Polydrug use among kratom users: Findings from the 2011 Thailand National Household Survey

Despite the availability of numerous anecdotal reports of polydrug use in kratom users, few studies have been carried out in Thailand. This study aimed to explore the problem of polydrug use among Thai kratom users. A national household survey on the prevalence of substance use was conducted in 2011 using a multistage random sampling technique. Participants were interviewed using a structured questionnaire. The frequency of other substance use was compared between respondents with and without a history of kratom use. Of the total sample (18,457), 544 (2.9%) acknowledged kratom use. Eighty-nine (46.1%) used it almost every day. The mean age of users (SD) was 42.7 (12.8) years old, 459 (84.4%) were male, and 264 (48.5%) had used other illicit drugs in the past. Kratom users were significantly more likely to use heroin, ecstasy, and ice with adjusted odds ratios of 39.7, 30.5, and 29.1, respectively. Of 195 who acknowledged kratom use in the past 12 months, 22 (11.3%) concurrently used other illicit drugs, including cannabis, amphetamine-type stimulants (ATSs), and inhalants. Polydrug use is common in Thai kratom users who are more likely to use opiates and ATSs in their lifetime. Another drug concurrently used was cannabis. Health personnel need to be aware of polydrug use in this population.     

A qualitative study of sexual behaviours among methamphetamine users in Chiang Mai, Thailand: a typology of risk

Introduction and Aims. Methamphetamine (MA) has become the leading drug of abuse in northern Thailand over the past several years, particularly among youth. The current qualitative study explores the relationship between sexual behaviours and MA. Design and Methods. Between March 2002 and January 2003, 48 in-depth interviews with young MA users aged 15 - 2 years in Chiang Mai. Interviews were transcribed verbatim in Thai and translated into English. Data were analysed inductively using the constant comparative method common to grounded theory methods. Atlas-ti was used for data management. The current analysis was stratified by gender. Results. Participants were 44% male and the median age was 20 years. At the time of the interviews, 70% were not using MA. A typology of experiences with and feelings about MA's relationship to sexual activity emerged: (1) enhanced libido—individuals who found that MA enhances their sexual experiences (n = 13); (2) decreased libido or no effect—individuals who found that MA detracted from sexual desire (n = 22); and (3) virgins (n = 13). Discussion and Conclusions. Participants reported several distinct patterns of relationship between MA and sex. Tailored interventions are needed that address specific patterns of sexual behaviors among youth in order to promote sustainable safer sex behaviours in this population. [Sherman SG, Gann D, German D, Sirirojn B, Thompson N, Aramrattana A, Celentano DD. A qualitative study of sexual behaviours among methamphetamine users in Chiang Mai, Thailand: a typology of risk. Drug Alcohol Rev 2008;27:263-269]     

Drug and alcohol services in middle-income countries

PURPOSE OF REVIEW: The present review summarizes current research in middle-income countries on drug and alcohol services for prevention, screening, treatment, care and rehabilitation between June 2006 and December 2007. RECENT FINDINGS: There is a dearth of scientific literature on prevention, treatment and rehabilitation in middle-income countries and no novel effective approaches reported during the review period. The Lancet Series on Global Mental Health showed only 0.7% of all papers reviewed were on low-income and middle-income countries. Several studies in these countries confirmed the effectiveness of brief interventions in treating alcohol use disorders at a primary care level. One study on alcohol screening in Brazil produced a promising screening tool. Other studies reported the availability of pharmacological and nonpharmacological treatments for alcohol and drug use disorders. Overall, poor accessibility to services and delayed onset of treatment persist. Political and cultural environments play a crucial role in providing services to fulfill treatment needs. SUMMARY: During the review period, reports from middle-income countries on alcohol and drug services were very limited. A few studies in some countries confirm the effectiveness of brief interventions in primary care settings. There is an obvious need for more research on alcohol and drug treatment services in middle-income countries.     

Surgical anatomy of the spinal accessory nerve in the posterior triangle of the neck

OBJECTIVE: The major complication of neck dissection and surgery at the posterior triangle of the neck is severe disability of the shoulder or "shoulder syndrome", which results from spinal accessory nerve injury. Surgical landmarks of the nerve in this area were studied. METHODS: Fifty-six fresh Thai cadavers (112 necks) were dissected to identify the anatomical relationship of the spinal accessory nerve and its commonly used landmarks. RESULTS: The spinal accessory nerve was found within 3.6 cm (mean, 1.43 cm) above Erb's point. The distance between the spinal accessory nerve entering the trapezius muscle and the clavicle was between 2.6 cm and 6.9 cm (mean, 4.5 cm). CONCLUSION: Our data were different from those described in the literature. Reconsideration of these two important landmarks can help to minimize iatrogenic injury of the spinal accessory nerve.     

Predictors of incident and recurrent participation in the sale or delivery of drugs for profit amongst young methamphetamine users in Chiang Mai Province, Thailand, 2005-2006

Background

Despite Thailand's war on drugs, methamphetamine (“yaba” in Thai) use and the drug economy both thrive. This analysis identifies predictors of incident and recurrent involvement in the sale or delivery of drugs for profit amongst young Thai yaba users.

Methods

Between April 2005 and June 2006, 983 yaba users, ages 18-25, were enrolled in a randomized behavioural intervention in Chiang Mai Province (415 index and 568 of their drug network members). Questionnaires administered at baseline, 3-, 6-, 9-, and 12-month follow-up visits assessed socio-demographic factors, current and prior drug use, social network characteristics, sexual risk behaviours and drug use norms. Exposures were lagged by three months (prior visit). Outcomes included incident and recurrent drug economy involvement. Generalized linear mixed models were fit using GLIMMIX (SASv9.1).

Results

Incident drug economy involvement was predicted by yaba use frequency (adjusted odds ratio [AOR]: 1.05; 95% confidence interval [CI]: 1.01, 1.10), recent incarceration (AOR: 2.37; 95% CI: 1.07, 5.25) and the proportion of yaba-using networks who quit recently (AOR: .34; 95% CI: .15, .78). Recurrent drug economy involvement was predicted by age (AOR: 0.81; 95% CI: 0.68, 0.96), frequency of yaba use (AOR: 1.06; 95% CI: 1.02, 1.09), drug economy involvement at the previous visit (AOR: 2.61; CI: 1.59, 4.28), incarceration in the prior three months (AOR: 2.29; 95% CI: 1.07, 4.86), and the proportion of yaba-users in his/her network who quit recently (AOR: .38; 95% CI: .20, .71).

Conclusion

Individual drug use, drug use in social networks and recent incarceration were predictors of incident and recurrent involvement in the drug economy. These results suggest that interrupting drug use and/or minimizing the influence of drug-using networks may help prevent further involvement in the drug economy. The emergence of recent incarceration as a predictor for both models highlights the need for more appropriate drug rehabilitation programmes and demonstrates that continued criminalization of drug users may fuel Thailand's yaba epidemic.