The atmosphere at the Rattanakosin Hotel in Bangkok, Thailand, was electric. It was the kind of energy that forms when a powerful idea sweeps the room, person by person, until everyone is charged with new passion.
It was December 10, 2002—International Human Rights Day. About 50 Thai drug users were gathered to discuss a documentation project detailing the extraordinary levels of human rights abuse endured by people who use drugs in Thailand. For decades they had been hunted by police, forced into compulsory treatment centers, denied access to basic medical care, degraded, marginalized and even tortured.
And yet in that room, a young man, an HIV-positive injection drug user, was insisting: We have rights. We have dignity. We need to act.
The speaker, 37-year-old Paison “Ott” Suwannawong, was the founding chairman of the Thai Network of People Living with HIV/AIDS (TNP+). Ott had collaborated on the documentation project with Karyn Kaplan, an American working for the International Gay and Lesbian Human Rights Commission. But he wasn’t content to merely show human rights abuses. He wanted to challenge them.
“Our friends will die if they don’t get clean needles. We need to start our own program.”
At that time, nearly 50 percent of injection drug users in Thailand had HIV, while hepatitis C rates hovered at 90 percent. Yet the government refused to endorse even basic harm reduction programs like needle exchange.
“Our friends will die if they don’t get clean needles,” Ott (pictured above in 2019) insisted. “We need to start our own program.”
Some people objected: No one in Thai society would support a needle exchange.
“Who fucking cares about society? They don’t care about you,” countered Ott.
People started to nod. A few spoke up with other ideas to save lives. Slowly, confidence grew.
“There was a palpable transformation in that room,” recalled Kaplan, now the executive director of Asia Catalyst, to Filter. “The creativity that poured out of that space was unstoppable.”
Ott asked people to join him to launch a national movement.
“We need a project managed by people who use drugs,” he said. “Drug users have to be involved in policy change. We need a system where we can talk openly about our issues.”
People stepped forward. Soon, what had begun as a human rights project gave birth to the Thai Drug Users Network (TDN): the very first user-led activist group in Thailand.
The timing of TDN’s creation was eerily perfect. In February 2003, two months after that first meeting, then-Prime Minister Thaksin Shinawatra launched a brutal war on Thailand’s drug users.
“We have to be as ruthless with drug dealers as they are to our children,” he declared in a speech in Bangkok. Thaksin authorized police to go after suspected drug users and sellers and take “an eye for an eye.”
Police entered Yai Sak’s home and sprayed bullets at everyone in the room, including his two sisters. No one survived.
Within three months, law enforcement had murdered 2,800 people. In a situation reminiscent of Philippines President Rodrigo Duterte’s present-day murderous drug war, Thaksin enjoyed up to 90 percent public support for his approach.
One victim of the extrajudicial killings was 22-year-old Yai Sak of Chiang Mai. According to his friend Nuttarapong “Tom” Punyodana, whom I interviewed, police entered Yai Sak’s home and sprayed bullets at everyone in the room, including his two sisters. No one survived.
The newly formed TDN scrambled to respond to the killings. Risking their own deaths, drug users organized a “die-in” in front of the Government House and an appeal on Father’s Day—the previous Thai king’s birthday—at the palace.
In April 2003 they held a peaceful protest during a speech by the Thai public health minister at the International Harm Reduction Conference, where they garnered international support. On June 12 that year, they launched a global day of action to draw the world’s attention to the murders. Drug user activist groups in 10 countries around the world held events in front of their respective Thai embassies and the United Nations to demand an end to the killings.
TDN activists even met with Prime Minister Thaksin himself.
“He didn’t listen to us,” Ott told Filter. “He talked over us. He acted like he knew more and always went back to his own issues.”
After a few months, Thaksin declared his drug war a success. He cited a study showing that self-reported rates of injection drug use in Thailand had plummeted 85 percent.
I spoke with Professor Apinun Aramrattana of Chiang Mai University, one of the leading drug policy researchers in Thailand, about this research. He confirmed that during Thaksin’s drug war, the use and sale of illicit drugs in Thailand declined.
“Drug suppliers didn’t foresee the announcement of the drug war,” he said. “There is evidence that the smuggling and supply operations reduced remarkably for a time.”
However, Aramrattana also pointed out research showing that as rates of illicit drug use declined, rates of licit drug use, such as alcohol and benzodiazepines, shot up.
She and other heroin users started mixing their limited supply with benzodiazepines obtained on the illicit market.
Supawan “Mod” Ngoencharoen, a former injection drug user whom I interviewed in Bangkok, confirmed this account. During Thaksin’s drug war, “drugs became more expensive and harder to get,” she told Filter. So she and other heroin users started mixing their limited supply with benzodiazepines obtained on the illicit market—a high-risk combination that led to more overdoses.
In addition to becoming more dangerous, once the drug market later recovered, it became flooded with a cheaper, more plentiful supply of drugs than before.
“The cartels lost the fight in the beginning, but they figured out how to change their tactics,” said Aramrattana. “They found a different way to produce meth and they bombarded the market. The price was reduced by five times.”
While Thaksin’s drug war was still raging, members of TDN were busy planning their next moves.
