The centre for treatment and rehabilitation of opium addicts, Rangsit, Thailand

Sections

Introduction
Present opium policy
The addict population
Conclusions

Details

Author: Dr. Malai Huvanandana
Pages: 1 to 10
Creation Date: 1962/01/01

The centre for treatment and rehabilitation of opium addicts, Rangsit, Thailand

Dr. Malai Huvanandana
Deputy Director-General of the Department of Public Welfare of Thailand

The Rangsit centre is, by the number of its inmates and by the size of its grounds and installa-tions, one of the most important establishments of its kind in the world. Having published articles on the St. John's Hospital in Singapore 1 and on the Tai Lam Prison Centre in Hong Kong, 2 the editors of the Bulletin are sure that it will be of interest to readers to have a description of this centre.

Introduction

The habit of smoking opium has existed in Thailand for a long time: one theory is that it was introduced into the country by Chinese traders and up to now, as will be seen from the figures quoted, it remains in large part a characteristic of the population of Chinese origin (more than three million out of a population of about 25 million for the whole of Thailand - centred principally in and around Bangkok). Morphine and diacetylmorphine (heroin) are of relatively recent introduction, and the addict population does not seem as yet to have taken to them: in the great majority of cases opium addiction is of a "social" nature; it concerns mainly the older generation.

Some of the causes of opium addiction are the same as those found in other countries: the workers believe that opium will stimulate them or else will cure them of the various diseases which they might have, especially tuberculosis.

In this way the habit was transferred to the Thai population and since the beginning of the nineteenth century the Government has tried to eradicate it. It might be of interest to recall here that even before the foundation of Bangkok, the Chakri dynasty (the present ruling dynasty in Thailand) tried to do something to solve the problem: in 1811 King Rama II issued the first edict banning the consumption of opium in the kingdom. Again, in 1839, King Rama III prohibited the buying and selling of opium and even started what was probably the first effort of mass propaganda in Thailand: nine thousand pamphlets were distributed throughout the country. These efforts were, however, of no avail; and, partly because of the demand of the Chinese population, partly owing to the wealth to be derived from the sale of opium by local and western traders alike, the opium trade and opium addiction continued. They were closely associated with the Chinese population, as may be shown by the edict issued by King Rama IV in 1852, wherein he restricted opium smoking to the Chinese and ordered that any Thai foundsmoking opium would have to wear a queue and pay Chinese poll tax, forfeiting all claims to Thai citizenship. Finally, one of the greatest rulers of Thailand, King Rama V, declared in 1908 that opium smoking could cause the degeneration of the people and of the country as a whole and proposed to reduce opium consumption gradually until final prohibition was reached.

See Bulletin, Vol. IX, No. 3 and Vol. X, No. 4.

See Bulletin, Vol. XIII, No.1.

Present opium policy

The present Government of Thailand under the leadership of Field-Marshal Sarit Thanarat has been concerned about the development of opium addiction in the country. On 9 December 1958 the Revolutionary Party issued an order to abolish the smoking and sale of opium in Thailand. Point number three of the ordinance was that the Ministries of Public Health and the Interior should set up a sanatorium and convalescent homes for opium addicts. A period of six months was provided from 1 January to 30 June 1959 for the voluntary treatment of addicts wishing to cure themselves, but as from 1 July 1959 smokers of opium would be regarded as offenders against the law relating to opium; and, after serving the sentence imposed in accordance with the said law, they would be sent by the administrative or police authorities to the sanatorium or convalescent homes, where they would be regarded as prisoners in custody, subject to the authority of the officers and punishable by the penal code in case of escape.

Organization of the Rangsit Centre

On the day of the proclamation of the prohibition policy, a committee was appointed to enforce this prohibition. One of its tasks was to build a sanatorium in the Klong-Rangsit area for taking care of opium addicts. The centre was to be ready by 1 January 1959. The Department of Public Welfare was responsible for the building of the centre; and, in little more than a week, it made ready on the site selected enough buildings to receive the first patients. On 10 February 1959 a permanent committee on co-ordination was created, composed of repre- sentatives of several ministries and government services (Ministry of the Interior, Public Health, Excise Department, Police Department, Penitentiary Department, Public Welfare Department). During the year 1959 operations were jointly conducted by the Medical Department of the Ministry of Public Health and the Public Welfare Department of the Ministry of the Interior; the former was primarily responsible for the medical treatment and the latter for the convalescent and rehabilitative treatment. Since January 1960 the functions have been integrated and are now handled by the Public Welfare Department. Under the general direction of the committee, the centre is divided into three sections, as follows.

