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Reports of evidence planting by police among a community-based sample of injection drug users in Bangkok,… Fairbairn, Nadia; Kaplan, Karyn; Hayashi, Kanna; Suwannawong, Paisan; Lai, Calvin; Wood, Evan; Kerr, Thomas Oct 7, 2009

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ralBMC International Health and ssBioMed CentHuman RightsOpen AcceResearch articleReports of evidence planting by police among a community-based sample of injection drug users in Bangkok, ThailandNadia Fairbairn1, Karyn Kaplan3, Kanna Hayashi1, Paisan Suwannawong3, Calvin Lai1, Evan Wood1,2 and Thomas Kerr*1,2Address: 1British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada, 2Department of Medicine, University of British Columbia, Vancouver, Canada and 3Thai AIDS Treatment Action Group, Bangkok, ThailandEmail: Nadia Fairbairn -; Karyn Kaplan -; Kanna Hayashi -; Paisan Suwannawong -; Calvin Lai -; Evan Wood -; Thomas Kerr* -* Corresponding author    AbstractBackground: Drug policy in Thailand has relied heavily on law enforcement-based approaches.Qualitative reports indicate that police in Thailand have resorted to planting drugs on suspecteddrug users to extort money or provide grounds for arrest. The present study sought to describethe prevalence and factors associated with this form of evidence planting by police among injectiondrug users (IDU) in Bangkok.Methods: Multivariate logistic regression was used to identify factors associated with evidenceplanting of drugs by police among a community-based sample of IDU in Bangkok. We also examinedthe prevalence and average amount of money paid by IDU to police in order to avoid arrest.Results: 252 IDU were recruited between July and August, 2008, among whom 66 (26.2%) werefemale and the median age was 36.5 years. In total, 122 (48.4%) participants reported having drugsplanted on them by police. In multivariate analyses, this form of evidence planting was positivelyassociated with midazolam use (Adjusted Odds Ratio [AOR] = 2.84; 95% Confidence Interval [CI]:1.58 - 5.11), recent non-fatal overdose (AOR = 2.56; 95%CI: 1.40 - 4.66), syringe lending (AOR =2.08; 95%CI: 1.19 - 3.66), and forced drug treatment (AOR = 1.88; 95%CI: 1.05 - 3.36). Amongthose who reported having drugs planted on them, 59 (48.3%) paid police a bribe in order to avoidarrest.Conclusion: A high proportion of community-recruited IDU participating in this study reportedhaving drugs planted on them by police. Drug planting was found to be associated with numerousrisk factors including syringe sharing and participation in government-run drug treatment programs.Immediate action should be taken to address this form of abuse of power reportedly used by police.Background mission and overdose [1,2]. Numerous strategies havePublished: 7 October 2009BMC International Health and Human Rights 2009, 9:24 doi:10.1186/1472-698X-9-24Received: 13 March 2009Accepted: 7 October 2009This article is available from:© 2009 Fairbairn et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Page 1 of 6(page number not for citation purposes)Illicit injection drug use is associated with significant mor-bidity and mortality, including infectious disease trans-been implemented to address these harms and deter druguse, including a variety of supply and demand reductionBMC International Health and Human Rights 2009, 9:24 [3,4]. Many governments internationally allo-cate the majority of resources to law enforcement strate-gies [5-7]. These tactics include arresting individuals whoallegedly use drugs or deal drugs in an effort to reducedrug availability and consumption [8,9]. Despite contin-ued investment in these efforts, there is evidence indicat-ing that this type of enforcement often has little impact onthe availability and use of drugs [10]. As well, drug lawenforcement has been associated with increases in health-related harms among drug users [3,11,12]. For example,policing within drug markets has been associated withHIV risk behaviour among injection drug users (IDU) as aresult of reductions in uptake of needle exchange andother harm reduction services [3,11,13-15]. Further, druglaw enforcement has been associated with