Hill tribe opium addicts: a retrospective study of 1,382 patients

Sections

Abstract
Introduction
Material and methods
Results
Discussion
Acknowledgement

Details

Author: Charas SUWANWELA,, Somsong KANCHANAHUTA,, Yupha ONTHUAM,
Pages: 23 to 40
Creation Date: 1979/01/01

Hill tribe opium addicts: 1 a retrospective study of 1,382 patients

M.D. Charas SUWANWELA, Institute of Health Research, Chulalongkorn University, Bangkok, Thailand
M.D., Somsong KANCHANAHUTA, Narcotic Treatment Centre for Hill Tribes, Department of Medical Services, Ministry of Public Health, Chiengmai, Thailand
Yupha ONTHUAM, Institute of Health Research, Chulalongkorn University, Bangkok, Thailand

Abstract

This paper presents the results of a retrospective study of 1,382 patients admitted to the Narcotics Treatment Centre for Hill Tribes in Thailand, which was operated by the WHO/UN/Thai Programme for Drug Abuse Control. The study revealed widespread opium addiction among the hill tribes. Of these, the Karen were the largest group. Mean age on admission for treatment was 35 years. The male:female ratio was 7:1. Sixty-six per cent were heads of households. About one-third came from households with more than one addict. The mean duration of daily opium use before admission was 7.9 years. Over 90 per cent of them were addicted to opium; there were eight heroin users. The mean amount of opium used daily was 3.9 g for males and 3.2 g for females. About three-quarters of them used salicylate analgesics with opium. Illness, in particular abdominal pain, was the most frequent cause of their addiction.

Introduction

The mountainous area in northern Thailand, eastern Burma and northwestern Laos is inhabited by ethno-culturally different groups of people, known as the hill tribes. The majority are involved in opium poppy cultivation. Hence the area is infamously known throughout the world as "the Golden Triangle" (figure 1). Some villagers own opium poppy fields where others are hired to work. The opium from this area is at present a major source of narcotics in the world's illicit market. These people live in small villages scattered over mountain tops, slopes and through valleys. In most villages opium is available. In opium-growing villages crude opium is stored for personal consumption or to be used in lieu of payment to addicted workers. It is also available in village stores. Villagers use opium as a drug for treatment of some physical illnesses and against anxiety and emotional disorders. It is also used for recreational purposes. Studies on opium use in the villages have been reported elsewhere [ 2] , [ 3] , [ 4] , [ 6] .

1. This study was a part of the WHO/UN/Thai Programme for Drug Abuse Control, operated in collaboration with the World Health Organization and the United Nations Division of Narcotic Drugs, funded by the United Nations Fund for Drug Abuse Control.

FIGURE 1

A. Map of mainland south-east Asia showing the opium producing area, the so-called Golden Triangle (striped area). The dotted area is the mountainous northern part of Thailand which is shown enlarged in B. The locations of the eleven provinces and Chiengmai City are shown

Full size image: 34 kB, FIGURE 1

In 1971 the United Nations Division of Narcotic Drugs, in collaboration with the Thai Government, established the United Nations/Thai Programme for Drug Abuse Control (UN/Thai/PDAC), which aimed at undertaking pilot studies to reduce narcotic supply and demand in Thailand. To this end crop substitution and community development programmes have been introduced in several villages.

In 1975 the Narcotics Treatment Centre for Hill Tribes was established as the health component of the Programme, to be executed in collaboration with the World Health Organization, and operated as an extension of Thanyarak Hospital, Department of Medical Services, Ministry of Public Health. The present report is a retrospective study of records of 1,382 patients admitted to the Centre over a 15-month period from 1 October 1976 to 31 December 1977 as well as of in-depth interviews and laboratory and radiographic investigations.

Material and methods

The Narcotics Treatment Centre for Hill Tribes, located in some redecorated old wards of Chiengmai City Hospital, Faculty of Medicine, Chiengmai University, was put at the disposal of the Centre on a loan basis. It has a capacity of 50 beds, occupying two floors. The medical and nursing staff as well as social workers are on rotation from Thanyarak Hospital for Addicts at Pratumtani near Bangkok.

