Addiction Treatment

In a new wave of repression aimed at drug users, the government of Thailand has begun rounding up suspected "drug addicts" to be forced into "rehabilitation centers." That has health, human rights, and harm reduction groups expressing grave concerns, especially given previous Thai pogroms against drug users, like that in 2003, when tens of thousands were rounded up and more than 2,000 killed by police in summary executions.

The official announcement from the National News Bureau of Thailand of the government's plans came only last week. "The Ministry of Interior has picked next week to get all drug addicts across Thailand clean," it said, with Deputy Permanent Secretary for Interior Surapong Pongtadsirikul as putting the number of untreated addicts at 30,000.

"During 20-27 February, 2011, drug abusers in Bangkok will be brought to the rehabilitation centers to get clean," the notice continued. "There will be those who are encouraged to receive treatment on their freewill and those who will be forced against their will. A rehabilitation camp will be open for addicts elsewhere in Thailand where a rehab center is scarce."

The announcement also said staff training would be carried out and a location for a "makeshift rehab center for drug addicts" will be selected. Chillingly, it added that "their names will be recorded in the database specifically designed for easy tracking and providing updates on their progress in the future."

The roundup has already begun in Bangkok, according to Karyn Kaplan of the Thai AIDS Treatment Action Group (TTAG). "Yes, people are being arrested right now," she said. "The police have quotas, they do this every few months, and this is just another excuse to round people up again. Even in our own small network of people who use drugs, people have been arrested, even workers at our harm reduction center."

While the Thai government officially embraces harm reduction principles -- it adopted harm reduction as a national strategy last fall -- it schizophrenically continues its crackdowns on drug users and sends them to "treatment centers" not worthy of the name.

"We don't call them treatment centers, because they aren't run by people who know how to treat people," said Kaplan. "They were originally set up because of prison overcrowding, but even though they have a policy that says drug users are patients, not criminals, they still use the police to sweep the streets and throw people into the system. But then the system says there is no room in prison, send them to the camps. The camps are in military bases and run by the military, and they aren't trained for that. The military is just housing them, and there are beatings and forced labor for no money. There is no due process," she said.

It is as if the Thai government's left hand doesn't know what its right hand is doing, said Kaplan. "The government at least pays lip service to harm reduction, but the Ministry of the Interior is not talking to the Narcotics Control Board, which sponsors the harm reduction policy," she said. "We have gotten unofficial statements from senior officials inside the Public Health Ministry saying they are going to speak with the board and the Interior Ministry about what Thailand might do more effectively."

In the mean time, the roundups continue.

The threat of the mass roundup of suspected drug users has led a coalition of Thai and international health, harm reduction, and human rights organizations to publicly air their fears that it will trample on human rights and could lead to the widespread abuses of drug users seen in other Thai anti-drug campaigns.

"These plans for mass detention and forced treatment raise considerable human rights concerns, especially given Thailand’s history of nationwide punitive and ineffective anti-drug campaigns," they said in an open letter to the Thai government. "There is no way for the government to implement a campaign to forcibly 'treat' tens of thousands of people who use drugs without widespread human rights abuses taking place."

Groups signing on to the letter include the TTAG, the International Harm Reduction Association (IHRA), the International Drug Policy Consortium (IDPC), the International Harm Reduction Program of the Open Society Institute, the Canadian HIV/AIDS Legal Network, and the International Network of People Who Use Drugs (INPUD).

"The mandatory rounding up and detention of people who use illicit drugs for the purpose of enforced treatment is not only a violation of their human rights, it's a violation of common sense -- enforced detention doesn't work," said INPUD's Jude Byrne. "Never has, never will! Communities need to look to the reason people are using drugs. Stop the systemic violence against the poor, minorities, people of different sexual persuasion and the unemployed. Rounding up the most marginalized people in the community will do nothing except provide jobs for the police and the people who run the detention centers. It will also drive INPUD's community underground so they are not able to access harm reduction information or equipment where it is available. The transmission of HIV and Hep C among the injecting drug using community will soar, and that is the real crime, not the use of drugs."

"This crackdown flies in the face of Thailand’s 2002 policy, which states that people who use drugs should be treated as patients, not criminals. There is nothing therapeutic about rounding up thousands of drug users and forcing them into military boot camps that fail to provide appropriate services and support," said Paisan Suwannawong, TTAG executive director and co-founder of the Thai Drug Users' Network.

While the Thai government refers to "drug addicts," its plans appear to include any drug users. Under the current plan, "occasional" users will be detained for one week, "continuous" users for two weeks, and those showing signs of drug dependence for 6 1/2 weeks (45 days).

