Border Crossing and Situation on Problems of Medicine and Health Products along Thailand’s Borders – the Case of Corticosteroids

Abstract

The distribution and usage of high-risk corticosteroids along Thailand's border areas reveal vulnerabilities in regulatory systems under the complex borderland contexts, affecting public health nationwide. This study aims to understand these phenomena to highlight structural realities and propose appropriate community-level and policy-level solutions. Methods: This qualitative study collected data through literature reviews, field notes, in-depth interviews, and participant observation. The research spanned Thailand's border provinces with Laos, Cambodia, Myanmar, and Malaysia, involving health officials, public health personnel, migrant workers, local vendors, and patients. Data underwent triangulation and thematic analysis, with insights validated through expert consultations between October 2024 and April 2025. Results: Thailand’s border regions face significant challenges related to the smuggling of unregulated and substandard pharmaceuticals, notably health products containing banned substances such as Dexamethasone. These findings underscore inadequacies in regulatory mechanisms, evident in all Thai border areas despite existing checkpoints. Border areas serve as hubs for medication access among local populations and migrant workers who lack formal health coverage due to systemic inequalities in neighboring countries. This has led to reliance on purchasing medicines from local vendors and markets, with many utilizing informal ‘YA - CHUD’ (a combination of different drugs in the form of a capsule or tablet and packed in small plastic bags) or counterfeit drugs with temporary efficacy. Overuse of certain drugs, such as Lincomycin injections at clinics, has also been observed. Conclusion: The Landscape of border medicine situation along Thailand’s borders highlights critical gaps in regulatory frameworks, particularly for high-risk drugs. Addressing these issues requires an understanding of the informal and pragmatic governance evident in these areas, where illegal but socially accepted practices persist alongside the transboundary movement of people, goods, and cultural exchanges. Recommendations include improving regulatory processes, leveraging surveillance technologies, fostering international collaboration, and empowering border-area volunteers to enhance public health and state security sustainably.