Patients were referred to the Centre by a number of agencies working with the hill tribes such as the extension station of the UN/Thai PDAC, His Majesty's Hill Tribe Development Projects, the Hill Tribe Development and Relief Centres of the Department of Public Welfare and the Border Patrol Police. Some patients came of their own initiative. The existence of the service at the Centre was broadcast by the regional radio which carries programmes in many hill tribe languages.

On admission histories on general health and drug use were taken. The frequency, quantity and duration of opium use was noted. The social history was also taken by social workers on a separate form. 2 During November 1977 a group of patients was also interviewed by the authors and the records were found to be replicable, thus confirming their reliability.

The service at the Centre consisted of a 10-day detoxification process using a combination of mixture-medications with a decreasing dosage of opium tincture. Tranquillizers and symptomatic treatments were also available.

A group of 126 consecutive patients, admitted from February to May 1978, were subjected to radiographic examinations of the chest and abdomen and a number of laboratory tests in order to study the presence of physical illness.

Results

Distribution by tribe

Distribution by tribe of addicts admitted for treatment as well as the estimated total population of these tribes in Thailand [ 5] is shown in table 1. The designations used were those given by the patients and might not correspond to conventional classifications. Of the 1,382 patients 617 were Karen (45 per cent), 331 Lahu (24 per cent) and 186 Hmong (13 per cent). Other tribes were represented in smaller numbers.

2. Social workers were absent for a number of months and the social history was then not taken.

TABLE 1

Distribution of addicts by tribe

Tribes and sub tribes

Number of addicts

Percentage

Estimated (5)populationin Thailand

Karen
617 45 174706
White Karen (421)
     
Black Karen (125)
     
Red Karen (71)
     
Lahu
331 24 21956
Red Lahu (193)
     
Black Lahu (106)
     
Not specified (32)
     
Hmong
186 13 29428
Black Hmong (77)
     
White Hmong (65)
     
Striped Hmong (21)
     
Not specified (23)
     
Akha
116 8 13428
Lua
36 3 10113
Shan (Thai-yai)
31 2
*
Lisu
25 2 11126
Yao
25 2 17898
Chinese Haw
3
-
*
Thai
12
-
*
TOTAL
1382 100 278687

*Not included in the hill tribe population.

Most of the Karen, who usually live at lower altitudes, came by themselves and admissions were spread throughout the year. The Akha, living mostly in Chiengrai and Nan provinces, which are at some distance from the Treatment Centre, were mainly referred by Government agencies. They were poor and needed financial support to make the journey. The large numbers of admission by the Hmong in August and the Lahu in September were also due to the activity of the referring agency.

Some 55 per cent of the male and 69 per cent of the female addicts came from opium-cultivating villages (table 2). Most Hmong, Lisu and Yao were from opium-cultivating villages, while only about one-third of the Karen were from such villages.

Monthly variation in admissions in 1976 for Hmong, Karen and Lahu is presented in figure 2.

TABLE 2

Number of addicts' villages where opium was cultivated *

 

Villages of male addicts

Villages of female addicts

Tribes

Total number of villages

Number of villages cultivating opium

Percentage

Total number of villages

Number of villages cultivating opium

Percentage

Karen
167 70 42 9 3 33
Lahu
103 57 55 35 20 57
Hmong
66 61 92 26 23 88
Akha
5 1 20 1 1 100
Lua
6 0 0 0 0 0
Shan
7 1 14 0 0 0
Lisu
10 8 80 4 4 100
Yao
13 12 92 3 3 100
Chinese Haw
1 1 100 0 0 0
Thai
2 0 0 0 0 0
TOTAL
380 211 55 78 54 69

*Limited to those cases where information is available.

FIGURE 2

Monthly variation in admissions in 1976 for Hmong, Karen, Akha and Lahu tribes

Date of admission, hill tribe patients, Chiengmai Hill Tribe Treatment Centre

Full size image: 20 kB, FIGURE 2

Characteristics of addicts

Age on admission. The age distribution of addicts by tribe is presented in table 3 and figure 3. Eighty-five per cent were between the ages of 20 and 50 years. Sixty-six per cent were above 30 years of age. The mean age was 35 years.

