Development of an Integrated Harm Reduction Model for Thailand’s Drug Treatment System under a Public Health Approach

Abstract

This action research aimed to examine the situation and barriers in the implementation of drug treatment, rehabilitation, and harm reduction services in healthcare facilities in Thailand, to develop and pilot a harm reduction operational model through a participatory process, and to evaluate the outcomes in order to generate policy recommendations. Quantitative data were collected from 59 hospital administrators, 180 healthcare providers, and 52 service users across 147 healthcare facilities. Qualitative data were obtained through in-depth interviews and observations in 11 healthcare facilities. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed using content analysis. The results showed that, (1) prior to the enactment of the Narcotics Code B.E. 2564 (2021), harm reduction had not been integrated as part of the healthcare service system. Retention rates in treatment during 2020–2021 were low (58.42% and 59.41%), and remission rates decreased from 29.99% to 25.16%, reflecting limitations in policy, resources, and service systems. (2) The developed model consisted of five components: integration of harm reduction into treatment, clarification of roles of healthcare facilities at each level, linkage with community-based rehabilitation, interdisciplinary collaboration, and development of a monitoring information system. (3) The evaluation of the developed model showed that most healthcare facilities had high levels of performance in planning, communication, and data management related to harm reduction, while the availability of budget, materials, and workforce remained at a moderate level in some facilities. In addition, 73.10–80.80% of service users reported safer drug use behaviors, and 69.20% reported improved self-care behaviors, reflecting the role of harm reduction services in behavioral change and quality of life.
The study led to policy recommendations, including the development of standardized practice guidelines, support for necessary resources, capacity building of personnel, improvement of data and monitoring systems, and strengthening collaboration with local partners to enhance continuity of care in the long term.