The authors have declared that no competing interests exist.
Conceived and designed the experiments: KH TK. Performed the experiments: KH SH. Analyzed the data: KH WS JC SH TK. Contributed reagents/materials/analysis tools: KH JC WS TK. Wrote the first draft of the manuscript: KH. Contributed to the writing of the manuscript: KH JC WS SH TK.
Using thematic analysis, Kerr and colleagues document the experiences of policing among people who inject drugs in Bangkok and examine how interactions with police can affect drug-using behaviors and health care access.
Despite Thailand's commitment to treating people who use drugs as “patients” not “criminals,” Thai authorities continue to emphasize criminal law enforcement for drug control. In 2003, Thailand's drug war received international criticism due to extensive human rights violations. However, few studies have since investigated the impact of policing on drug-using populations. Therefore, we sought to examine experiences with policing among people who inject drugs (PWID) in Bangkok, Thailand, between 2008 and 2012.
Between July 2011 and June 2012, semi-structured, in-depth interviews were conducted with 42 community-recruited PWID participating in the Mitsampan Community Research Project in Bangkok. Interviews explored PWID's encounters with police during the past three years. Audio-recorded interviews were transcribed verbatim, and a thematic analysis was conducted to document the character of PWID's experiences with police. Respondents indicated that policing activities had noticeably intensified since rapid urine toxicology screening became available to police. Respondents reported various forms of police misconduct, including false accusations, coercion of confessions, excessive use of force, and extortion of money. However, respondents were reluctant to report misconduct to the authorities in the face of social and structural barriers to seeking justice. Respondents' strategies to avoid police impeded access to health care and facilitated transitions towards the misuse of prescribed pharmaceuticals. The study's limitations relate to the transferability of the findings, including the potential biases associated with the small convenience sample.
This study suggests that policing in Bangkok has involved injustices, human rights abuses, and corruption, and policing practices in this setting appeared to have increased PWID's vulnerability to poor health through various pathways. Novel to this study are findings pertaining to the use of urine drug testing by police, which highlight the potential for widespread abuse of this emerging technology. These findings raise concern about ongoing policing practices in this setting.
In many countries, the dominant strategy used to control illegal drugs such as heroin and methamphetamine is criminal law enforcement, a strategy that sometimes results in human rights abuses such as ill-treatment by police, extrajudicial killings, and arbitrary detention. Moreover, growing evidence suggests that aggressive policing of illicit drug use can have adverse public-health consequences. For example, the fear engendered by intensive policing may cause people who inject drugs (PWID) to avoid services such as needle exchanges, thereby contributing to the HIV/AIDS epidemic. One country with major epidemics of illicit drug use and of HIV/AIDS among PWID is Thailand. Although Thailand reclassified drug users as “patients” instead of “criminals” in 2002, possession and consumption of illicit drugs remain criminal offenses. The 2002 legislation also created a system of compulsory drug detention centers, most of which lack evidence-based addiction treatment services. In 2003, the Thai government launched a campaign to suppress drug trafficking and to enrol 300,000 people who use drugs into treatment. This campaign received international criticism because it involved extensive human rights violations, including more than 2,800 extrajudicial killings of suspected drug users and dealers.
Drug-related arrests and compulsory detention of drug users are increasing in Thailand but what is the impact of current policing practices on drug users and on public health? In this qualitative study (a study that aims for an in-depth understanding of human behavior), the researchers use thematic analysis informed by the Rhodes' Risk Environment Framework to document the social and structural factors that led to encounters with the police among PWID in Bangkok between 2008 and 2012, the policing tactics employed during these encounters, and the associated health consequences of these encounters. The Risk Environment Framework posits that a range of social, political, economic, and physical environmental factors interact with each other and shape the production of drug-related harm.