TABLE 3

Distribution of addicts by age and tribe (both sexes)

Age

Karen

Lahu

Hmong

Akha

Others

Total

10-14
3 1 1 1 1 7
15-19
25 13 10 0 6 54
20-24
79 49 15 10 8 161
25-29
112 72 28 27 16 255
30-34
113 70 36 24 19 262
35-39
94 48 32 16 18 208
40-44
67 36 25 20 21 169
45-49
21 59 5 15 0 120
50-54
35 10 6 7 15 73
55-59
20 5 8 3 9 45
60-64
5 4 2 1 1 13
65-69
3 2 2 2 1 10
over 70
2 1 0 0 2 5
TOTAL
617 331 186 116 132 1382

FIGURE 3

Distribution of hill tribe addicts by age

Full size image: 17 kB, FIGURE 3

Sex. The male:female ratio was 7:1 (table 4). The highest male:female ratio was found among the Lua and Karen, while among the Lahu, Hmong, Lisu and Yao this ratio was only 3 or 4:1.

TABLE 4

Distribution of addicts by tribe and sex

 

Male

female

Male:Female ratio

Karen
598 19 32
Lahu
252 79 3
Hmong
143 43 3
Akha
107 9 12
Lua
35 1 35
Shah
29 2 15
Lisu
20 5 4
Yao
20 5 4
Haw
3
-
-
Thai
12
-
-
TOTAL
1219 163 7

Marital status. Approximately 48 per cent were not married (tables 5 and 6). Almost 40 per cent of addicts above 30 years of age were still single. There were no striking differences among the tribes except for the Akha who had a higher percentage of married addicts (74 per cent).

TABLE 5

Distribution of addicts by age and marital status

Age

Number of addicts

Number of married addicts

Percentages

10-19
61 7 11.5
20-29
416 162 38.9
30-39
470 286 60.8
over 40
435 269 61.8
TOTAL
1382 724 82.4

TABLE 6

Distribution of addicts by tribe and marital status

 

Number of addicts

Number of married addicts

Percentages

Karen
617 284 46.0
Lahu
331 192 58.0
Hmong
186 103 55.4
Akha
116 86 74.1
Others
132 59 44.7
TOTAL
1382 724
52.4

Head of household. Of the 1,049 patients for whom information about their status in the household was available (table 7), 693 (66 per cent) were heads of households. The Akha had a significantly higher proportion of addicts who were heads of households.

TABLE 7

Distribution of addicts by head of household

Head of household

Number of addicts *

Number

Percentages

Karen
448 303 67.6
Lahu
304 152 50.0
Hmong
120 88 73.3
Akha
94 88 93.6
Lua
14 11 78.6
Shan
27 21 77.8
Lisu
13 8 61.5
Yao
19 14 73.7
Chinese Haw
3 3 100.0
Thai
7 5 71.4
TOTAL
1049 693 66.0

*Limited to those cases where information is available.

TABLE 8 smokers

Distribution of addicts' households by number of opium

 

Number of households of male addicts

Number of households of female addicts

   

Households with (Addicts)

 

Households with (Addicts)

Tribes

Total number

1

2

3

4

5

Total number

1

2

3

4

5

Karen
271 191 63 14 3 0 11 8 2 1 0 0
Lahu
118 58 42 17 0 1 74 50 17 7 0 0
Hmong
79 27 36 12 4 0 45 31 12 1 1 0
Akha
59 44 14 1 0 0 8 6 1 1 0 0
Lua
8 7 1 0 0 0 0 0 0 0 0 0
Shan
11 10 1 0 0 0 0 0 0 0 0 0
Lisu
7 3 4 0 0 0 5 4 1 0 0 0
Yao
12 6 3 3 0 0 0 0 0 0 0 0
Chinese Haw
0 0 0 0 0 0 0 0 0 0 0 0
Thai
7 7 0 0 0 0 0 0 0 0 0 0
All tribes
572 353 164 47 7 1 143 99 33 10 1 0
Percentages
100 61.7 28.6 8.2 1.2 0.2 100 69.2 23 6.9 0.7
0

Number of opium smokers in the addict's household. Of the male addicts approximately 61 per cent were the only opium smokers in their household. Nearly 29 per cent came from households with two addicts and 8 per cent from households with three addicts (table 8). The corresponding figures for female addicts were 69 per cent, 23 per cent and 7 per cent, respectively. Only nine households had more than three opium smokers.

