Over the past decade, methamphetamine use has grown more popular in Myanmar, Thailand and Southern China. Based on in-depth interviews conducted with individuals who use methamphetamine, this briefing sheds light on the importance of promoting an environment that reinforces, rather than undermines, the ability of people who use methamphetamine to regulate their drug use, preserve their health and adopt safer practices.

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The use of amphetamine type stimulants in Myanmar, Thailand and Southern China has continued to increase over the past few years, despite the intensification of police efforts and the growing number of seizures and related arrests. Using methamphetamine has become more popular, especially among youths but also among those working in difficult environments and conditions. Unfortunately, people who use these substances too often learn their negative consequences at the cost of their own health. Access to specific and evidence-based information, harm reduction and treatment services for people who use methamphetamine should therefore be considered as a priority.

The knowledge and experience of people who use these substances should be recognised and leveraged, and their efforts to adopt safer use practices encouraged and supported. Punitive approaches implemented in the region have a negative impact on the health and lives of people who use methamphetamine. They are also ineffective for preventing drug use and the emergence of more risky practices. In order to build healthier and safer communities for all, it is urgent to replace repressive laws with robust public health programming, more respectful of people’s rights and dignity.

Key Points

• Over the past decade, methamphetamine use has grown more popular in Myanmar, Thailand and Southern China. The substance has become more easily available, while prices have either decreased or remained at low levels. A similar trend has been observed across the entire region, despite a sharp increase in drug seizures and related arrests. This situation highlights the ineffectiveness of current policies, mainly based on repression, to curb the availability and consumption of methamphetamine.

• Methamphetamine tablets are the most popular form of amphetamine-type stimulants (ATS) in the region, in particular in Myanmar. However, crystal methamphetamine, commonly known as “ice”, is strengthening its position on the market. While methamphetamine tablets are mostly smoked, crystal methamphetamine has a greater potential to be injected and is also a more potent substance. It therefore carries specific health risks that need to be addressed through the lens of public health, rather than criminal justice.

• A great diversity of people are using methamphetamine, although patterns of use can vary significantly. Methamphetamine use is a highly social practice that is particularly common among youths but also among people working at night and/or engaging in difficult manual tasks. Understanding methamphetamine use first requires to acknowledge the perceived benefits these substances can provide. At the same time, people who use them are aware of their negative consequences. There is much to learn from their experiences and the methods they have developed to reduce harms associated with methamphetamine use.

• Access to reliable, unbiased and evidence-based information on ATS is insufficient. As a result, people who use these substances have to learn about their negative consequences primarily through experience, at the cost of their own health. Because a wide range of people are likely to experiment with methamphetamine use at some point in their lives, access to information for a wide audience must be improved, including through the use of new technologies.

• The introduction and scale up of specific harm reduction services can play a critical role in promoting safer methamphetamine use practices. In particular, it can help prevent a major switch from inhalation to injection. Organisations providing harm reduction services should recognise and leverage the considerable experience of people who use methamphetamine and support them in their efforts to adopt safer practices.

• Access to evidence-based treatment for methamphetamine use disorders is insufficient and inadequate. Existing services almost exclusively rely on residential stay in closed facilities that consider complete abstinence as the only possible treatment plan. In contrast, cognitive therapies in community-based settings would be more cost-effective, easier to implement and better adapted to the needs of the majority of people with methamphetamine use disorders. The use of dexamphetamine as a substitution therapy has shown positive outcomes for people with severe methamphetamine use disorders in some other countries. Its introduction should be seriously considered. The potential benefits of milder plant based stimulants such as kratom and cannabis should also be investigated in pilot projects or controlled research trials.

• Stigma and discrimination against people who use methamphetamine are high and affect their lives in multiple ways. The fear of being arrested acts as a significant barrier for those willing to access health services. Existing laws, punitive in nature, fail to prevent the emergence of risky practices, such as a switch towards injection, and reinforce the marginalisation of people who use these substances. It is therefore crucial to ensure that drug use, as well as the possession of small quantities of methamphetamine for personal use, do not lead to prison penalties. Overall, a greater focus should be placed on harm reduction, and more efforts should be made to promote an environment that reinforces, rather than undermines, the ability of people who use methamphetamine to regulate their drug use, preserve their health and adopt safer practices.

This publication is dedicated to our great friend and colleague Thura Myint Lwin, who passed away on the 10th of February 2019. This report would have never seen light without him. We are immensely grateful to him for his tireless work and wish his wife and family strength and wisdom to deal with his loss.