  1. Medical section - 3 doctors, a pharmacist, a nurse, a house doctor and assistants. In all, 44 persons with responsibility for medical care and treatment.

  2. Rehabilitation section - superintendent, assistant superintendent, 5 social workers, cooks, guards, etc.; a total of 101 persons with responsibility for general supervision and control of patients, nutrition, convalescence, occupational assistance and follow-up after the patients leave the centre.

  3. Police section - 34 in all, responsible for maintaining order within the compound, for prevention of escape and for the prevention of the smuggling of drugs into the compound.

The centre is located at klong 5, Tambol Rangsit, Ampur Tanyaburi, Patumthani province. The total area of the centre is about 240 acres. It is situated about 43 kilometres from Bangkok. The land belongs to the Public Welfare Department. This site was chosen firstly because there were already some buildings there which could be transformed for the use of the patients; secondly because it is at a convenient distance from Bangkok; and finally because the fertility of the land is such that it will be possible to provide the patients with occupational training in agriculture. It should be possible for the centre to produce the food it needs.

The total cost of construction in 1959 was about 14 million bahts. 3 In addition, the centre was granted a budget for improvement and construction of new buildings of about 18 million bahts in 1959. In 1960 it was granted a budget of about 4 million bahts for maintenance.

The centre consists of the following elements: three sanatoria, five convalescent houses, five dining-rooms and kitchens, a police station, one hundred and thirty-four lodging apartments for officials, two generators of 50 kW each, one water tank of 120 cubic metres capacity and a water pump engine, and three handicraft training workshops.

Treatment and Rehabilitation at the Centre

The great majority of addicts coming to Rangsit are opium addicts. Some morphine and heroin addicts appear from time to time, but their number is so small that it is not worth recording for the time being. The tables given in the present article will show that there is a relatively homogeneous population in the hospital, and the treatment can therefore be fairly standardized.

One baht is about 5 U.S. cents.

The first aspect of the cure of the addict is, of course, purely medical. When the addict enters the centre, he is placed in one of the sanatoria where he is put to bed and where he will stay for a period of ten to fifteen days during which the drug will be withdrawn: the treatment itself consists in the administration of dosages of a special mixture, three times a day for three days, twice a day for three days and once a day for the last four days. The composition of the mixture is the following: chloral hydrate, gr. 15; pot. bromide, gr. 15; tr. opium, m. 15; aq. chloroform ad. oz. q.s.; fig. 15 cc tid. pc., (3 days); 15 cc bid. pc., (3 days); 15 cc daily, (4 days); In addition, the addict receives heavy doses of vitamin B complex. For the cases of heroin addiction, methadone is used in 10 mg injections, three times a day for the first three days, 6 mg three times a day for another period of three days, then 4 mg for the last four days in combination with injections of vitamin B complex. If necessary, solutions of glucose at 25% are given. While the drug is being withdrawn, the addict receives medical attention for any illness from which he suffers. The most common illnesses seem to be pulmonary diseases, such as tuberculosis and asthma. The withdrawal symptoms are the common ones found in morphine or heroin withdrawal - general aching pain, perspiration, watery nasal discharge, insomnia, etc. For the time being no tables of intensity have been established for any of these phenomena.

After the completion of medical treatment, patients are transferred to one of the convalescent houses within the compound. They then come under the care of the social workers. The period of convalescence lasts seventy-five days, and the addict receives medical and nursing care as needed. Special attention is paid to his diet, since a number of addicts enter the centre in a state of malnutrition, Recreation is provided in the form of films, television, music, sports, etc.; also, special buildings have been erected where occupational therapy is given, consisting of such activities as carpentry, painting, drawing, kitchen gardening and duck breeding.