Pattern of addiction

Duration of opium addiction. The mean duration of daily opium use before admission for treatment was 7.9 years (table 9 and figure 4). There was no striking difference in the duration of daily opium use among the tribes (table 10).

TABLE 9

Duration of daily opium use before admission for treatment (all tribes)

Duration (years)

Male

Female

Total

Percentages

Less than 1
36 4 40 2.9
1 94 14 108 7.8
2 124 25 149 10.8
3 136 21 157 11.4
4 99 20 119 8.6
5 118 22 140 10.1
6 69 11 80 5.8
7 52 4 56 4.1
8 57 5 62 4.5
9 22 1 23 1.7
10-19
261 25 286 20.7
20-29
127 7 134 9.7
30-39
20 2 22 1.6
Over 40
1
-
1
-

TABLE 10

Mean number of years of daily opium use by addicts of the Karen, Lahu, Hmong and Akha tribes before admission for treatment

Tribes

Number of addicts

Mean number of years

Range of years

Karen
617 8.5
1-50
Lahu
331 6.0
1-35
Hmong
185 7.5
1-50
Akha
116 7.9
1-30
TOTAL
1249 7.9
1-50

FIGURE 4

Duration of daily opium use before admission for treatment

Duration, in years, of daily opium use

Full size image: 11 kB, FIGURE 4

The mean duration of daily opium use progressively increased with age (table 11). The time period between the first daily use of opium and the first treatment is shown in figure 5.

TABLE 11 Mean number of years of daily opium use before admission for treatment, by age

Age at time of admission (years)

Number of addicts n

Mean number of years x

Range of years

10-14
7 2.4
1-5
15-19
54 2.6
1-8
20-24
161 3.6
1-10
25-29
255 4.8
1-20
30-34
262 7.1
1-25
35-39
208 8.1
1-30
40-44
169 10.0
1-30
45-49
120 11.1
1-30
50-54
73 15.2 140
55-59
45 14.9
1-40
60-64
13 20.5 140
65-69
10 20.1
1-30
70 and above
5 25.8
1-50
TOTAL
1382 7.9
1-50

FIGURE 5 Duration of time between first daily use of opium and first treatment

Hill tribe drug dependent patients, Chiengmai Hill Tribe Treatment Centre

Full size image: 17 kB, FIGURE 5 Duration of time between first daily use of opium and first treatment

Age at first daily opium use. The mean age at first daily opium use was 26.3 years (table 12 and figure 6). It was computed on the basis of age at admission and the duration of daily opium use.

Drug type. Opium was the drug of addiction among more than 99 per cent of addicts. There were only eight heroin addicts. Addicts who used salicylate analgesics in combination with opium were 76.5 per cent (table 13). Such use was widespread among all tribes. Salicylate was more often used in the form of powder than in the form of aspirin tablets.

TABLE

Mean age at first daily opium use by addicts of the Karen, Lahu, Hmong and Akha tribes

Tribes

Number of addicts n

Mean age at first daily use x

Karen
617 26.7
Lahu
331 26.9
Hmong
185 28.5
Akha
116 28.2
TOTAL
1249
26.3

FIGURE 6 Age at first daily opium use

Hill tribe drug dependent patients (n = 1 381), Chiengmai Hill Tribe Treatment Centre

Full size image: 16 kB, FIGURE 6 Age at first daily opium use

TABLE 13

Use of salicylate analgesics with opium

Tribes

Number of addicts

Number of addicts who used salicylates

Percentages

Karen
617 457 74.1
Lahu
331 283 85.5
Hmong
186 129 69.4
Akha
116 90 77.6
Lisu
25 19 76.0
Lua
36 29 80.6
Yao
25 22 88.0
Shan
31 22 71.0
Chinese Haw
3 2 66.7
Thai
12 4 33.3
TOTAL
1382 1057
76.5

Amount of opium used. The mean amount of opium used daily was 3.9 g for males and 3.2 g for females (table 14(a) and (b)). The Hmong had the highest mean: 5 g and 3.5 g for males and females respectively. The largest daily consumption was 18 g for females and more than 20 g for males (one even used more than 30 g).

Reasons for addiction. Illness was recorded as the main reason for addiction (some 62 per cent of the cases). Among the illnesses, abdominal pain accounted for 42 per cent (table 15). Lahu and Hmong reported the highest percentage of illnesses.