"There are many reasons to be worried," said IHRA executive director Rick Lines. "Due process guarantees have been thrown out the window. What is the legal basis for mass detention? There are numerous examples of how forced detention in the name of drug dependence 'treatment' can lead to human rights violations and breaches of accepted principles of medical ethics," he continued. "What is more, many who do not need any form of drug dependence treatment will be herded into detention centers. Where is the clinical assessment?" he asked.

The activists also expressed concern about the temporary detention centers that will be set up outside Bangkok. They feared they would be operated not by health workers, but by police or soldiers, they said.

"We are profoundly concerned that these centers may be run by public security forces such as the police or paramilitary civil-defense organizations" said Kaplan. "It is dangerous and extremely disheartening given recent progress made in the country on injecting drug use and HIV. This can only serve to undermine those efforts in the long term. The immediate concern, however, is for the safety and well-being of those targeted."

But the medium term goal is to persuade the Thai government to embrace not merely the rhetoric of harm reduction, but the practice. That is going to take continuing pressure on the government, and the United Nations needs to step up, said Kaplan.

"We need more high-level action to push the government over to harm reduction," she said. "The World Health Organization and the UN Office on Drugs and Crime don't listen to civil society, so we need governments to step up. It is very important and progressive that Thailand is talking harm reduction, but to actually do it, they need a lot of help."

The Obama administration released its a href="http://www.whitehousedrugpolicy.gov/policy/12budget/fy12Highlight.pdf">proposed 2012 National Drug Control Budget Monday and, despite President Obama's statement just over two weeks ago that the federal government needed to "shift resources" to have a smarter, more effective federal drug policy emphasizing public health approaches, there is little sign of any resource shifting.

Although budget documents said the administration seeks "a balanced approach" of prevention, treatment, and domestic and international law enforcement, law enforcement continues to get the lion's share of federal drug dollars. Of the more than $26 billion allocated for federal drug control efforts, nearly 60% would go to "supply reduction" (read: domestic and international drug law enforcement and military interdiction) and only 40% would go to treatment and prevention.

And in a time when the clamor for deficit reductions and budget cuts grows louder by the day, the Obama administration drug budget actually increases by 1.3% over 2010. That means it could be in for a rough ride when congressional appropriations committees get their hands on it, although no Republican leaders have yet commented on it.

[Editor's Note: All year-to-year comparisons are to Fiscal Year 2010 because Congress still hasn't passed a FY 2011 budget.]

On the other hand, at least the administration is being honest. Since 2004, the Office of National Drug Control Policy (ONDCP -- the drug czar's office), which produces the drug budget, under drug czar John Walters had used accounting legerdemain to substantially understate the real costs of federal drug control by not including the drug component in the work of a number of different federal agencies. Using the understated figures, this year's drug budget would have appeared to have been only $15.3 billion instead of the more accurate $26.2 billion, with a false appearance of equality between supply-side and demand-side funding.

[Editor's Note: Bush-era drug czar John Walters stated directly, in response to a question I asked at an event, that they omitted budget items that included drug control but were not 100% about drug control -- claiming that made the numbers "more accurate," but not explaining how that made sense in any way. -DB]

"At least they finally got around to fixing the accounting problem," said Bill Piper, national affairs director for the Drug Policy Alliance."It took them five years after Congress told them to fix it, but at least they are showing the true cost of things, like incarceration."

But neither Piper nor representatives of other drug reform groups had much else nice to say about the budget. "It's very much like last year's budget, with most money going to ineffective supply side programs and not enough going to treatment," Piper said. "You have the president and the drug czar talking about treating drug abuse as a public health issue just weeks ago, but their budget continues to treat it as a law enforcement and military issue."

"I don't understand how the president can tell us with a straight face that he wants to treat drugs as a health issue but then turn around just a few weeks later and put out a budget that continues to emphasize punishment and interdiction," said Neill Franklin, executive director of Law Enforcement Against Prohibition and a former narcotics officer in Baltimore. "The president needs to put his money where his mouth is. Right now it looks like he's simply all talk and no game."

"I see this similarly to Obama's approach on needle exchange and crack sentencing -- the president supported those reforms verbally, but did nothing else to help them at first, even when he had the opportunity," said David Borden, executive director of StoptheDrugWar.org, publisher of this newsletter. "But when Congress was ready to take them on, the administration provided enough support to get them through. Obama has also supported the idea of shifting the drug budget's priorities, but again has done nothing whatsoever to make it happen. Maybe what he wants is for Congress to do the heavy lifting on this as well. If so, our movement's task is to propose a politically viable new version of the budget that does change the priorities, to build support for it in Congress, and then look for the administration to get on board."

"We're definitely going to be focused on cutting funding to the drug war during the congressional appropriations process," said Piper. "We're already meeting with both Republicans and Democrats to increase support for cutting funding to the Byrne grants, the media campaign, and other ineffective drug war programs. I don't think there are any sacred cows now, and our goal is to get the drug war on the chopping block along with everything else."