various humanrights abuses including illegal searches, unlawful detain-ment, and assault [16-18].Thailand, a country with a longstanding HIV epidemicamong IDU and prevalence rates as high as 40%, has his-torically favored strict enforcement as drug policy [19,20].This approach has led to high rates of incarceration forindividuals convicted of possession of illicit substances,and nearly two-thirds of those in prison are drug offenders[21]. Anecdotal reports by drug users in Thailand suggestthat abuse of power by police does occur. For example, theplanting of drugs on known or suspected drug users forthe purposes of extorting money or meeting set quotas forarrest have been noted [22]. In light of these anecdotalreports and the growing concern regarding the adverseconsequences of drug law enforcement approaches, wesought to investigate the prevalence and correlates of thisform of evidence planting by police among a community-recruited sample of IDU in Bangkok, Thailand.MethodsParticipant recruitmentThe Mitsampan Community Research Project (MSCRP) isa collaborative research project involving the BritishColumbia Centre for Excellence in HIV/AIDS (Vancouver,Canada), the Mitsampan Harm Reduction Center (Bang-kok, Thailand), the Thai AIDS Treatment Action Group(Bangkok, Thailand), and Chulalongkorn University(Bangkok, Thailand). During the summer of 2008 theresearch partners designed and undertook a cross-sec-tional study involving 252 community-recruited IDU.Potential participants were recruited through peer-basedoutreach efforts and word of mouth. Study participantswere invited to attend the Mitsampan Harm ReductionCentre to participate in the study. All participants pro-vided informed consent and completed an interviewer-administered questionnaire eliciting demographic data aswell as information about drug use, HIV risk behaviour,given a nominal stipend of 250 Thai Baht ($7.50 USD)upon completion of the questionnaire. The study wasapproved by the Research Ethics Boards of the Universityof British Columbia and Chulalongkorn University.Statistical analysesThe primary aim of this analysis was to document theprevalence and correlates of self-reported evidence plant-ing of drugs by police. Demographic and drug use varia-bles were used to compare IDU who reported ever havingdrugs planted on them by police with those who did not.These variables of interest were selected on the basis ofhaving some potential explanatory power and included:median age, gender, education level (< secondary schoolvs.  secondary school), employment status (regular, tem-porary or self-employed vs. unemployed), participation inillegal income generating activities i.e. drug dealing, theft,or sex trade (yes vs. no), heroin use (yes vs. no), "yaba"(methamphetamine) use (yes vs. no), midazolam use (yesvs. no), use of drugs in combination (yes vs. no), injectingwith a used syringe (yes vs. no), lending syringes (yes, history of non-fatal overdose (yes vs. no), history ofincarceration (yes vs. no), history of forced treatment (yesvs. no), and a history of prescription methadone use (yesvs. no). We also asked participants to indicate if they paidthe police to avoid arrest (yes vs. no) and, if so, theamount paid in Thai Baht. Multivariate logistic regressionwas then used to identify those variables independentlyassociated with reporting evidence planting by police. Toexamine the bivariate associations between each inde-pendent variable and the dependent variable of interest,we used the Pearson's Chi-Square test. Fisher's exact testwas used when one or more of the cells contained valuesless than or equal to five. We then applied an a prioridefined statistical protocol that examined the independ-ent effect of syringe borrowing by fitting a multivariatelogistic regression model that included all variables thatwere significantly associated with the dependent variableat the p  0.05 level in univariate analyses. All p-valueswere two-sided.ResultsIn total, 252 IDU were recruited between July and August2008, including 66 (26.2%) females. The median age was36.5 years. In total, 122 (48.4%) participants reported ahistory of having drugs planted on them by police. Table1 presents the univariate