Case illustration: A 25-year-old male of Lahu tribe came from a village on the mountain top east of Prao District, Chiengmai Province. There were 10 households in his village. There was at least one opium addict in each household and about 30 opium addicts in the village. Fellow villagers in many households grew opium poppy and kept some product for their own use. Opium was also available for sale in the village.

TABLE 14

Distribution of addicts by tribe and daily amount of opium used

 

Amount of daily opium use (in grams)

 

Tribes

Number of addicts with known daily opium use

1-3

4-6

7-21

12-18

19-30

>30

Mean amount x

(a) Male
               
Karen
556 410 104 16 23 3 0 3.5
Lahu
251 161 62 11 17 0 0 3.9
Hmong
142 80 38 3 18 3   5.0
Akha
104 74 15 3 5 6 1 4.9
Lua
35 26 7 1 1 0 0 3.2
Shan
29 24 3 1 1 0 0 3.0
Lisu
20 12 6 1 1 0 0 3.9
Yao
20 16 3 0 1 0 0 3.1
Haw
3 1 0 1 1 0 0
-
Thai
12 11 1 0 0 0 0 2.2
(a) Female
               
Karen
19 14 4 0 1 0 0 3.3
Lahu
79 58 18 1 2 0 0 3.1
Hmong
43 28 13 0 2 0 0 3.5
Akha
9 7 2 0 0 0 0 2.0
Lua
1 1 0 0 0 0 0 2.7
Shan
2 1 1 0 0 0 0 3.5
Lisu
5 4 0 1 0 0 0 3.4
Yao
5 4 1 0 0 0 0 2.6
Haw
-
-
-
-
-
-
-
-
Thai
-
-
-
-
-
-
-
-
TOTAL
163 117 39 2 5 0 0
3.2

TABLE 15

Principal reasons for drug use

Tribes

Number of addicts with recorded reasons

Illnesses*

Experiment or social reasons

Percent age from illnesses

Karen
610 316 (141) 294 51.8
Lahu
328 264 (103) 64 80.5
Hmong
184 134 (66) 50 72.8
Akha
114 66 (32) 48 57.9
Lua
35 18 (2) 17 51.4
Shan
31 8 (2) 23 25.8
Lisu
22 13 (4) 9 59.0
Yao
23 16 (5) 7 69.6
Chinese Haw
3 2 (1) 1 66.7
Thai
12 5 (0) 7 41.7
TOTAL
1362 842 (356) 520 61.5

*The figures in parentheses represent abdominal pain alone.

The patient lived with his parents, wife, brothers and sisters in an extended family. He and his parents did not grow opium poppy. They grew rice and sesame and kept pigs and chickens. They also worked on hire in their own and nearby villages.

Both of the patient's parents were addicted to opium. At the age of six the patient started smoking tobacco which was accepted in his village. He had since been smoking 10 self-prepared cigarettes a day. At the age of fifteen, he had several bouts of abdominal pain and his father gave him opium to smoke. He had good relief from the symptoms, but the pain recurred when he stopped taking the drug. Hence he smoked opium every day and became addicted. He then smoked opium three times a day: small amounts in the morning and at midday and a larger one in the evening. He used two and a half "μ" or about 4 g of opium daily. Powdered analgesics available at the village stores as patent drugs were mixed with opium before smoking. In spite of his addiction to opium, he was still able to work on his farm and as a hired labourer.

He realized that opium smoking was costly for his limited income and therefore sought treatment. He was assisted by the Hill Tribe Development and Welfare Centre of the Department of Public Welfare to make the journey to the Treatment Centre.

Heroin addicts

In this series eight hill tribe men were found to be addicted to heroin. Five were Hmong, one Karen, one Lahu and one Akha. They were between 20 and 35 years of age. All were originally addicted to opium and had in recent years been shifting to heroin. Seven smoked heroin either by the "chasing-the dragon" technique or by inserting it inside cigarettes. Only one used intravenous injections. All gave a history of frequent visits to the lowland cities or towns; some actually spent some time working in the lowland.