During the period of rehabilitation the patient is examined by a physician, and if he is physically fit to work, vocational training is begun. Those who have no past experience may be taught carpentry, masonry, or a family type of industry, such as shoemaking or leatherwork. Those who seem to be more interested in agriculture may use the land of the centre to cultivate vegetables and other crops or to learn rice farming. Patients who have had experience may be put to work according to their skill, sharing their profits with the centre. At the same time they will be helping to teach the unskilled.

During their stay at the centre the patients are allowed visits, but great care is taken that no drugs are smuggled in. The Rangsit centre is a closed institution, arid the patients cannot go out, except in the case of the voluntary patients who wish to go back home. There are instances of escape.

After-care Measures

After the patients are released, usually after a period of ninety days, they return home and the doctor checks their state of health and registers the cure in detail (see annex).

They will then be contacted by the social workers to ascertain the results of the treatment and also for any assistance that they or their family may need. In 1959 the Government thus helped 369 families in the form of relief, hospital placement, sending children to institutions or finding jobs for the released addicts.

The addict population

Number of Addicts

While it is not easy to determine the total number of addicts in any given country, such an evaluation was made easier in the case of Thailand by the fact that habitual opium smokers were registered prior to the abolition order of 9 December 1958. According to that order, the unregistered smokers were to apply for registration before 31 December 1958. There has therefore been a possibility to ascertain their number, except of course for the smokers belonging to the so-called hill tribes (Meos, Yaos, etc.) and also for the morphine and heroin addicts who, however, do not appear to be numerous (cannabis and synthetic narcotic drugs do not seem to be used at all by addicts in Thailand). The figure reported in the United Nations document entitled "Incidence of Drug Addiction " 4 is 70,985 opium addicts. 5 More than half are concentrated in the Bangkok area.

Doc. E/CN.7/404, 8 February 1961.

The population of Thailand is about 25 million; the inhabitants of Chinese origin number about 3,500,000.

The above-mentioned abolition order provided for the treatment of addicts in such a way that it is possible to distinguish three classes of patient: ( a) the addict coming voluntarily for treatment, ( b) the person who has been found to smoke opium after 30 June 1959 and who is committed for treatment to a centre, and ( c) the ordinary criminal who is an opium smoker and is treated in the prison hospital. 6

Of the addicts in the centre about half are voluntary patients. The Rangsit centre is by far the most important in Thailand: in 1959 it took care of 6,843 patients, whereas all the other hospitals in the country including the jail hospitals took care of 5,827 patients. 7

Results of Treatment

Table 1 shows the distribution and movement of the patients in the centre in 1959, the only year for which complete and detailed records are, up to now, available. It will be noted that by far the greatest number of admissions were recorded in June, the reason being that June 30 was the deadline for the authorized smoking.

Out of the 6,843 admissions, 1,872 cases or 27.3% were readmission cases (patients who had been discharged during the course of the year but came back because they had taken to opium again).

The draft of a new narcotic drugs law which is supposed to come into force as soon as possible would apply to convicted addicts by sending them to the hospital not more than one year after imprisonment so that they may be completely cured before being released.

See No. 1 in references at the end of this article.

Table l. - Distribution and movement in the centre in 1959

 

Total admission

Total discharge

 

Month

Monthly admission

Remainder from previous month

Total

Sent to rehabilitation

Back home and imprisoned

Escaped

Dead

Total

Remained for treatment

January
368
- -
368 234 45 17 5 301 67
February
263 67 330 111 75 36 2 224 106
March
403 106 509 159 174 48 3 384 125
April
496 125 621 156 266 41 2 465 156
May
776 156 932 197 236 129 3 565 376
June
2 582 367 2 949 344 929 588 4 1 865 1 084
July
875 1 084 1 959 502 507 535 9 1 553 406
August
528 406 934 334 20 336 3 693 241
September
183 241 424 116 7 97 2 222 202
October
135 202 337 93 12 42 3 150 187
November
132 187 319 181 16 55 2 254 65
December
102 65 167 97 13 8
-
118 49

Table 2. - Results of treatment in the centre

Result of the treatment

Number of cases

Percentage

Total number of admissions
6 843 100
Returned home during treatment
2 978 43.5
Escaped
2 571 37.3
Dead
48 0.7
Imprisoned
236 3.4
Completed course of treatment and discharged
640 9.4
Remained in the centre
370 5.4

