[Materia medica resources benefits Lancang-Mekong River:a new approach for sub-regional cooperation on traditional medicine].

Lancang-Mekong Cooperation is a new type of subregional cooperation mechanism initiated and built by China and other five countries of the Lancang-Mekong subregion, namely Laos, Myanmar, Thailand, Cambodia, and Vietnam. Countries in the Lancang-Mekong subregion are geographically and culturally connected, and they have nurtured their unique traditional medicine. By combing the history of traditional medicine exchanges between China and other Lancang-Mekong countries and their progress of modern research, this paper summarized the challenges and opportunities of traditional medicine cooperation in the Lancang-Mekong subregion. It has been found that many regional cooperation mechanisms coexist for a long time in the Lancang-Mekong subregion and the medicinal resources are abundant. However, the degree of their development and utilization varies, and modern scientific research is insufficient. Lancang-Mekong Cooperation has provided a strong support for integrating the advantageous resources in Lancang-Mekong subregion countries and making progress together. Focusing on the development and protection of medicinal resources, this paper puts forward a new path of cooperation in the intellectual property rights and characteristic seed resource protection, the compilation of universal herbal pharmacopoeia in various countries, the research and development of public health products, and the construction of traditional herbal industry bases, thus enabling the traditional medicine to better protect the public health and building a human health community.

The pro-heroin effects of anti-opium laws in Asia.

Over 25 years anti-opium laws were enacted by three Asian governments in countries where opium use was traditional. Within months, heroin use suddenly appeared; and within a decade, heroin addiction surpassed opium addiction. The laws led to (1) increased price of narcotic drugs, (2) a heroin "industry," (3) corruption of the law enforcement system, and (4) major health problems involving parenteral drug use. The Asian experience indicates that antinarcotic laws can be effective only with careful preparations: (1) changing society's attitude toward the traditional drug from ambivalence to opposition; (2) mobilizing resources to treat and rehabilitate all addicts within a short period of time; (3) developing the social will to incarcerate all "recidivist" addicts for a prolonged period; and (4) preventing narcotic production or importation.

HIV infection among female drug users in Northern Thailand.

Reports on HIV infection and risk behaviors among female drug users in developing countries, particularly in Asia, are limited. In this study, we investigated HIV prevalence and risk factors for HIV infection among 200 women admitted for 21-day inpatient drug detoxification in Chiang Mai, Thailand. Volunteers completed a face-to-face interview using a structured interview, HIV pre-test counseling, specimen collection for HIV and STD tests, and were provided test results and HIV post-test counseling 1 week later. Two-third of participants (68%) were ethnic minorities with no formal education. Overall, 14 (7%) were HIV positive: 25% among 28 heroin injectors and 4.1% among 172 opium or methamphetamine smokers (p<0.001). History of drug injection and sexual abuse were associated with HIV infection. HIV prevention strategies for drug-using women in Thailand should consider both harm reduction strategies for drug use and promoting safer sex measures in a culturally appropriate context.

Fatal melioidosis in a tourist returning from Thailand.

Severe infections with Pseudomonas pseudomallei, the causative agent of melioidosis, is a common cause of community acquired septicaemia in South East Asia and parts of Northern Australia, but infection in travellers returning to the United Kingdom is extremely rare. We describe the case of a tourist who acquired melioidosis in Thailand. Despite intensive intravenous therapy with antibiotics to which the organism was sensitive, the patient's infection proved fatal. Ps. pseudomallei was isolated from blood cultures at a late stage in his illness by use of a commercial blood culture system that included an antibiotic removal device (Bac/TAlert, Organon-Technica).

Harm reduction and alternative development in the Golden Triangle.

The authors of this Digest are anthropologists from Macquarie University, Sydney Australia. At the invitation of the German aid agency GTZ, they have been monitoring opium use and the impact of drug rehabilitation in Muang Sing Laos over the past 3 years. Their role is to provide analyses of how development projects alter the social make-up of their target communities and contribute to ways in which substance use/abuse is understood, practiced and controlled or reconfigured. In their consideration of development projects they take the perspective that harm reduction can and should include pre-emptive concern with factors that promote damaging drug use in the first place and furthermore, that these factors are at times the products of the distinct drug reduction strategies themselves.