Case illustration: A 23-year-old male of Karen tribe came from Mae Sariang District of Mae Hongsorn Province. He stated that the opium poppy was not grown in his village where there were five opium addicts. At the age of 18 he became addicted to opium. At the beginning he was travelling with a group of friends after working in their rice field. In the evening a number of villagers were smoking opium and out of curiosity he tried and liked the effect. After frequent smoking he soon became addicted. Two years ago he came to Chiengmai to work as a labourer on a vegetable farm. He was given heroin by the owner of the farm and by smoking became addicted. Six months ago he had begun using heroin intravenously, supposedly in order to cut the cost of the drug. At the time of admission he was either smoking five "μ" or 7.5 g of opium daily or injecting half a "tube" or 150 mg of heroin, depending on the availability of the drug or the money to buy it.

He was brought to the Narcotics Treatment Centre by an acquaintance who lived in Chiengmai. He stated on admission that he wanted to be treated because of poverty due to addiction. In the evening of the day of admission he was suspected of having taken narcotics, and a body search revealed a syringe and a tin-foil cup which are common utensils for heroin consumption. He was then referred to the Lumpang Hospital for treatment.

Health problems

Of the 126 hill tribe patients who had roentgenograms of their chest and abdomen taken, the condition of 38 patients (30 per cent) was found to be abnormal. Lung infections, in particular tuberculosis, were most common (14 per cent). Urinary tract stones were also encountered in 8 patients.

About 10 to 12 per cent of patients were found to be anaemic with a hemoglobin level below 11 g per cent or hematocrit below 37 per cent. Twelve per cent had leucocytosis and 12 per cent had more than 10 per cent of eosinophilic leucocytes in the differential leucocyte count, indicating a high prevalence of infection and parasitic infestation.

Discussion

This population of opium addicts was a biased group because it included only those who sought treatment. Older, and some of the female, addicts may have less readily come forward for treatment. Since the Treatment Centre was located in Chiengmai City, tribes living in other provinces such as the Akha and Yao were less represented. Distance, expense and travel difficulties acted as barriers. The differing activities of the referring agencies also accounted for some uneven distribution. Nevertheless this population represented the largest group of hill tribe opium addicts so far studied.

The opium problem among the hill tribes

It is clear that the opium problem is widespread among almost all tribes. The over-all distribution according to the calendar year of first daily opium use (figure 7) was misleading because of the age differences. Considering only those above 30 and above 40 years of age (figure 8), a steady incidence was found. The peaks showed a tendency to recur at intervals of decades rather than years.

FIGURE 7

Calendar years of first opium use by addicts treated

Full size image: 13 kB, FIGURE 7

FIGURE 8

Calendar years of first daily opium use by different age groups of hill tribe patients

Full size image: 21 kB, FIGURE 8

Opium addiction has therefore been indigenous in the region for several decades and perhaps centuries.

The opium addiction problem among the hill tribes appears to be most serious for the Karen who constituted the largest group at the Treatment Centre. This is due probably to the large population in the country and the high prevalence rate. In village surveys [ 3] , [ 4] 16-38 per cent of Karen villagers above 10 years of age were found to be addicted to opium. Social and recreational purposes were given as a reason for use by almost half of them. The economic status of the Karen is poor. Only a small portion of the villagers grow enough rice for their own consumption. The majority have to depend on labouring, which pays only poorly, 20 bahts per day. Some were paid in food for the day and 10 bahts. Addicts were given food and opium required for the day, without money. They were generally in debt with little chance of improvement. Karen people were found to have a rather tolerant attitude towards tobacco and perhaps a somewhat less tolerant attitude towards opium. Young girls may begin to smoke tobacco at the age of six and possess a tobacco pipe by the age of ten. Opium is smoked in the house in front of the children. The high socio-economic stress, illness and the social attitude, together with the availability of opium may, to a great extent, account for the high addiction rate. The result of simple detoxification of Karen opium addicts, so far assessed, was very poor. A large proportion, if not all, reverted to drug taking soon after returning to their villages.

