The influence of Thailand's 2003 ‘war on drugs’ policy on self-reported drug use among injection drug users in Chiang Mai, Thailand

Abstract

In February 2003, the Thai Government enacted a ‘war on drugs’ to reduce supply and demand for illicit drugs. This study aimed to examine the impact of this policy on injection drug users (IDUs) drug utilisation patterns and to explore IDU attitudes toward and experiences with the policy in Chiang Mai province. In April 2003, 263 IDU who participated in a study in the preceding year were followed up and 165 IDUs (63%) were available and consented to participate in a cross-sectional survey. Of these 85% had ceased injecting and 70% had done so since the implementation of the policy, with a higher percentage of rural compared to urban IDUs ceasing injection (78% versus 55%, p < 0.001). One-third of those who had ceased drug injection reported smoking opium or methamphetamine, with a lower percentage of urban compared to rural dwellers (24% versus 36%, p < 0.01). Paradoxically, 88% of participants reported that government policy was “good,” ostensibly because it might reduce the temptation to use drugs among the non-initiated by reducing the supply. The majority of study participants reported ceasing injection, often transitioning to other substance use. Differences in drug utilisation patterns were found between urban and rural dwellers. The fear produced by the policy probably led to an underreporting of injection practices and could lead to increased risky syringe behaviours. Continued research is needed to monitor the effects of the policy on patterns of drug use, routes of administration, and HIV risk behaviours.

Introduction

On 1 February 2003, the Prime Minister of Thailand, H.E. Pol. Lt. Col. Thaksin Shinawatra, enacted his much anticipated ‘war on drugs’ in Thailand (Office of the Narcotic Control Board, 2003a), hereafter referred to as the war. The policy's main objectives were to reduce the supply of and demand for illicit drugs throughout the kingdom of Thailand. The policy was primarily aimed to abate the substantial increase in methamphetamine (ya baa) use throughout the country since the mid-1990s. Increased production and trafficking of methamphetamine, predominately from the neighbouring country of Myanmar, resulted in its extensive availability and use throughout Thailand. (Manufactured as brightly coloured pills often flavoured like candy that are commonly heated on foil until they vaporise and the resulting fumes inhaled through a straw or similar.) Additionally, there has been a rise in heroin injection over the past several decades in response to Thailand's successful eradication of indigenous opium cultivation (Renard, 2001).

To meet the aims of demand reduction, the government enacted a ‘drug user rehabilitation’ law, which mandated that all drug users attend drug treatment. Prior to the new policy, there were 7065 facilities throughout Thailand that provided drug treatment (Office of the Narcotic Control Board, 2003b). District and community health centres, hospitals, and traditional drug treatment programmes were counted among these facilities, although very few had trained personnel familiar with modern drug treatment approaches. During the war's first phase, which was 3 months in duration, drug users were offered the opportunity to voluntarily be placed in drug treatment facilities which included thousands of newly established drug rehabilitation centres or camps which were located within community hospitals, and health centres, as well as short-term military style drug rehabilitation ‘boot camps’. The boot camps were operated by the Thai military on Royal Thai Army reservations in collaboration with the Ministry of Public Health (MOPH) and were located throughout the country. Drug users would spend 4 to 21 days in the camps undertaking traditional boot camp physical activities and were provided training in ‘life skills’ to enable them to live drug-free in their communities after discharge.

Drug users who did not volunteer for drug treatment by 21 April 2003 were subject to the compulsory treatment phase of the policy. Through widespread media campaigns, drug users were asked to turn themselves in and enter compulsory treatment or be arrested. The compulsory treatment phase was administered by the Thai Ministry of Justice. By law, all known drug users and dealers who had not reported themselves to government authorities by this date were placed on lists that were highly publicised throughout local communities and given to local law enforcement officials. Communities were pressured to turn in drug users on the lists to local police in order for them to be placed in the appropriate level of treatment. The demand for drug treatment far exceeded the availability.

Incarcerated drug users were assigned by a team of public health, psychological, and probation personnel to one of four treatment modalities: (i) in custody of the probation office and sentenced to a military boot camp for 4 months; (ii) in custody of the probation office and placed at an in-patient drug treatment facility; (iii) in the custody of their local community; or (iv) mandated to report on a regular basis to the probation office. Placement in each of the four modalities was dependent upon the amount of drugs typically used and the amount in their possession on arrest. Through July 2003, the majority of drug users were assigned to either the boot camps or mandated to report to probation offices where they participate in life skills training and a range of activities. Concurrent to these demand reduction efforts, supply reduction was executed by a variety of means, including targeted arrests of drug syndicates and confiscation of drug supplies.

The Thai Government reported an initial success in the war as measured by the numbers of drug users who completed treatment as well as the number of drug users and dealers who were arrested. In the first 4 months of the campaign, according to the Office of the Narcotic Control Board an estimated 285,200 drug users had turned themselves in to government authorities for drug treatment and a total of 55,983 people were arrested for the following charges: 353 were charged with the production of drugs; 1729 were charged with large-scale sales; 14,585 were charged with the sale of small quantities; 19,663 were charged with drug possession; and 19,653 were charged with drug use (Office of the Narcotic Control Board, 2003c). The policy coincided with an increase in drug-related shootings, with over 2275 drug-related murders of drug dealers and drug users of which 51 cases were reportedly at the hands of the police (Office of the Narcotic Control Board, 2003c). Government reports claimed the remaining murders were carried out by large-scale drug dealers against small time drug dealers to prevent them from turning them in to authorities. These latter killings are called kha htad hton. As of September 2004, the majority of these killings remain uninvestigated. An estimated 1360 million baht (US$33.4 million) were confiscated by the police (Office of the Narcotic Control Board, 2003c).

Northern Thailand, with its close proximity to Myanmar is characterised by high rates of illicit drug use, primarily heroin injection and methamphetamine smoking (Razak et al., 2003). During the first 3 months of the new drug policy, 88,545 drug users and 15,710 drug dealers turned themselves in to government authorities in this region (Office of the Northern Region Narcotic Control Board, 2003). Additionally, 14,080 were arrested and charged with the production of drugs and/or drug sales. In the first 4 months of the campaign, 533 campaign-related murders were reported in Chiang Mai, 29 of these murders were drug dealers shot by police during attempted arrests and the remaining 504 were deemed Kha htad hton killings (Office of the Northern Region Narcotic Control Board, 2003). An estimated 600 million baht (US$15 million) were confiscated by the police in northern Thailand (Office of the Northern Region Narcotic Control Board, 2003).

The war on drugs created tremendous pressure on many segments of Thai society. The responsibility placed on local leaders to produce lists of resident drug users and dealers has resulted in widespread fear of and discrimination towards all drug users. This was particularly the case in rural areas where communities are small, and the resident population is relatively stable and where recrimination may occur on a community-wide basis.

From February 2002 to February 2003, we conducted formative, qualitative research in preparation for a large-scale randomised HIV prevention peer-outreach intervention targeting injection drug users (IDUs) in the northern province of Chiang Mai. The environment resulting from the war delayed our initiation of the intervention trial, which had been scheduled to begin in mid-2003, so in order to examine the effects of the war on IDU, in April 2003 we administered a survey among a sample of IDUs who had participated in our formative research. The survey's aim was to examine drug use, routes of administration, and attitudes towards the policy after the implementation of the government's new policy. Comparisons were made between urban and rural IDUs due to the potential differences in the policy's effects on these areas, resulting from the aforementioned pressure placed on rural communities.