analyses of factors associatedwith this form of drug planting. As shown here, individu-als who reported having drugs planted on them weremore likely to report: midazolam use (Odds Ratio [OR] =3.03; 95% Confidence Interval [CI]: 1.73 - 5.30), combi-nation drug use (OR = 2.20, 95%CI: 1.26 - 3.83), injectingwith a used needle (OR = 2.16, 95%CI: 1.27 - 3.65), lend-Page 2 of 6(page number not for citation purposes)experiences with health care, and interactions with policeand the criminal justice system. All participants wereing syringes (OR = 2.06, 95%CI: 1.22 - 3.48), non-fataloverdose (OR = 3.17, 95%CI: 1.79 - 5.61), having been inBMC International Health and Human Rights 2009, 9:24 drug treatment (OR = 1.99, 95%CI: 1.16 - 3.41),and prescription methadone use (OR = 1.82, 95%CI: 1.10- 3.02).Table 2 presents the multivariate analyses of factors inde-pendently associated with evidence planting by police. Asuse (Adjusted Odds Ratio [AOR] = 2.84; 95% ConfidenceInterval [CI]: 1.58 - 5.11), non-fatal overdose (AOR =2.56; 95%CI: 1.40 - 4.66), syringe lending (AOR = 2.08;95%CI: 1.19 - 3.66), and having been in forced drug treat-ment (AOR = 1.88; 95%CI: 1.05 - 3.36).Table 1: Factors associated with drug planting by police among Thai injection drug users (N = 238)*Characteristic Yesn (%)n = 72Non (%)n = 166Odds Ratio(95% CI)p - valueMedian Age> 36.5 years 63 (52) 63 (48) 0.88 (0.54 - 1.44) 0.614 36.5 years 59 (48) 67 (52)GenderFemale 29 (24) 37 (28) 0.78 (0.45- 1.38) 0.398Male 93 (76) 93 (72)Education level< Secondary school 45 (37) 58 (45) 1.38 (0.83 - 2.28) 0.213 Secondary school 77 (63) 72 (55)EmploymentYes 20 (16) 26 (20) 0.78 (0.41 - 1.49) 0.460No 102 (84) 104 (80)Illegal IncomeYes 8 (7) 6 (5) 1.45 (0.49 - 4.31) 0.503No 114 (93) 124 (95)Heroin Use* Yes 115 (94) 119 (92) 1.52 (0.57 - 4.05) 0.404No 7 (6) 11 (8)Yaba Use*Yes 82 (67) 79 (61) 1.32 (0.79 - 2.22) 0.288No 40 (33) 51 (39)Midazolam Use*Yes 97 (80) 73 (56) 3.03 (1.73 - 5.30) < 0.001No 25 (20) 57 (44)Combination Drug Use*Yes 95 (78) 80 (62) 2.20 (1.26 - 3.83) 0.005No 27 (22) 50 (38)Syringe Borrowing*Yes 54 (44) 35 (27) 2.16 (1.27 - 3.65) 0.004No 68 (56) 95 (73)Syringe Lending*Yes 55 (45) 37 (28) 2.06 (1.22 - 3.48) 0.007No 67 (55) 93 (72)Non-fatal Overdose*Yes 51 (42) 24 (18) 3.17 (1.79 - 5.61) < 0.001No 71 (58) 106 (82)Incarceration*Yes 6 (5) 8 (6) 0.79 (0.27 -2.34) 0.669No 116 (95) 122 (94)Forced Drug Treatment*Yes 48 (39) 32 (25) 1.99 (1.16 - 3.41) 0.013No 74 (61) 98 (75)Prescription Methadone Use*Yes 63 (52) 48 (37) 1.82 (1.10 - 3.02) 0.019No 59 (48) 82 (63)*Variables refer to ever in the past.Page 3 of 6(page number not for citation purposes)shown here, reporting a history of evidence planting wasindependently and positively associated with midazolamAmong those who reported an experience of having drugsplanted by police, 59 (48.3%) reported paying the policeBMC International Health and Human Rights 2009, 9:24 in an attempt to avoid arrest. The amount paidranged from 500 - 100,000 Thai Baht (median = 5000THB; $140 USD).Discussion and ConclusionAccording to the participants in this study, Thai policecommonly plant drugs on IDU, with 50% of participantsreporting a history of this form of evidence planting. Inmultivariate analyses, after extensive covariate adjust-ment, midazolam injection, non-fatal overdose, syringelending and participation in forced drug treatment wereindependently and positively associated with evidenceplanting by police. In sub-analyses, 48% of IDU report-edly paid police in an effort to avoid arrest following suchan occurrence. The amount of money paid varied greatly,with a median amount of 5000 Thai Baht ($140 USD).Our analysis of self-reported evidence planting helps tocorroborate previous anecdotal reports by suggesting thatThai police routinely plant drugs on suspected drug usersand dealers [16]. Human rights groups and the UnitedNations Special Rapporteur on Right to Health have criti-cized Thailand regarding use of excessive force and brutal-ity as part of its drug enforcement approach, most notablyduring the "drug war" of 2003 [22]. This particular initia-tive, purportedly aimed at suppressing drug traffickingand preventing drug use, left an estimated 2,800 peopleliving