For the Hmong, the second largest tribe, the addiction problem is also serious. In village surveys [ 4] the prevalence of opium addicts was found to be between 6 and 16 per cent of the population above 10 years of age. Most Hmong are opium growers and opium is widely available in their villages. There is practically no medical care in the villages, the villagers using local medicinal herbs. They believe in the value of sacrifices to spirits. Opium is used as a medicine for treatment of physical illnesses to relieve pain, diarrhoea and coughs. Chronic diseases such as peptic ulcer, pulmonary tuberculosis, urinary stones and serious injuries lead to frequent use and eventual addiction. It is also used as a psychoactive drug for relief of anxiety and sleeplessness. Recreational use occasionally leads to addiction. The Hmong are aware of the bad effects of opium addiction. Their attitude towards opium use, however, varies considerably. Some would not allow their youngsters to use opium for fear of addiction, although some would not hesitate to give it to them when they are ill. With provision of basic health care and the substitution of opium by better and more acceptable medicines, the addiction problem among the Hmong might be expected to diminish.

Even though the Lahu are a relatively small tribe in Thailand, there was a large number of Lahu in this series, perhaps due to the high rate of addiction.

The situation of the Akha is not very different from that of the Karen: they are poor, do not usually grow opium, but have a high prevalence of addiction. Not many of them sought treatment at the Centre, probably due to the distance involved. Most of them came from Chiengrai and Nan provinces. The Yao have been growing opium on the same scale as the Hmong, and were also suffering from addiction. Almost all came from more distant provinces.

It is evident that the underlying causes of addiction and the motivation for seeking a cure, as well as the socio-cultural setting, vary greatly. An appropriate goal and strategy is therefore needed for the treatment of each individual. The presence of physical illness also requires attention.

Economic and social effects of opium addiction

Economic loss. The cost of opium in the villages varies between 2 and 3 bahts a μ (a μ = 1.5 g). The mean daily expense for opium is therefore approximately eight bahts. For those opium growers who can keep a part of their product for their own consumption and who have a rather high income, the economic loss is neither very apparent nor very serious. For the Karen and Akha who are poor, the economic loss is seen to be very deleterious to their level of subsistance.

In addition, advanced opium addiction very likely interferes with their work. It was repeatedly stated that addicts could not work or were not willing to work as well as before acquiring the habit. A number of addicts were, however, seen to be adjusted. They worked effectively and were productive members of the village. Some were able to work in spite of illness because their symptoms were suppressed by opium. Some worked very hard in order to obtain enough income in spite of poor health, and opium kept them going at a very precarious level.

Social effect. Elderly addicts are well respected by their relatives and fellow villagers. Being an addict has not down-graded them. Sixty-six per cent of addicts at the Treatment Centre were heads of household. Some remained village headmen. The social respect for younger addicts was apparently impaired. About half of the addicts in this series were single. In contrast, it was found in the village surveys [ 4] that almost all villagers, especially amongst the Hmong, were married by the age of 20. Those remaining single above the age of 20 were usually addicts. It is more difficult for a known addict to find a spouse.

Acknowledgement

The authors would like to thank the UN/Thai Programme for Drug Abuse Control, in particular its Director, Mr. I. M. G. Williams, for the continuous support of the activities described in this report; Dr. Mogens Nimb, WHO Consultant to the UN/Thai Programme for Drug Abuse Control, who was involved in the initial planning and establishment of the Centre, and the staff of the Narcotics Treatment Centre for Hill Tribes, who were responsible for the care of these patients.

References

001

D. Komkampan and P. Chaipikusit. Report of a follow-up study of treatment programme for hill tribal addicts in Mae Hongsorn and Chiengmai provinces. A. mimeograph published by the Hill Tribe Research Centre, Department of Public Welfare, Chiengmai, Thailand, 1972.

002

P. Lewis. Opium addiction among Akhas of Northern Thailand, Part I-V. Mimeographed reports, 1975.

003

C. Suwanwela, P. Tasanapradit, A. Dharmkrong-At, V. Poshyachinda and V. Artkampee. Opium use in a Meo village, Institute of Health Research Technical Report No. DHI, 1976.

004

C. Suwanwela, P. Tasanapradit, A. Dharmkrong-At, V. Poshyachinda. The hill tribes of Thailand, their opium use and addiction. Bulletin on Narcotics XXX: 2, 1-20, 1978.

005

Tribal Data Project. Directory of tribal villages in Thailand, 1971-1977.

006

T. Uneklabh. The experiences in the management of hill tribe drug dependent people in Thailand. Thailand Central Bureau of Narcotics Report, Bangkok, Thailand, pp. 21-31, 1975.