In April 2003 they partnered with international and local NGOs, including Thai AIDS Treatment Action Group (TTAG), to submit a $1.3 million grant proposal to the Global Fund to establish a network of drug user-led harm reduction centers in Thailand.
The centers would provide harm reduction education, access to clean injecting equipment, linkage to HIV and hepatitis C care, overdose prevention, peer-led outreach and ongoing documentation of harms experienced by drug users. Because Thailand does not officially recognize organizations run by drug users or sex workers, TDN had to invite a registered NGO to be the principal recipient.
The proposal was a long shot. No group had ever secured such a grant with their government actively trying to kill them. But to everyone’s shock and jubilation—and after concerted activism by TTAG, TDN, and international allies like HealthGAP Coalition, who helped advocate to the Global Fund Board—the Global Fund approved the funding.
The project represented the first large-scale harm reduction investment in Thailand, and the team hoped it would lay the groundwork for the government to eventually take over such services.
“I was so excited when we got the money,” recalled Ott. “I thought, ‘Our friends will not die in the streets anymore.’”
TDN activists struggled to meet the strict, quantifiable grant deliverables imposed. Burnout spread among over-worked outreach workers.
Unfortunately, that happiness was short-lived. With a huge amount of funding to disburse and ambitious deliverables to meet, tensions arose between TDN and the NGO that had agreed to manage the grant over how best to use the money.
Despite their hard work and passion for the cause, TDN activists struggled to meet the strict, quantifiable grant deliverables imposed. Burnout spread among over-worked outreach workers. Tension and petty squabbles arose. Some people who had stopped using illicit drugs began using again. All of them continued to suffer at the hands of the government, through prison, police brutality and coerced treatment.
“After a year I felt like, ‘This is shit,’” Ott said. “This killed us.”
Thaksin declared an end to his drug war in December 2003, 10 months after it began. But although widespread and visible extrajudicial killings ended, people who use drugs in Thailand are still under siege.
Under successive prime ministers, long prison sentences and forced drug treatment remain the norm. In 2017 the government approved a “harm reduction” approach to drug policy and agreed to treat drug use as a public health issue. But this proposal is still being batted back and forth between the Ministry of Justice and the Ministry of Health, with neither wanting responsibility for a stigmatized population.
But Thai drug users haven’t given up. In November 2019, I attended an assembly in Bangkok, the first of five meetings designed to revitalize the activist spirit of Thai people who use drugs. Several of TDN’s founders were there.
I was excited myself—and honored—to witness the birth of a new organization, now called Thai Network of People Who Use Drugs (TNPUD). The group of about 35 people who use drugs began the assembly in high spirits. They laughed and called out jokes to each other as a representative from Ozone Foundation, the NGO financing the meeting, led introductions.
The facilitators did the majority of the talking.
Over the course of the day, participants discussed problems with compulsory treatment centers, “clean” villages where drug users are forcefully removed, marijuana legalization, police corruption, harm reduction, and other issues affecting their lives.
But as the day wore on, much of the initial energy faded. Although the two Ozone Foundation employees who facilitated the meeting repeatedly emphasized that TNPUD would be drug-user led, with Ozone serving only as a consultant, the facilitators did the majority of the talking.
Several participants asked Ozone what the drug user networks should look like, rather than discussing amongst themselves what their role should be. To me, it felt like history repeating itself—another NGO, albeit one with good intentions, attempting to spearhead a movement of people who use drugs.
The experiences in Thailand echo challenges faced by many drug user-led movements around the world.
Activists who may be excellent at mobilizing and advocacy often lack grant management experience and may have to depend on allies to secure financing. Tensions often arise between those who want to take down power structures and those who prefer to work within existing frameworks. Many groups that form during a moment of crisis quickly fizzle once the work becomes formal and tedious. Burnout is common among peers who are expected to comply with rigid grant deliverables that do not reflect the reality of outreach work.
Of course, grant foundations should prioritize funding for user-led advocacy and service delivery. The question is how to provide this funding in a way that supports activists, but does not stifle creativity and drain energy.
Support means taking a back seat and allowing the most impacted people to lead.
To Kaplan, one of the key lessons from Thailand is the importance of helping newly formed activist groups develop sustainable leadership and organizational structure.
“We didn’t have time to build leadership,” she said of TDN. “We just had to take it and run with it … There was so much advocacy to do and it felt like there was no time to think about the organizational stuff.”
She recommends that funders avoid imposing overly burdensome reporting requirements on grassroots organizations. “Sometimes funders demand quantitative goals without recognizing the extraordinary amount of preparatory groundwork that people have to lay to build up new movements,” she said.
She also encourages groups seeking funding to be more forceful with donors about their needs. “You have power and agency. You have to tell the donors what you need,” she said. “Don’t be afraid to say, ‘We can do this work but we need long-term support.’ We need development and capacity-building, not just program money.”
To Ott, the most important lesson from Thailand is that if activist groups and NGOs must work together on a grant, drug users should be holding the reins.
“These movements must be led by drug users,” he said, “but we need more support.”
Unfortunately, “support” can come with strings attached that weaken the agency of people who use drugs. For funders, allies and NGOs truly committed to drug policy reform, flexibility and humility are essential. Support means taking a back seat and allowing the most impacted people to lead.
Photographs by Tessie Castillo.