Comparison of the sensitivity of various anti-HIV tests in early seroconversion sera.

Paired sera from 4 patients with proven HIV infection whose initial specimens obtained 14-51 days earlier were indeterminate were simultaneously retested with 7 screening anti-HIV test kits and the immunoblot assay. The study aimed to evaluate the sensitivity of various new and old anti-HIV screening tests. The test kits evaluated were 4 ELISA test kits from Wellcome (Wellcozyme), Organon (Vironostika anti-HTLV-III), Pasteur (Rapid Elavia) and Diagnostic Biotechnology (DB, HIV-1 ELISA), 2 rapid tests based on microfiltration enzyme immunoassay procedure from Rapport (SUDS) and Disease Detection International (SeroCard), and 1 particle agglutination (PA) test (Serodia-HIV). Immunoblot strips from Diagnostic Biotechnology (HIV-1 Western blot) were used to confirm the HIV infection in these serum specimens. Out of the 4 initial serum specimens tested, all were positive by PA, 2 by SUDS, Wellcome and Pasteur, 1 by SeroCard and DB, and none by Organon. When tested by immunoblot, 1 was negative (i.e., completely without any bands) whereas 3 were indeterminate (i.e., 1 with very weak band for p18, 1 with weak band for p24, 1 with very weak band for gp160. All repeat specimens obtained 14-51 days later (mean 32.5 +/- 16 days) were positive by all screening tests as well as immunoblot. Therefore, with these 4 early seroconversion sera, the sensitivity of the PA was 100%, that of SUDS, Wellcome and pasteur was 50%, of that SeroCard and DB was 25%, and Organon, 0%. None of these sera was considered positive by immunoblot.

Co-existence of HIV-1 subtypes B' and E infections among Thai injecting drug users.

Subtypes B' and E are the two major subtypes of HIV-1 among injecting drug users (IDU) in Thailand. However, there are not many reports on subtype distribution during the early epidemic. Random blood specimens collected during 1994-2000 from 3,286 IDU at the Thanyarak Hospital were tested for HIV antibody and subtyped by using peptide binding enzyme immunoassay. The prevalence rate of HIV infection was 36.8%. All HIV-seropositive IDU were ascertained for "year of first HIV seropositivity" from their medical records. Of 1,512 HIV-seropositive samples, 1,408 (93.1%) were typeable. During 1987-1988, the proportion of subtype B' was as high as 80% but decreased rapidly to 27.6% during 1999-2000. At the same time, the proportions of subtype E increased correspondingly (Chi-square test for the trend, p < 0.05). The relatively high proportion of subtype E among IDU since an early stage of the epidemic suggests early co-existence of both subtypes and needs further investigation.

Development of enzyme-linked immunosorbent assay for hepatitis B e antigen.

Hepatitis B e antigen (HBeAg) in sera indicates infectivity and when found during pregnancy, indicates a need for vaccination against hepatitis B virus. A sensitive test for HBeAg is needed in all hospitals but this test is expensive. Local development of enzyme-linked immunosorbent assay (ELISA) for HBeAg and its antibody (anti-HBe) was considered necessary and it was successfully conducted. The developed test was compared with ELISA test for HBeAg and anti-HBe manufactured by Organon Teknika (205 routine specimens and 103 sera positive for HBsAg) and Roche Diagnostic (160 routine specimens). The locally made and imported kits showed overall agreement of 97.5 to 98.1 per cent and the locally made test was always slightly more sensitive. The local test was also rapid, reproducible, and specific. The development lead to self reliance on ELISA test for HBeAg and anti-HBe.

In the golden triangle with a handful of dollars.

