Since President Rodrigo Duterte took office in mid-2016, his administration has begun a nationwide crackdown on drug use, which has attracted much condemnation both at home and overseas, largely due to the fact more than 8000 people have died due to extra-judicial killings. Data from the country’s Dangerous Drugs Board (DDB) suggests there are 1.7m drug users, or 1.6% of the population. About 860,000 people are thought to be users of shabu, a local, cheap form of methamphetamine, with marijuana being the second-most-commonly used drug, according to a Reuters October 2016 report.
Away from the headlines, the drug war has opened up a discussion about the best way to tackle drug use and abuse, and how to help people who struggle with drug addictions kick the habit. It also comes as the Philippines reports an alarming rise in HIV/AIDS, with the rate of new infections surging in the past few years. The 844 cases reported by the Department of Health (DoH) in January 2017 were the highest monthly figure since 1984. About 4.5% of cases are due to sharing needles, the second-most-common form of transmission after sexual contact. NGOs warn a punitive approach to drugs will only exacerbate the spread of HIV/AIDS.
The administration has initiated a number of other measures as part of its anti-drug campaign, developing a framework to tackle substance and drug use through more effective public education, enhanced treatment and more widely available rehabilitation services. These policies are aligned with the DDB’s regulations and amendments, as well as the Comprehensive Dangerous Drugs Act of 2002. The DDB coordinates preventative programmes, which are offered on college campuses and at primary and secondary schools. The board also offers training to parents on how they can educate their children regarding drugs.
“We have to remember that the problem of illegal drugs is not only a security dilemma, but also a health problem,” Paulyn Jean B Rosell-Ubial, secretary of health, said in a statement at the country’s first Dangerous Drug Abuse Summit in February 2017. “Drug abusers are mental health patients. So, we should treat them as patients that have an illness, and we have to ensure they recover and get cured from this illness.”
According to the DoH, the enhanced rehabilitation programme will include the provision of comprehensive, integrated health care services from treatment centres down to the community level, as well as the collation of better data on addiction. Users will first be assessed at the local level by a Barangay Anti-Drug Abuse Council and health officers, trained by the DoH, to determine whether the person is an occasional or heavy user and decide on an appropriate treatment.
The Philippines currently has 15 government-run treatment rehabilitation centres, out of a total of 44 DoH-accredited facilities across the country, according to the DoH. These centres have beds for only 7200 patients. Data from admissions to rehab centres collated by the DBB for the period of 2009-14 suggests that the typical inmate is male – there are about 10 men for every woman – and unemployed. More than 74% had a household income of less than P11,000 ($233) a month. In 2015 the mean age of those admitted was 31 years and 93% were male. Some 53% were unemployed, according to the DDB.
Since Duterte has made the war on drugs a priority of his administration, fear of being dealt with more harshly has prompted at least 700,000 people to turn themselves into the Philippine authorities, which has put pressure on the government to scale up the national rehabilitation network to cater to the surge in the number of people seeking treatment. In provinces without a drug treatment centre, district hospitals are being converted into drug treatment and rehabilitation centres, with enhanced training of primary care workers in line with the World Health Organisation’s Alcohol, Smoking and Substance Involvement Screening Test framework, as well as for doctors in the management of substance use, abuse and dependence. At the same time, the DoH aims to deepen ties with civil society and church organisations, in order to better tackle drug-related issues, through increased discussion and education at the community level.
NoBox is one NGO that is working on the ground to improve rehabilitation services. An advocate of harm reduction strategies, the group offers a range of rehab options, from a 12-step programme to family-centred therapies. “Drug use doesn’t exist in a vacuum, and how it plays out is influenced by the social, cultural, political [and] economic environment,” Inez Feria, executive director and founder of NoBox, told Seattle-based human rights news site Humanosphere in August 2016. “The discussion should be at that level. Is it there now with us? Not quite yet.” Humanosphere also reported that congressman Rodel Batocabe is calling for an expansion of treatment options, and in August 2016 he proposed the Accessible Drug Rehabilitation Treatment Act calling for the construction of government-funded rehab centres in every legislative state. In the Bicol region that Batocabe represents, for a population of 4m there are only two centres with beds for 100 people in each. He has also expressed concern about the cost of treatment, since a large number of drug users are from low-income families.
The National Health Insurance Programme (PhilHealth) is now offering coverage of up to P10,000 ($212) to ensure members can afford treatment. The insurer’s single-use claim detoxification package is targeted at users with “acute physical symptoms” resulting from the use of amphetamine-type stimulants. It can be used at PhilHealth-accredited government hospitals, as well as DoH-registered drug treatment centres. “PhilHealth is mandated to provide health insurance coverage for all Filipinos and supports the government’s efforts in the fight against drugs,” Ramon F Aristoza Jr, acting president and CEO of PhilHealth, said in press release issued in January 2017.
The government has already started to build more centres, with plans to open eight in 2016 and 2017. It also aims to open four mega-rehabilitation centres to provide temporary shelter for those who have surrendered themselves until more permanent facilities have been established. The first such centre, established in Fort Magsaysay, Nueva Ecija, with P1.4bn ($29.6m) in funding from a Chinese philanthropist, opened in November 2016, with space for 2500 people requiring in-patient rehabilitation. Once complete the centre is expected to be able to take in 10,000 drug-dependent people. Rehabilitative services in the centre currently include group activities, psycho-educational lectures and mindfulness meditations, among other things.
The government is appealing to the private sector for funding to build such centres and ensure that there is an effective after-care programme to help drug users reintegrate into society and find work. PhilWeb Corporation, a gaming technology company, and San Miguel Corporation, a food and beverage conglomerate, are both supporting the campaign, with San Miguel donating P1bn ($21.2m) to fund the construction of rehab facilities. “In the fight against illegal drugs, rehabilitation is crucial to providing drug dependents a chance at restoring their lives and becoming part of the solution to a better Philippines,” Ramon Ang, president and COO of San Miguel, in an official statement released in August 2016. Meanwhile, PhilWeb has stated that it plans to donate P2m-3m ($42,300-63,500).
The country is also receiving international support to enhance its drug treatment strategies. In January 2017 the Japan International Cooperation Agency (JICA) signed an agreement with the Philippines for the treatment and rehabilitation of drug users. In cooperation with the Inter-Agency Task Force for the Establishment and Support of Drug Abuse Treatment and Rehabilitation Centres, JICA agreed to work on the Comprehensive Assistance for Rehabilitation in Malacañang programme to establish rehab centres, and strengthen treatment policies and interventions for people using illicit substances.
The EU, which has criticised Duterte over drug-related killings and more extreme tactics, has expressed a willingness to fund rehabilitation programmes under the DoH. Health advocates are urging the expansion of community-based outpatient services to meet the needs of the more than 90% of drug users who do not require institutionalised rehabilitation. The government estimates only a tiny fraction of around 9% of those using drugs, mainly shabu, will actually require residential care, with the remainder likely to be directed to outpatient treatment at the community level with the participation of local volunteers. The Barangay Anti-Drug Abuse Council, which has its own budget for educational programmes, has also been revived. Despite the tense environment surrounding Duterte’s war on drugs and an alarming number of deaths, there is a recognition that tackling the use and abuse of illicit substances demands a public health response – an initiative in which international donors, private companies and NGOs have shown they are ready to participate.