Between July 2011 and June 2012, the researchers conducted in-depth interviews with a convenience sample (a non-random sample from a nearby population) of 42 participants in the Mitsampan Community Research Project, an investigation of drug-using behavior, health care access, and drug-related harms among PWID in Bangkok. Respondents reported that policing activities had intensified since rapid urine toxicology screening became widely available and since the initiation of a crackdown on drug users in 2011. They described various forms of violence and misconduct that they had experienced during confrontations with police, including false accusations, degrading stop and search procedures, and excessive use of force. Urine drug testing was identified as a key tool used by the police, with some respondents describing how police caused unnecessary humiliation by requesting urine samples in public places. It was also reported that the police used positive test results as a means of extortion. Finally, some respondents reported feeling powerless in relation to the police and cited fear of retaliation as an important barrier to obtaining redress for police corruption. Others reported that they had adopted strategies to avoid the police such as staying indoors, a strategy likely to impede access to health care, or changing their drug-using behavior by, for example, injecting midazolam rather than methamphetamine, a practice associated with an increased risk of injection-related complications.
These findings suggest that the policing of PWID in Bangkok between 2008 and 2012 involved injustices, human rights abuses, and corruption and highlight the potential for widespread misuse of urine drug testing. Moreover, they suggest that policing practices in this setting may have increased the vulnerability of PWID to poor health by impeding their access to health care and by increasing the occurrence of risky drug-using behaviors. Because this study involved a small convenience sample of PWID, these findings may not be generalizable to other areas of Bangkok or Thailand and do not indicate whether police misconduct and corruption is highly prevalent across the all police departments in Bangkok. Nevertheless, these findings suggest that multilevel structural changes and interventions are needed to mitigate the harm associated with policing of illicit drug use in Bangkok. These changes will need to ensure full accountability for police misconduct and access to legal services for victims of this misconduct. They will also need to include ethical guidelines for urine drug testing and the reform of policies that promote repressive policing and compulsory detention.
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This study is further discussed in a
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More information about the
In many countries, repressive criminal law enforcement is the dominant strategy for drug control
Thailand has been contending with longstanding dual epidemics of illicit drug use
Since the launch of this system, the Thai government has implemented a series of police crackdowns focused on illicit drug use and expanded the system
Despite concern that recent drug policy developments may have marked a return to the old drug war
This study was approved by the research ethics boards at Chulalongkorn University and the University of British Columbia.
A qualitative descriptive approach
Between July 2011 and June 2012, semi-structured in-depth interviews were conducted with 48 PWID in Bangkok. Potential respondents were recruited face-to-face from the concurrent quantitative arm of the project
Two bilingual Thai research assistants (including the study's fourth author, SH) were trained by KH (a PhD student) and TK (a public health researcher) to conduct interviews in Thai based on a semi-structured interview guide (
Throughout the data collection process, the research team discussed the content of interview data as well as the focus and direction of subsequent interviews. Data collection was continued until data reached a point of saturation (new respondents' narratives reiterated points made previously). All respondents provided informed consent and were interviewed by the two interviewers. No respondents dropped out from interviews. All interviews were conducted in private rooms at the Mitsampan Harm Reduction Center and O-Zone House. During the interviews, only the respondent and interviewer were present in the room. Interviews lasted between 40 and 90 minutes and were audio-recorded. Upon completion of the interview, respondents received a stipend of 450 Thai Baht (approximately US$15), and interviewers took brief notes of the interviews summarizing the key topics covered and any problems identified during the interviews. There were no repeat interviews. While transcripts were not returned to respondents for comments, interviewers summarized the main points during the interview, which provided opportunities for respondents to confirm whether interviewers properly captured the content of the respondents' narratives.
All audio-recorded interviews were transcribed verbatim in Thai and translated into English. The interviewers who were bilingual in Thai and English and who have developed familiarity with terms used among local PWID reviewed the translated transcripts for accuracy. Further, a native English-speaking proof-reader with an excellent knowledge of both Thai and English also verified the English transcripts for grammatical accuracy and nuance by comparing the English transcripts with Thai transcripts and audio-files.
In-depth interview data were analysed to identify the situational factors leading to police encounters as well as to identify policing tactics employed during these interactions, particularly with respect to international human rights norms for policing. We also analysed respondents' actions and behaviours after the police encounters, and any subsequent health consequences. All data were entered into Atlas.ti (version 6.2), software designed to assist qualitative data management and analyses. Data analysis was informed by the Risk Environment Framework
Data analysis was conducted inductively, employing a multi-step thematic analysis. On the first pass, KH created an initial set of codes. Subsequent reviews involved refining the codes and assigning data segments to categories with substantive input from other co-authors, including WS, JC, and TK who had extensive experience in qualitative investigations of the impacts of policing among people who use drugs
In total, 42 PWID were interviewed for this study, including 17 (40.5%) women. The median age was 35.5 years (range: 23–52 years).