Table 2 shows the main difficulty encountered by the centre: the patients do not understand the necessity of the prolonged period for a successful treatment. The voluntary patients simply go back home and those who have been committed try to escape and often succeed, since the centre is run more as a hospital than as a prison. The staff of the centre has studied the reasons for this state of affairs. Some of them are listed below, without any attempt at classifying their relative importance, since in most cases the patient is not quite able to analyse them (besides, in most cases there is obviously a combination of causes): the patient, as soon as the withdrawal symptoms are gone, believes that he is cured; the patient does not want to be cured or, in the case of a voluntary patient, prefers after a few days to go back to his addiction; the withdrawal symptoms frighten the patient to the point that he believes he will die; the patient is afraid of losing his job or has financial difficulties.

Table 3. - Results of treatment in medical section

Result of treatment

Number of cases

Percentage

Total number of case admissions
6 843 100
Sent to rehabilitation
2 524 36.8
Returned home during treatment
2 214 32.4
Escaped
1 932 28.2
Dead
38 0.6
Imprisoned
86 1.2
Remaining
49 0.7

Table 4. - Result of treatment in rehabilitation section

Result of treatment

Number of cases

Percentage

Cases received from the medical section
2 524 100
Discharged after complete course of rehabilitation
640 25.3
Back home during rehabilitation
764 30.2
Escaped
639 25.3
Dead
10 0.4
Imprisoned
150 5.9
Remaining
321 12.7

As for the patients sent to prison, generally it is because they have been caught smoking, smuggling or selling opium.

Tables 3 and 4 show the detailed results of medical treatment and of rehabilitation. The final figure of 640 patients discharged after complete rehabilitation is of course disappointing: many of the other patients will return in the following months. It should, however, be borne in mind that opium addiction is in most cases less dangerous than morphine or heroin addiction and that a number of patients who do not go through the complete course of rehabilitation are nevertheless practically cured; finally, the year 1959 was the first year of operation of the centre, and a number of opium addicts were frightened by a prolonged stay simply because the idea of a cure was, as such, quite foreign to them. In due course, it will be better known and the sort of fear it provokes will probably disappear.

Table 5 shows the causes of death while in the centre. The very low number of fatal occurrences is rather surprising if one considers that most of the 6,843 addicts were from the poorest strata of the population and very often suffered from malnutrition: the fact that so few died is a good reflection on the general conditions in the centre.

Table 5. - Causes of death

Disease

Number of deaths

Tuberculosis
9
Acute diarrhoea
6
Asthma
5
Intoxication
4
Anuria
2
Fever
1
Cirrhosis of liver
1
Exhaustion
3
No diagnosis
4

Characteristics of the Addict Population

In order to analyse the characteristics of the addict population, the medical adviser of the Rangsit centre, Dr. Prayoon Norakarnphadung, utilized the very detailed forms reproduced in the annex to the present article and chose, during the period from 1 July to 31 December 1959, 1,000 cases for which fairly complete data could be collected. The following tables are adapted from those he published in his paper on the epidemiology of opium addiction. 8 The author of the present article thought that these self-explanatory tables would give the reader a clearer idea of the facts than any detailed analysis. Whenever necessary, footnotes have been added.

Table 6. - Age and ethnic origin of addicts

 

Total

Thai

Chinese

Age

Number

Percentage

Number

Percentage

Number

Percentage

20-30
57 5.7 31 3.1 26 2.6
31-40
159 15.9 69 6.9 90 9.0
41-50
359 35.9 79 7.9 280 28.0
51-60
318 31.8 47 4.7 271 27.1
61-70
94 9.4 13 1.3 81 8.1
71-80
13 1.3 6 0.6 7 0.7

Table 7. - Education

 

Total

Thai

Chinese

Education

Number

Percentage

Number

Percentage

Number

Percentage

Illiterate
311 31.1 75 7.5 236 23.6
Able to read
26 2.6 7 0.7 19 1.9
Primary school: 1-4 years
.107
10.7 102 10.2 5 0.5
Secondary school:
           
