and treatment for STIs and Hepatitis C. However, despite their inclusion in benefit packages, individuals who inject drugs face significant barriers due to pervasive stigma and discrimination, including self-stigma," says Patchara Benjarattanaporn, UNAIDS Country Director. “In this landscape, key population-led health services like Ozone’s emerge as invaluable one-stop shops, providing stigma-free care and ensuring that no one is left behind, especially those who use and inject drugs.”

Looking toward the future

Each Ozone client has their own dreams. One wants to run for political office. Another hopes to get his gender affirming surgery soon. A third imagines a life in the countryside with a small farm: “Not too many people,” he says with a chuckle. “Then I get in more trouble”.

He came to Ozone because he was depressed, anxious and dealing with a sexually transmitted infection.

“I did not have the confidence to go to a hospital and say, ‘I want treatment’. But I knew if I did nothing it would get worse. At Ozone they understand. They give me guidance. They’ve advised me to use social security to get mental healthcare. They tell me ‘people make mistakes sometimes’. I am one of those guys who makes many mistakes,” he confesses with another uneasy laugh. “But now the mistakes are getting less.”

A group of journalists visited the Ozone Foundation as part of the UNAIDS, UNDP, APN Plus and USAID/PEPFAR Southeast Asia Regional Workshop on HIV-related Stigma and Discrimination in Bangkok, Thailand on June 8, 2023. Learn more about this novel training.