Characteristic | |
Female gender | 17 (40.5%) |
Age: | |
≤30 years | 7 (16.7%) |
31–40 years | 21 (50.0%) |
>41 years | 14 (33.3%) |
Drugs most frequently injected |
|
Midazolam | 30 (71.4%) |
Heroin | 17 (40.5%) |
Methamphetamine | 13 (31.0%) |
Crystal methamphetamine | 10 (23.8%) |
Methadone | 4 (9.5%) |
Self-reported HIV seropositivity | 14 (33.3%) |
a Refers to the 6 months prior to the interview. Multiple answers were allowed.
Various factors surrounding and leading to police confrontations were identified from respondents' accounts and grouped into four main themes including drug policies and laws, financial incentives within policing structures, police surveillance methods, and individual characteristics. Respondents' narratives indicated that many of these main themes as well as sub-themes interacted with each other and could result in various forms of police misconduct and violence as described in the following section. Under the theme of drug polices and laws, several sub-themes were identified, including the 2011 large-scale police crackdown; changes in drug laws that enabled police officers to use rapid urine drug testing; mobilization of civil volunteers in drug policing; and the focus on young people. Sub-themes of the police surveillance methods were further categorized into those specific to physical environments (i.e., roadside checkpoints, vicinities of methadone clinics, and police raids on one's home) and social environments (i.e., undercover police operations, police informants, and civil volunteers). Sub-themes within the individual characteristics included age, prior contact with the local police, and having visible signs of drug use (e.g., needle marks and tattoos).
Respondents noted that policing during the past 3 years was experienced as recurrent waves of crackdowns on people who use drugs. It was reported that policing activities had noticeably intensified since rapid urine toxicology screening became widely available to police.
Respondents also indicated greater police pressure since the government initiated a large-scale crackdown on people who use drugs in 2011
During the 2003 “war on drugs” campaign, the police had to fill arrest quotas and were rewarded for making drug-related arrests
Respondents described various overt and covert surveillance methods employed by police officers to identify people who use drugs. Many police officers reportedly wore plain clothes at work. A couple of respondents also reported that officials of the Office of the Narcotics Control Board of Thailand engaged in arresting drug dealers. Although many respondents claimed they could immediately identify a plain-clothes officer by his/her appearance, some respondents reported confusion because these plain-clothes officers sometimes demanded a search without identifying themselves as police, and at the same time would not show identification when asked. One account noted that in this situation an unscrupulous person could pretend to be a policeman and position himself to rob a person who uses drugs.
Many respondents cited roadside checkpoints as a police surveillance method. These checkpoints were set up in diverse locations at various times but particularly at night and in “red zones,” which denote districts in which many drug dealers and people who use drugs are believed to congregate, including “slum-like neighbourhoods” (respondent #1, male, age 37).
Respondents also reported that the police were present around methadone clinics, presumably to take advantage of the volume of people who use drugs coming and going from these venues. A patient in methadone treatment reported that the police threatened to send him and other patients to compulsory drug detention centres:
Respondents perceived that several individual factors made them “look like drug users” or otherwise increased the chance of being subjected to stop-and-search procedures by the police. These factors included being known to the local police as a person who uses drugs (e.g., those with criminal records), being young, having visible tattoos or needle marks, and looking nervous. Some respondents shared a belief that tattoos signified that a person had been in prison and were indicative of being a drug offender.
In addition to roadside stop-and-search surveillance, the police also reportedly relied on information supplied by people who use drugs or local residents to identify potential offenders. For example, some respondents were forced by police to identify known drug dealers (“to be a finger for the police”). However, all of them reported that they refused to “be a finger” out of fear of retaliation and distrust from drug dealers and other people who use drugs.
As the Thai drug authorities have ordered local authorities to engage civilians in identifying people who use drugs
One consequence of being identified by the local police as a person who uses drugs was a police raid on one's home, sometimes after midnight. Some respondents who were raided in their homes tended to experience it more than once.