1-2 years
13 1.3 12 1.2 1 0.1
3-4 years
18 1.8 17 1.7 1 0.1
5-6 years
15 1.5 13 1.3 2 0.2
Chinese school
443 44.3 2 0.2 441 44.1
No report
67 6.7 17 1.7 50 5.0

Table 8. - Number of times of smoking per day

 

Total

Thai

Chinese

 

Number

Percentage

Number

Percentage

Number

Percentage

1-2
688 68.8 162 16.2 526 52.6
3-4
289 28.9 69 6.9 220 22.0
5-6
6 0.6 0 0 6 0.6
Uncertain
10 1.0 7 0.7 3 0.3
No report
7 0.7 7 0.7 0 0

See No. 2 in references at the end of the article.

Table 9. - Occupation

 

Total

Thai

Chinese

Occupation

Number

Percentage

Number

Percentage

Number

Percentage

Temporary servant
386 38.6 62 6.2 324 32.4
Labourer
59 5.9 9 0.9 50 5.0
Pedlar
205 20.5 40 4.0 165 16.5
Permanent servant
26 2.6 80.8 18 1.8  
Carpenter
63 6.3 15 1.5 48 4.8
Goldsmith
13 1.3 3 0.3 10 1.0
Machine repairer
4 0.4 4 0.4 0 0
Teacher
1 0.1 1 0.1 0 0
Fisherman
10 1.0 7 0.7 3 0.3
Rice farmer
17 1.7 16 1.6 1 0.1
Salt farmer
1 0.1 1 0.1 0 0
Gardener
18 1.8 12 1.2 6 0.6
Employee in opium den
50 5.0 2 0.2 48 4.8
Tricycle driver a
30 3.0 27 2.7 3 0.3
Motor-tricycle driver
1 0.1 1 0.1 0 0
Motor-car driver
11 1.1 11 1.1 0 0
Dependant
74 7.4 20 2.0 54 5.4
No report
31 3.1 6 0.6 25 2.5

The use of tricycle "samlors" - taxis driven by men pedalling - was prohibited on 1 January 1960.

Table 10. - Duration of smoking

 

Total

Thai

Chinese

Years

Number

Percentage

Number

Percentage

Number

Percentage

Under 1
1 0.1 1 0.1 0 0
1-5
101 10.1 57 5.7 44 4.4
6-10
175 17.5 59 5.9 116 11.6
11-15
170 17.0 39 3.9 131 13.1
16-20
140 14.0 26 2.6 114 11.4
21-30
279 27.9 46 4.6 233 23.3
31-40
82 8.2 17 1.7 65 6.5
41-50
50 5.0 0 0 50 5.0
Over 50
2 0.2 0 0 2 0.2

Table 11. - Age at which smoking was started

 

Total

Thai

Chinese

Age

Number

Percentage

Number

Percentage

Number

Percentage

10-20
139 13.9 52 5.2 87 8.7
21-30
456 45.6 112 11.2 344 34.4
31-40
301 30.1 52 5.2 249 24.9
41-50
86 8.6 24 2.4 62 6.2
51-60
15 1.5 3 0.3 12 1.2
61-70
3 0.3 2 0.2 1 0.1

Conclusions

The great effort undertaken in Thailand in 1959 to suppress opium addiction has led to the creation of the Rangsit centre, one of the most important establishments of its kind in the world. In its first year the centre has received almost 7,000 patients; but it has been very difficult to achieve a satisfactory proportion of cures, because most of the addicts belong to a class of people who are morally irresponsible, uncooperative and maladjusted.

Table 12. - Amount of opium consumed per day

 

Total

Thai

Chinese

Grammes

Number

Percentage

Number

Percentage

Number

Percentage

0.5- 1
144 14.4 38 3.8 106 10.6
1.5- 2
512 51.2 116 11.6 396 39.6
2.5- 3
177 17.7 44 4.4 133 13.3
3.5- 4
45 4.5 10 1.0 35 3.5
4.5- 5
21 2.1 3 0.3 18 1.8
5.5- 6
18 1.8 6 0.6 12 1.2
6.5- 7
1 0.1 0 0 1 0.1
7.5- 8
2 0.2 0 0 2 0.2
8.5- 9
6 0.6 3 0.3 3 0.3
9.5-10
3 0.3 1 0.1 2 0.2
11 - 15
1 0.1 1 0.1 0 0
Opium eating
55 5.5 20 2.0 35 3.5
No report
15 1.5 3 0.3 12 1.2

