‘Steroid’ is a household name only for a few exclusive numbers of people such as the body builders noted for using the substance to unnaturally boost their muscles. Beyond that, steroid has been adopted as a panacea claimed to cure any diseases, even though its toxicity could be quite severe if its use is unregulated by physicians. 

1983 saw the first time steroid was registered with the Food and Drug Administration Thailand. 32 years past, 93 of every one thousand Thais are found to have suffered clinical effect from misuse of the substance. Its mortality rate is 6.4% Patients suffering from the substance have the bodies and faces swollen, a hump on the neck, bodily malfunction, and they may even succumb to renal failure eventually. Economic losses can reach 1.9 billion baht every year. 

In urban areas, the spread of steroid is not acute. But in the province, particularly in the North and Northeast, it has been widely used owing to cultural reasons, belief, impeded access to information and health services. Steroid has made its penetration in disguise of traditional medicine. 

Popularity of steroid in the Northeast with Buddhist monks as its presenters 

From our investigation, most traditional medicines mixed with steroid are unlicensed. From 2010-2014, the Department of Medical Sciences have found among 670 samplings of traditional medicine that 118 or 17.6% of it contain steroid. They can appear as pills, powder, generic household drug, herbal solution, a set of drug, individual drug, microorganism solution, fruit juice, supplementary food, candy and body lotion. 

The drugs are variably known to the villages including Roi-Et drug, Sarakham drug, Pradong Painkiller, E-Khiaw Noi, Orange Power Boost, etc. They are highly accessible to the villagers as it can be advertised through community radio, cable TV, and direct sale. Some Buddhist monks including abbots have even agreed to be presenters of the drug, knowingly or unknowingly. Initially, the drug sellers would give the drug for free to the abbot, then the monk who finds it effective will help to spread it by word of mouth. Some drugs have undergone some consecration ceremonies making it even more credible. Such marketing ploys are widely used in the province of Sri Saket, since it is a border town. Another major venue to spread the fake drug mixed with steroid is a caravan of hawkers. 

Khon Kaen: The steroid hub of the Northeast

Before getting to know the caravan of hawkers, we should understand how the fake drug mixed with steroid can be obtained and these caravan of hawker vehicles help as a distributor of it. Some hawkers are the producers themselves, too. 

In 1983, there were seven traditional medicine factories registered in Khon Kaen. It has now shot up to 22 with more than 354 drugs being licensed. Why do we focus on Khon Kaen? This is simply because it has become a major hub to distribute the fake drug mixed with steroid in the Northeast. More than 50% of such drugs are found to have been produced in the province. 

Most interestingly, there have been attempts by the authorities to raid the production places, but none of the steroid drugs have been found. According to our source, it could be possible that the officials have given their acquiescence to the crime? 

Nevertheless, it does not mean all factories producing herbal solution are a part of the steroid movement. Several of them are legal factories. Some have waived the law and simply mixed some steroid in their herbal solutions. How the substance has been spread through herbal solution can be divided into two types. First, the factories producing herbal solutions have been complicit in mixing steroid in their products. There remain a few of this kind of factories. 

Second, the factories know nothing about the mixture. The steroid hawkers simply buy their products and then mix them with steroid. This type of production is widespread. 

The hawker movement

Most of the steroid hawkers use high six-wheeled trucks, mostly attached with fake license plates or license plates belonging to other cars to avoid surveillance and arrest. They do not drive on main roads. The drivers often carry with them some certificates from the factories to produce to the officials to support their claim that their products are legally registered.

Previously, the trucks were owned by the factories producing the herbal solution. But now, some relatives of the same families can group together and operate by themselves. According to our source in Khon Kaen, some of the hawkers gave built up their power and become local influential political and economic groups. Some have moved from an ordinary villager to a local politician and can influence local authorities. 

“They are so influential that when public health officials plan to visit any village, they have to first obtain their permission.” 