Respondents described various forms of police violence and misconduct that they experienced first-hand. Main themes in this section included: false accusations, degrading stop-and-search procedures, urine drug testing, extortion of money, coerced confessions, and excessive use of force. In particular, urine drug testing was identified as a key tool used by the police, and the provision of test results appeared to be closely associated with other forms of police violence and misconduct (e.g., extortion of money and excessive use of force). Urine drug testing also served as a sub-theme of degrading stop-and-search procedures.
Some respondents known to local police officers as people who use drugs reported that they were coerced into “helping” the country by admitting guilt to false charges.
Many respondents reported that police would immediately search their bodies or belongings, often in degrading ways. Possession of drug paraphernalia was experienced by some respondents as grounds for arrest, despite the National Police Office's memorandum instructing that it should not be done
Respondents reported that police attempted to extort money from them, particularly when the results of drug testing were positive. In many cases, the respondents were presented with an opportunity to provide a bribe and negotiate with police for lighter charges or avoid the charge altogether. The negotiation was initiated by either the person detained or the police, who may cite a specific monetary value or goods (e.g., a bottle of whiskey) in return for a bribe.
Many respondents also stated that they were falsely accused, had evidence planted on them by police, or were coerced into confessing to a crime that they did not commit (e.g., theft). Some respondents reported that they were compelled to sign a blank sheet and were not informed of the charges they faced until at a later stage.
Excessive use of force was reported as another means employed by police to extract a confession from a detainee. Many of the respondents who experienced this form of violence asserted that these confessions were often false. The methods used by police included beating or kicking suspects, sometimes combined with a physical restraint (e.g., handcuffs), electric shock, and being soaked in ice water.
The data regarding PWID's reactions to policing were grouped into two categories: barriers to seeking justice and strategies to avoid the police. In the first category, two main themes were identified: social factors and factors related to the judicial system and processes. Sub-themes under the social factors theme included police corruption and feeling powerless in relation to police, whereas sub-themes related to the judicial system and processes included poor availability of legal services, slow judicial proceedings, fear of detention, and being a drug offender. Regarding the strategies to avoid the police, main themes included restricting one's activities, moving out of “red zones,” changing drug-using behaviour, or not employing any strategies. Retreating into one's house and reduced access to health care were identified as sub-themes of restricting one's activities. Sub-themes related to drug-using behaviour included resorting to discreet locations for drug use, hurried injections, refraining from using methamphetamines, and changing types of drugs consumed. Sub-themes assigned to the last theme included anxiety, fatalism, and drug use as stress coping.
Despite having experienced police abuse, respondents showed reluctance to report these experiences to the authorities or seek justice. Some respondents reported feeling powerless in relation to police, and felt discouraged and intimidated by the police officers' disregard for their rights:
Other respondents reported police corruption and fear of retaliation from the police as being important barriers to obtaining redress.
In addition, respondents reported barriers related to the judicial system and processes, including limited knowledge about or access to legal services, slow judicial proceedings, and fear of detention while awaiting a trial. One respondent recounted a 3-year-long court fight against a false accusation. Furthermore, some respondents believed that a previous drug conviction meant that they could not win a court case over police misconduct or prove their innocence. One respondent reported that a court-appointed lawyer even advised that he accept a false charge rather than fight it:
As a result of numerous and repeated negative interactions with the police, many respondents employed strategies to avoid the police. Common strategies included retreating to one's house or a new location outside “red zones” and making changes to drug use behaviours. Many of these tactics had negative impacts on respondents' health and well-being.
The simplest strategy for avoiding police was to refrain from going outside where one could be subjected to police scrutiny. This strategy often impeded respondents' access to health care, including methadone clinics.
Some respondents also reported that they changed the venues where they used drugs, resorting to injecting drugs alone in more discreet locations, while others engaged in hurried injections out of fear of being detected by the police.
Respondents noted that police actions also sometimes led them to change the types of drugs they consumed. Several respondents believed that the rapid urine screening kits used by the police detected the presence of methamphetamines only, so they stopped using methamphetamines and shifted to other drugs, including midazolam, a short-acting benzodiazepine that can be obtained from private clinics.
Finally, some respondents did not actively employ any strategies to avoid police confrontations but felt concerned and anxious about the intensive and endless police pressure. These individuals reported either becoming fatalistic about the risk of police encounters and the associated harms or engaging in drug use to cope with the excessive stress.