Table 13. - Daily income

 

Total

Thai

Chinese

Bahts per day

Number

Percentage

Number

Percentage

Number

Percentage

1- 10
194 19.4 22 2.2 172 17.2
11- 20
428 42.8 94 9.4 334 33.4
21- 40
223 22.3 72 7.2 151 15.1
41- 60
64 6.4 15 1.5 49 4.9
61-100
20 2.0 8 0.8 12 1.2
No report
71 7.1 34 3.4 37 3.7
a

See footnote 3.

Table 14. - Causes of addiction

 

Total

Thai

Chinese

Bahts per day

Number

Percentage

Number

Percentage

Number

Percentage

Suggestion and persuasion
557 55.7 160 16.0 397 39.7
Hard work
166 16.6 19 1.9 147 14.7
Work in con- nexion with opium
26 2.6 6 0.6 20 2.0
Liking for opium
49 4.9 15 1.5 34 3.4
Headache
7 0.7 2 0.2 5 0.5
Colicky pain
45 4.5 5 0.5 40 4.0
Aching pain
25 2.5 4 0.4 21 2.1
Diarrhoea
3 0.3 1 0.1 2 0.2
Dysentery
5 0.5 1 0.1 4 0.4
Asthma
8 0.8 3 0.3 5 0.5
Tuberculosis
42 4.2 1 0.1 41 4.1
Venereal disease.
40 4.0 17 1.7 23 2.3
Snake bite
5 0.5 4 0.4 1 0.1
No report
22 2.2 7 0.7 15 1.5

The Thai Government is doing its utmost to overcome the difficulties inherent in the magnitude of the task and the lack of experience of its personnel in handling it: the most important members of the staff of the Rangsit centre are studying similar establishments outside Thailand under United Nations Technical Assistance fellowships. It is hoped that in the future the Rangsit centre will, in turn, be used as an orientation unit for doctors and social workers from other countries in the field of treatment and after-care of addicts; especially since the considerable amount of case material already assembled would offer a good possibility for epide-miological studies, with special emphasis on the aetiology of addiction and the socio-economic factors involved.

Table 15.-Other diseases of the addict

 

Total

Thai

Chinese

Disease

Number

Percentage

Number

Percentage

Number

Percentage

Malaria
302 30.2 121 12.1 181 18.1
Syphilis
424 42.4 130 13.0 294 29.4
Tuberculosis
77 7.7 20 2.0 57 5.7
Asthma
19 1.9 5 0.5 14 1.4
Dysentery
281 28.1 107 10.7 174 17.4
Gastritis
28 2.8 1
0. 1
27 2.7
No report
4 0.4 4 0.4 0 0

Table 16. - Personality characteristics

 

Total

Thai

Chinese

Personality

Number

Percentage

Number

Percentage

Number

Percentage

Psychopathic personality
159 15.9 77 7.7 82 8.2
Extrovert
55 5.5 13 1.3 42 4.2
Introvert
662 66.2 128 12.8 534 53.4
Neurotic personality
33 3.3 3 0.3 30 3.0
Feeble-minded individual
2 0.2 0 0 2 0.2
Integrated individual
44 4.4 6 0.6 38 3.8
No report
45 4.5 18 1.8 27 2.7
a

See footnote 3.

References

1. Statistical record of opium addicts in the medical section of the Rangsit opium treatment centre, Thailand, by Dr. Prayoon Norakarnphadung, M.D., C.N.P. clinical director (mimeographed).

2. Epidemiology of opium addiction, by Dr. Prayoon Norakarnphadung, M.D., C.N.P., Medical Service Department, Ministry of Public Health-clinical director of the government opium treatment centre, Thailand (mimeographed).

3. The treatment and rehabilitation of opium addicts in Thailand, M.A. thesis, Institute of Public Administration, Thommasat University, by Vibul Phancharoen, Bangkok, Oct. 1960 (mimeographed).

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