in Thailand murdered [16,23,24]. During the drugwar, the government prepared blacklists of suspected drugusers and local officials were required to meet set quotasto reduce the number of people on blacklists, eitherthrough arrest or forced drug treatment [16]. Our findingsindicate that evidence planting by police is indeedanother way in which abuse of power by police may beexerted in Thailand, perhaps for the purpose of maximiz-ing rates of arrests for drug possession or for the simplepurposes of extortion.The association observed in the present study betweenidentified policing, especially in the context of "crack-downs", to be a strong predictor of syringe sharing, abehaviour independently associated with HIV infectionamong Thai IDU [11,25-27]. Though causal relationshipscan not be inferred in the present study, it may be thatafter experiencing drug planting, IDU become more fear-ful of arrest or harm by police and less likely to carry drug-related equipment. Additionally, fear of confrontationswith police has previously been identified as leading to areluctance to visit HIV clinics (where antiretrovirals aredistributed) for fear of their drug-using status beingreported to police by the clinics, thereby decreasinguptake of services by IDU with HIV [22].Midazolam, a legal benzodiazepine with potent amnesicand ventilatory depressant effects [28], was found to beindependently associated with evidence planting of drugsby police. We postulate that the drowsiness and amnesiaassociated with benzodiazepine use may allow for easyidentification of these IDU by police. Further, it has beenargued that IDU may inject in a more hurried and oppor-tunistic fashion due to fear of police, which may be exac-erbated in settings where abuse of power by police occursand lengthy prison sentences are enforced for drug posses-sion. Prospective data is needed to determine if police tac-tics such evidence planting of drugs may underpin theassociation between overdose and drug planting observedin the present study [15,29].Forced drug treatment centers are widespread in Thailand[24,30,31]. Though the temporal relationship in the asso-ciation between reporting evidence planting by police andhaving a history of being in forced drug treatment isunclear, we hypothesize that some individuals in drugtreatment have had drugs planted on them as policeworked to meet set quotas for arrest [22]. Alternately, thisassociation may represent an important breach of confi-dentiality in that police can identify and target individualswho have previously been in treatment [22].Table 2: Multivariate logistic regression analysis of factors associated with drug planting by police among Thai IDU (N = 238)**Variable Adjusted Odds Ratio (AOR) 95% Confidence Interval (95% CI) p - valueMidazolam use*(Yes vs. No) 2.84 (1.58 -- 5.11) < 0.001History of Overdose*(Yes vs. No) 2.56 (1.40 -- 4.66) < 0.001Syringe Lending*(Yes vs. No) 2.08 (1.19 -- 3.66) 0.010Forced Drug Treatment*(Yes vs. No) 1.88 (1.05 -- 3.36) 0.030*Variables refer to ever in the past.**The model was adjusted for syringe borrowing, combination drug use, and prescription methadone use.Page 4 of 6(page number not for citation purposes)self-reported drug planting by police and syringe lendingis particularly concerning since previous studies haveBMC International Health and Human Rights 2009, 9:24 conjunction with Thailand's Narcotic Addict Rehabili-tation Act, B.E. 2545 (2002) stating that people who aredependent on drugs should be 'treated as patients and notcriminals', we recommend Thai drug policy shift focusfrom one of excessive reliance on enforcement to a health-focused approach, such as through improving access tovoluntary and confidential drug treatment centers insteadof forced centers [32]. Additionally, urgent action must betaken to reform any policing practices, including tacticspotentially used by police such as evidence planting,which violate the human rights of drug users.Numerous efforts have been made in other settings tochange policing practices as a means of reducing thehealth and social consequences commonly associatedwith policing that target illicit drug use. Examples includethe provision of harm reduction