The findings of this study suggest that policing of PWID in Bangkok has involved injustices, human rights abuses, and corruption. Consistent with a large body of literature from several settings
This study has several limitations that should be noted when interpreting the findings. First, our findings are based on interviews with PWID who had direct encounters with police in the previous 3 years. Therefore, experiences and views of non-PWID or other PWID who did not confront police officers were not included. Second, because the respondents were asked to remember experiences they had up to 3 years ago, their narratives may have been affected by recall bias. Third, although efforts were made to attain a balance in demographic characteristics among the interviewees, we could not meaningfully reach sub-populations of PWID who also belonged to other vulnerable populations, including transgendered persons, migrants, and sex workers. Their experiences with police may be different from those reported here. The potential biases associated with our small convenience sample may limit the transferability of the findings. Lastly, it was not possible to determine from this analysis whether the police misconduct and corruption reported by respondents were highly prevalent and ongoing across the all police departments in Bangkok.
A notable finding of this study is evidence of harm related to the use of urine testing by police. In Thailand, the 2000 amendment of the
Our findings shed light on some social and structural factors contributing to the observed rights violations. Some respondents perceived increasing police pressure in 2011 when the Thai government substantially increased numerical targets for drug treatment enrolment
Consistent with studies from other countries
In addition, the findings indicate that police corruption and other police misconduct have further contributed to PWID's vulnerability to drug-related harm. We identified extortion of money by the police as a main theme of the police violence and misconduct. This is consistent with a previous study from this setting reporting that half of PWID who reported having drugs planted on them paid police a bribe in order to avoid arrest
Our findings also suggest that policing practices may have disproportionately affected some persons, particularly former drug offenders. Even though there is no registration system for people who use drugs in Thailand, as there is in many eastern European countries
It is particularly concerning that many respondents who experienced police abuse were forced to bear this abuse in silence. In accordance with its international human rights obligations, Thailand has a legal framework that prohibits state corruption, prohibits the use in court of evidence obtained through unlawful means, and grants victims of torture the right to seek redress and compensation
Collectively, our findings suggest a need for multilevel structural changes and interventions to mitigate the harm associated with policing in Bangkok. These include abolishing numerical targets for drug treatment enrolment that effectively promote compulsory detention, banning financial incentives and blacklists to reduce the potential for abusive policing practices, establishing binding commitments from the police not to interfere with health and harm reduction services, and training police to understand harm reduction activities. Globally, the latter two interventions have been applied in many settings and have faced such challenges as high turnover among police, varied public perceptions of the role of police, and police corruption
Repressive policing of PWID is largely attributable to harsh application of criminal penalties to a wide range of drug offenses. In recent years, a number of countries have experimented with alternative regulatory frameworks for illicit drugs, including decriminalization of personal drug use
Lastly, clear ethical standards need to be established to safeguard against abusive practices related to the police's use of drug testing. While drug testing is increasingly used in many settings, including health care settings, workplaces, schools, and correctional facilities
In sum, this study suggests that policing in Bangkok has involved various injustices, human rights abuses, and corruption, and policing practices in this setting appeared to have increased PWID's vulnerability to poor health through various pathways. Novel to this study are findings pertaining to the use of urine drug testing by police, which highlight the potential for widespread abuse of this emerging technology. These findings raise concern about ongoing policing practices in this setting and indicate an urgent need to ensure full accountability for police abuses and access to legal services among the victims of police abuses. Further, ethical guidelines for urine drug testing by police are needed, as are reforms of policies that promote repressive policing and compulsory drug detention. The Thai government should instead develop policies that encourage access to voluntary evidence-based drug treatments and incorporate evidence-based harm reduction approaches. Future research should explore the views and experiences of police officers in order to identify challenges and opportunities related to the implementation of these policy recommendations.
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We would particularly like to thank the staff and volunteers at the Mitsampan Harm Reduction Center, Thai AIDS Treatment Action Group, and O-Zone House for their support and Niyada Kiatying-Angsulee of the Social Research Institute, Chulalongkorn University, for her assistance with developing this project. We also thank Tricia Collingham, Deborah Graham, and Peter Vann for their research and administrative assistance, and Prempreeda Pramoj Na Ayutthaya, Arphatsaporn Chaimongkon, Sabrina K. Gyorvary, Orntima Kularb, Somkiat Meetham, and Lianping Ti for their assistance with data collection.
people who inject drugs