Compulsory drug detention center experiences among a community-based sample of injection drug users in Bangkok, Thailand

Joanne Csete,Nadia Fairbairn,Thomas Kerr,Paisan Suwannawong,Karyn Kaplan,Evan Wood,Kanna Hayashi,Ruth Zhang

doi:10.1186/1472-698x-11-12

Abstract

BackgroundDespite Thailand's official reclassification of drug users as "patients" deserving care and not "criminals," the Thai government has continued to rely heavily on punitive responses to drug use such as "boot camp"-style compulsory "treatment" centers. There is very little research on experiences with compulsory treatment centers among people who use drugs. The work reported here is a first step toward filling that gap.MethodsWe examined experiences of compulsory drug treatment among 252 Thai people who inject drugs (IDU) participating in the Mitsampan Community Research Project in Bangkok. Multivariate logistic regression was used to identify factors independently associated with a history of compulsory treatment experience.ResultsIn total, 80 (31.7%) participants reported a history of compulsory treatment. In multivariate analyses, compulsory drug detention experience was positively associated with current spending on drugs per day (adjusted odds ratio [AOR] = 1.86; 95%CI: 1.07 - 3.22) and reporting drug planting by police (AOR = 1.81; 95%CI: 1.04 - 3.15). Among those with compulsory treatment experience, 77 (96.3%) reported injecting in the past week, and no difference in intensity of drug use was observed between those with and without a history of compulsory detention.ConclusionThese findings raise concerns about the current approach to compulsory drug detention in Thailand. Exposure to compulsory drug detention was associated with police abuse and high rates of relapse into drug use, although additional research is needed to determine the precise impact of exposure to this form of detention on future drug use. More broadly, compulsory "treatment" based on a penal approach is not consistent with scientific evidence on addressing drug addiction and should be phased out in favor of evidence-based interventions.

Highlights

Despite Thailand’s official reclassification of drug users as “patients” deserving care and not “criminals,” the Thai government has continued to rely heavily on punitive responses to drug use such as “boot camp"-style compulsory “treatment” centers
We investigated the prevalence of injection drug use in the past week among those who reported a history of compulsory drug detention
Compulsory drug detention experience was positively associated with spending > 300 Thai Baht per day on drugs, use of drugs in combination (OR = 1.99; 95%Confidence Interval (CI): 1.07 - 3.69), and ever having experienced drug planting by police (AOR = 1.99; 95%CI: 1.16 - 3.41)

Summary

Introduction

Despite Thailand’s official reclassification of drug users as “patients” deserving care and not “criminals,” the Thai government has continued to rely heavily on punitive responses to drug use such as “boot camp"-style compulsory “treatment” centers. Ensuring access to sterile injecting equipment and to humane and scientifically sound treatment for drug dependence, including methadone maintenance therapy, should be. Where illicit drug use is heavily criminalized, health services for people who inject drugs may be influenced or controlled by criminal law authorities. Various forms of compulsory or mandated drug dependence treatment, including drug courts, have been implemented in various settings. While evaluations have suggested some benefits of this type of approach, including reductions in drug-use-related criminal activity [6], a number of commentators have raised methodological concerns about existing evaluations (e.g., lack of data on post-release drug use, failure to incorporate intent-totreat analyses, use of inappropriate control comparison groups) [7,8,9,10,11]. There is some evidence indicating the benefits of offering integrating drug dependence treatment within criminal justice systems [6,13]

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