While there are individual programs that saw cuts in both the treatment and prevention side and the law enforcement side, only in the realm of international anti-drug assistance was there an overall decrease in spending. Although the budget funds foreign assistance at $2.1 billion, that is $457 million less than the 2010 budget, a decrease of 17%. The decrease results from the winding down of Plan Colombia funding, a shift from expensive technologies for Mexico to more programmatic aid, and the re-jiggering of some of the Afghanistan anti-drug spending to be counted as "rule of law" spending.

Proposed spending on interdiction is set at $3.9 billion, an increase of $243 million over 2010 levels. The departments of Defense and Homeland Security account for the bulk of that spending, which includes an increase of $210 million for border security and port of entry facilitation on the US-Mexico border.

But international anti-drug aid and interdiction spending are dwarfed by domestic drug law enforcement, which would gobble up $9.5 billion under the Obama drug budget, an increase of $315 million over 2010 levels, or 3.4%. Unsurprisingly, the single largest domestic law enforcement expenditure is $3.46 billion to incarcerate federal drug war prisoners.

[Editor's Note: In the budget, the authors refer to high federal corrections costs because of the high number of drug war prisoners -- they make up well over half the more than 200,000 federal prisoners -- as "a consequence of drug abuse," when those costs are more than anything a consequence of public policy decisions made over decades.]

The Office of Justice Grants program, which includes the Byrne Justice Assistance Grants used to fund anti-drug multi-jurisdiction law enforcement task forces, would be slashed substantially, from $3.52 billion in 2010 to $2.96 billion in 2012, but on the other hand, the Justice Department 2012 budget contains $600 million to hire and retain 4,500 new police officers.

"It's encouraging that they cut funding for the Byrne grants," said Piper, "but they're increasing funding for the COPS program. The money is still going to law enforcement, but cutting those grants is a step in the right direction."

There are a few law enforcement side losers in addition to the Byrne grants. The DEA budget is down slightly, from $2.05 billion in 2010 to $2.01 billion in 2012, but that reflects supplemental spending for the southwest border that was included in 2010. The High Intensity Drug Trafficking Area (HIDTA) program, which has evolved into a prime example of pork, saw its funding slashed to $200 million, down from $239 million.

And while overall treatment and prevention funding was up slightly, by 1% and 8% respectively, those increases are relatively slight, and there are some losers there, too. The Substance Abuse and Mental Health Services Administration (SAMHSA) Prevention grant program would decline from $565 million in 2010 to $550 million in 2012, Drug Free Communities funding would decline from $95 million to $89 million, and substance abuse treatment Medicaid grants to the states would decline from $3.78 billion to $3.57 billion.

On the plus side, spending for the Successful, Safe, and Healthy Students grant program would increase from $177 million to $267 million, Medicare treatment spending would increase by about 10% to $1.463 billion, Substance Abuse Treatment Block Grant funding would increase fractionally, and reentry funding under the Second Chance Act would increase from $30 million to $50 million.

The much criticized ONDCP youth media campaign would remain at $45 million, and the mostly praised drug court program would also remain unchanged, at $57 million.

All in all, despite slight changes in emphasis, the 2012 federal drug control budget is much of a muchness with previous drug budgets, despite the Obama administration's lip service about changing priorities and embracing the public health paradigm.

"Everyone wants to cut federal spending somehow," said Piper. "It seems that cutting the drug war would be an easy way to do that without cutting funds to the poor, to education, and other desirable social programs. Obama has said how sad he was to have to cut programs he likes, but he probably could have saved those programs by cutting funding for the drug war."

A prestigious Washington, DC-based center for hemispheric policy analysis and discussion, the Inter-American Dialogue, is calling for a refashioning of US drug policy. It demands an end to "the silent tolerance of ineffective, socially harmful laws, institutions, and policies" and has some suggestions as to where to go next.

In a report authored by the Dialogue's Peter Hakim, Rethinking US Drug Policy, the Dialogue said: "The available evidence suggests that in the past two decades, US anti-drug policies have done little to diminish the problems they were designed to address." The report proposed a number of initiatives the US government could undertake to set the stage for a thorough rethinking of US drug policy:

• Support recent Congressional initiatives to establish House and Senate commissions to review US anti-drug strategies and develop alternative approaches;
• Join with other nations to organize an inter-governmental task force on narcotics strategy that would review and appraise global drug policies;
• Revise outdated UN treaties that underpin the international narcotics regime;
• Expand data collection, analysis, and research on multiple aspects of drug problems and the policies and programs designed to address them; and
• Identify and scale up successful drug programs that promise to reduce drug addiction and the health risks to addicts, increase the prospects of rehabilitation, and decrease drug related crimes.

The Inter-American Dialogue is holding a public discussion of the report and its recommendations Thursday, 2/10/11 on Capitol Hill.