The only way of reaching this part of the world, which is on the borders of northern Thailand, Burma and Laos, is by helicopter. It is a mountainous region, mostly covered by forest and inhabited by a tribal population estimated at 300,000 to 500,000 persons who live in some 3,000 villages. The people, who are seminomadic move about with their personal property and weapons, without any form of control. They have been cultivating the opium poppy since the beginning of the century and this single crop provides all that is needed for the livelihood of the families. In an area where all transport is by back-pack, opium provides a good return for a low weight. The opium is used to supply the international market and is also the source of regional drug addiction, which can perhaps be better described as the local therapy for the pains of illness and old age. To consider banning poppy cultivation or destruction of the plantations is a pipe-dream in this inaccessible, uncontrollable area, which has no administrative infrastructure. Consequently, repressive action is directed only against traffickers. Because of the geographical position of the "Golden Triangle", there is substantial cross-frontier traffic. The boundary lines are tortuous, mountainous and frostcovered, and surveillance is therefore quite impossible. Police tactics are therefore to let traffickers proceed sufficiently far into the country so that they can be attacked without their being able to escape across the frontier. The over all enforcement activity throughout Thailand has yielded results and statistics are available to prove it. What is now needed is to find a substitute for opium poppy cultivation and start on this has been made with the help of the United Nations Fund for Drug Abuse Control (UNFDAC). This very ambitious plan consists in completely transforming the economic life of the tribes. The people will be induced to abandon their nomadic life and become sedentary and to switch over from a single-crop system to mixed farming. The first stage of the plan is scheduled to operate until 1977. An agronomy station has been set up to carry out trials and tests of crop varieties that might be adapted to the region. At the same time, five "pilot" villages have been chosen to carry out the experiment. By force of example, the experience of these five villages will be applied by 30 other so-called "satellites". Later, there is no reason why there should not be 300 and then 1,000. But this small group of experts must be given support, because there is still a great deal to be done.

Community-based intervention to reduce demand for drugs in Northern Thai tribal villages.

This is an evaluation study of a community-based intervention model used in a project designed to reduce the demand for and use of opium, heroin, and other drugs among 85 tribal villages located in Northern Thailand. The Integrated Drug Abuse Prevention (IDAP) Project was conducted from 1995 to 1997 and used a community-based approach which included innovative methods such as multimedia awareness raising campaigns, networking between villages and local government agencies, and village-based drug detoxification and treatment to assist villages in solving their drug problems. The intervention model was successfully implemented in most villages and demonstrated very good results in improving awareness, decreasing the number of active drug users living in the villages, and preventing new cases of addiction. However, a follow-up study at 6 months after project termination indicated problems with sustainability of demand reduction activities and outcomes. These problems were attributed in part to a lack of empowerment among village leaders to continue activities without assistance from project staff. Also, village leaders expressed problems in resisting drug dealers who returned to the area, which suggested that support from law enforcement is critical to the viability of drug demand reduction programs.

UN/Thai programme for drug abuse control in Thailand-A report on phase I:February 1972-June 1979.

The paper describes the principal achievements of the UN/Thai programme for drug abuse control which was carried out during the years 1972-1979. The programme was of a pilot nature and covered five selected key villages and 25 satellite villages in the north of Thailand. The major components of the programme were crop replacement and community development, treatment and rehabilitation, and drug information and education. The Royal Thai Government has accepted the achievements of this project as models for greatly expanded programmes for the eradication of the opium poppy cultivation. Two key villages-Ban Mae Tho and Hui Tund Jaw which were included in a pilot programme have provided to be opium free.

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

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% 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.

Anaesthetic experiences in three sets of conjoined twins in King Chulalongkorn Memorial Hospital.

We describe the anaesthetic management for magnetic resonance image scanning, angiography and surgical operations in three sets of conjoined twins (ischiopagus, throracopagus and pygopagus) in King Chulalongkorn Memorial Hospital during 1996-2002. The anaesthetic technique and associated problems are summarized.

Reawakening the dragon: changing patterns of opiate use in Asia, with particular emphasis on China's Yunnan province.

Asian countries adjacent to the Golden Triangle and their neighbors have witnessed an evolution in "drug abuse" from traditional opium smoking to heroin eating, smoking, and finally heroin injection. A recent study of 630 heroin users was conducted in China's Yunnan Province, located close to the Golden Triangle. Data collected between August 1997 and February 1998 indicate injecting heroin users, in comparison to noninjectors, were more likely to have used drugs for a longer period of time, and to use drugs more frequently everyday. Other major differences existed between urban and rural subjects, especially highlighting differences between men and women. Women comprised a much higher proportion of urban subjects than rural subjects. Rural injectors were much more likely to be male, but urban injectors were almost evenly split between men and women. The emerging epidemic of heroin use in China and the continuing substance abuse problem in the United States provide an opportunity for collaborative research of mutual benefit.