According to our source, in one Tambon of Waeng Yai District, Khon Kaen, there are more than 50 networks and each has about 5-10 hawker trucks. Some even have their satellite units in other provinces with about three to five trucks. 

According to the “Ya Wipak” journal, vol. 6, no. 22, September-October 2014;

‘Initially, the hawkers have to spend around 100,000 baht to stock their drugs (excluding expenses concerning the procurement of pickup trucks or six-wheeled trucks for selling the drug). Another investment is put into the procurement of film projector, truck roofing, and other equipment, around 30,000 baht more. In one week long trip (two days to one week), they can make about 15,000-25,000 baht as their profit per one truck. In every purchase of drug from the factories, they shall receive some complimentary products such as fans, blankets, mosquito nets, etc. Oftentimes, the producers would ship the drug right at the front door of the hawkers. 

As to how they have developed their networks. According to our source;

“A ring leader would contact the hawkers telling them to contact him and then he will arrange it with the factories. He can recommend some drugs which are stronger than those bought from the factories. The ring leader will then take the herbal solution from the factories and then mix it with steroid and gives it to the hawkers, more or less a direct sale. It happens similarly in the provinces of Roi Et, Maha Sarakham and Kalasin. There are about a couple networks in each province. Let’s say, the middleman buys it at 150 baht per box and resell it 600 baht to the hawker which can then rake it up to 1,200 baht. They have to find their ways to keep their clientele relations otherwise the hawkers will go and form another network. They can build up their own new networks anytime. These people till their land during farming season and when it is off-season, they go out as hawkers. It has happened like this for two years. But it is not easy for newcomers to become hawkers.” 

“For a week long trip, they can make about 12,500 baht. In one month, they can make about a couple trips. The more they work, the better they earn. Normally, they won’t drive on main roads, but on minor routes to avoid the police. They also use fake license plates. Very few use real license plates. Prior to getting to any villager, they have to check it out if some other hawkers had been there, or if some other drugs had been sold there. They have some homework to do.” 

However hard the authorities have announced to the community about the danger of such fake herbal solution mixed with steroid, the movements have found their way around. For example, they can simply change new drug labels, or use fake FDA registration numbers, fake address of the factories. 

The hawkers are…just the tip of the iceberg

That the herbal solution has been purchased from the factories and then mixed outside with steroid has made the authorities fail to detect any steroid when they made a raid to the factories.

The ring leaders or each hawker will buy the herbal solution and steroid from their sources and then mix them are their places. Some just mix them before entering a village. About 25 pills of steroid are mixed in one bottle of herbal solution. The dosage is quite high and extremely dangerous. A normal intake of steroid per patient is only one to three pills.

Asst. Prof. Niyada Kiatying-Angsulee, a pharmacist and manager of the Thai Drug Watch said that at present, the hawkers have started to resort to use Dexamethasone to mix it with the herbal solution instead of using the steroid pills since the pills can leave a trace of powder whereas Dexamethasone leaves no sediment in the bottle. 

Apart from distribution through the hawkers, the fake herbal solution mixed with steroid is also available for online sale via websites whose names cannot be publicized by TCIJ.

It is thus curious to know since both Dexamethasone and Prednisolone which are raw material used for producing steroid have to be imported and the FDA Thailand has to be notified of each import, and even the factories that use the material to produce steroid pills and distribute them to medical facilities and drug stores are required to report to the FDA Thailand, and FDA Thailand has also conducted inspection of the volume and distribution of such steroid in medical facilities and rug stores, why is it so easy for the hawkers to have access to such drug?

In the middle of last December, public health officials of Khon Kaen have raided a drug store in Ban Phai Disrtict, Khon Kaen, and found more than one million steroid pills stored in naked containers with no labels. Is this just the tip of the iceberg?

What lies underneath is the underground movements that smuggle steroid causing it to spread widely in the Northeast.  
 

Follow our next Investiigative Report  on "Exposing Underground Steroid Sellers" .

Go to 'จับตา' for “Underground Steroid Scam”  
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