training for police offic-ers, or involving police directly in harm reduction activi-ties [33-35]. While a small number of evaluations haveindicated some positive benefits of such efforts, such asincreased awareness of health issues and harm reductionamong police and greater collaboration among partners,the impacts have generally been modest, and success inachieving many of the more ambitious goals associatedwith these initiatives has proved difficult [36-38]. Further,the available evidence indicates that substantial barriers tochange exist within police structures and cultures [39-41].As well, while police departments may accept policies thatcomplement public health efforts, the behaviour of indi-vidual police officers on the street may deviate fromdepartment policies [33,36,39]. Introducing novel meth-ods to address policing practices that compromise healthand violate human rights is therefore important. A smallnumber of novel practices have been implemented in theUnited States and Australia through the use of specializedtrainings, public and police surveys, and proactive policeoversight mechanisms [42], although there is a clear needfor ongoing development in this area.This study has several limitations. First, self-report wasused to gather data, and therefore the results could be sus-ceptible to socially desirable reporting. Though previousresearch has found self-report by drug users to be suffi-ciently reliable in descriptions of drug-related problems[43], socially desirable reporting of drug use and riskybehaviours as well as memory difficulties remain con-cerns [44,45]. However, features of this community-basedresearch study, including recruitment and interviewadministration by peer drug users and paperless consentacquisition, may help to reduce social desirability biasand enhance the reliability of self-report in the presentstudy. Second, the study sample was not randomlyselected, and so the findings presented herein may notin the observed associations can not be inferred. We rec-ommend further research including longitudinal studiesthat seek to tease out the temporal relationship betweenthe experience of drug planting and risk behaviours suchas overdose and syringe lending. Qualitative researchmethods could also be used to shed light on the types ofcircumstances that result in drug planting, as well as theeffects of these events on the behaviours of IDU.In the present study, we observed an alarmingly high rateof reports of evidence planting by police among a com-munity-recruited sample of Thai IDU. Threat from policemay contribute to engagement in risk behaviours, such assyringe lending, observed in this study. Immediate actionshould be taken to address this form of abuse of powerand other punitive tactics reportedly used on Thai IDU bypolice.Competing interestsThe authors declare that they have no competing interests.Authors' contributionsNF participated in the study design, study coordinationand drafted the manuscript. KK, KH and PS participated instudy design and coordination. CL provided assistance instatistical analysis. EW and TK conceived of the study andparticipated in its design, coordination, statistical analysisand manuscript preparation. All authors read andapproved the final manuscript.AcknowledgementsWe would particularly like to thank the staff and volunteers at the Mitsam-pan Harm Reduction Center for their support. We also thank Dr. Niyada Kiatying-Angsulee of the Social Pharmacy Research Unit (SPR), Faculty of Pharmaceutical Sciences, Chulalongkorn University for her assistance with developing this project. We also thank Daniel Miles Kane, Deborah Gra-ham and Calvin Lai for their assistance with data management, and Prem-preeda Pramoj Na Ayutthaya and Donlachai Hawangchu for their assistance with data collection. This work was funded by the Canadian Institutes for Health Research grant RAA-79918.References1. Mathers BM, Degenhardt L, Phillips B, Wiessing L, Hickman M, Strath-dee SA, Wodak A, Panda S, Tyndall M, Toufik A, et al.: Global epi-demiology of injecting drug use and HIV among people whoinject drugs: a systematic review.  Lancet 2008,372(9651):1733-1745.2. 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