Operating needle exchange programmes in the hills of Thailand.

Injecting drug use is increasingly markedly amongst the ethnically distinct Hilltribe peoples of northern Thailand in the notorious 'Golden Triangle'. This paper reports on the establishing of needle exchanges in three remote Hilltribe villages, examining the success and the failure. Up to 60% of adult males and a smaller percentage of adult females in these villages are habitual users of opium and/or heroin. Overcoming initial concern that needle distribution would encourage increased use, the villagers themselves have assumed responsibility for much of the needle exchange operation. Prior to the introduction of the needle exchanges all the injecting drug users were sharing needles. This behaviour changed significantly with the introduction of the exchanges. Reluctance on the part of locally-based government officials to participate fully in the programme created difficulties in maintaining needle supplies which saw some resumption in needle sharing. HIV seroprevalence rates amongst the tested injecting drug users remained fairly stable at 33% in February 1993 and 32% in February 1994. The conclusion can be drawn that needle exchange programmes are operable in the Hilltribe context and that they are the best means of limiting HIV/AIDS transmission amongst injecting drug users and the wider community. The success of needle exchange programmes, however, is dependent upon co-operation from various government agencies and non-government agencies, in addition to the local communities. To this end mechanisms ensuring co-operation, training, monitoring and evaluation need to be developed alongside the introduction of needle exchanges.

PIP: Injecting drug use is increasing markedly among the ethnically distinct Hilltribe people of northern Thailand in the notorious Golden Triangle. This paper reports on the establishment of needle exchanges in 3 remote Hilltribe villages. The needle and syringe exchanges were established in 3 villages: Anamai Village 1, 2, and 3, each with an average of 47 households and 5-6 people per household. Altogether there were 46 injecting drug users participating: 16 from Anamai Village 1; 12 from Anamai Village 2; and 18 from Anamai Village 3. Up to 60% of adult males and a smaller percentage of adult females in these villages were habitual users of opium and/or heroin. Through a series of meetings in the villages various means available to prevent the transmission of HIV/AIDS in an injecting drug use context were discussed. The villagers themselves have assumed responsibility for much of the needle exchange operation. The sharing of needles by injecting drug users changed significantly with the introduction of the exchanges. Reluctance on the part of local government officials to participate in the program created difficulties in maintaining needle supplies, which led to some resumption in needle sharing. The needle and syringe exchanges in November 1992 supplied 5000 1 cc needle and syringe fits, a 1-years' supply. HIV seroprevalence rates among the tested injecting drug users remained fairly stable at 5 cases (33%) of 15 IDUs tested in February 1993. In February 1994, 8 (32%) of 25 IDUs tested were found to be HIV seropositive. The 17 men found to be HIV negative in February 1994 despite their injecting behavior would seem to indicate that the needle exchange programs in the Hilltribe context are effective in limiting HIV/AIDS transmission among injecting drug users and the wider community. The success of needle exchange programs is dependent upon cooperation from various government agencies and nongovernment agencies as well as the local communities.

Correlates of illicit drug use in Karen villages in Northern Thailand.

A study was conducted in 31 Karen tribal villages in Northern Thailand in 1999-2000 to address the question of why some villages have a relatively high prevalence of illicit drug use compared with others? Data were gathered from village leaders, residents, and through observations by field workers and the researchers, and included demographic, economic, and infrastructure development, and social and acculturation measures. Overall, few village-level variables were related significantly to drug use in the villages; those that were included: 1) better access to elementary education reported by "high drug" villages (81%) in comparison with "low drug" villages (29%) and 2) high drug villages reported having more alcoholic residents than low drug villages. The findings provide some support for the hypothesis that illicit drug use is positively associated with socioeconomic development, acculturation, and socialization into mainstream attitudes, values, and behaviors.