07/18/2008 05:12 am ET | Updated Nov 17, 2011

The Public Health Consequences Of Thailand's War on Drugs

Over the past six months I have been involved in a project addressing access to health care in the prison system in Northern Thailand. The initial focus of the project was HIV/AIDS and public health information and services in Chiang Mai Women's Prison. The community legal education aspect of the project is the development of curriculum that aims to increase awareness of health issues and empower prisoners to access the health care services to which they are legally entitled - which is primarily what I was working on. More broadly the project looks at structural and policy issues that contribute to problems with availability of services and access to those services.

As I learned about the Thai prison system it quickly became clear that Thai drug policy is directly impacting public health both within and outside of prison. As background information: in 1997 the Thai government criminalized yaabaa in the same way as heroine. As a result, the prison population doubled within four years and up to 2/3 of all prisoners in Thailand are incarcerated for drug related offenses. The current prison population exceeds capacity by over 50%. Overall, 80% of the people arrested and incarcerated in Thailand in 2006 were arrested for yaabaa related offenses. In addition the use of 'Drug Treatment Centers' is rising rapidly in Thailand, Cambodia and Laos. These drug treatment centers are compulsory drug treatment facilities that provide no actual treatment services, are poorly managed, over crowded and under resourced.

There are a number of public health consequences of a policy that encourages and overuses incarceration, especially amongst youth. For example, a history of incarceration is associated with unprotected sex and injection drug use which increases the risk of HIV infection. Furthermore, outside of prison drug users, and in particular injection drug users, are reluctant to use government heatlh services because it is common for doctors to report suspected drug use and this can lead to arrest and imprisonment. On a structural level, prisons don't have the necessary medical staff and resources to deal with the increased number of prisoners.

I went into the prison a number of times to observe and monitor lessons taught by students at Chiang Mai University's Faculty of Law CLE program on various areas of the law. The lessons were taught to prisoners that were incarcerated for drug related offenses - which can be something as minor as possession of a few yaabaa pills. I expected high security, overcrowding, dismal conditions... all the things that come to mind when thinking of prisons in Thailand. Chiang Mai Women's Prison is definitely unique in Thailand - particularly in comparison with conditions in the men's prisons - but it was none of the things that I was expecting.

What was most surprising was the women themselves. There is something pretty special about watching a group of Thai 'drug offenders' dancing around or dressing up in silly outfits to do a skit on introduction to the law. The group overall gave an impression of incredible normacly, varying in age from quite young (early 20s) to middle aged and older. Sitting there watching them participate in the lessons I just kept thinking about what circumstances led them to be where they are. It is all too easy to think of all the people imprisoned for 'drug offences' and distance yourself from them. They are criminals and therefore deserve to be in prison. But when you think about the policies that decided what qualifies as a drug offence, and who those policies target, it all starts to feel very questionable.

I have a problem with drug policies that focus on imprisonment and criminalization as the primary method to combat drug use and trafficking, mostly because they don't work, and also because they end up targeting and imprisoning poor and marginalized people. A policy that caters to fear, an us versus them mentality, and sheer ignorance is destined to fail and cause harm along the way. Thailand is not by any means unique in their approach to drug policy but seeing a small portion of the impact of the "War on Drugs" and learning about the directly related public health consequences - which was an aspect of it that I had not considered before - made me consider the issue from a different perspective.

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